Subjective and clinical oral symptoms in patients with primary Sjögren's syndrome

To study subjective and clinical oral symptoms and their possible correlations in patients with primary Sjögren's syndrome (1 degree SS).

In 40 cases fulfilling the Copenhagen as well as the San Diego criteria for 1 degree SS, different subjective symptoms were registered during an interview and by using a questionnaire and visual analogue scales (VAS). A clinical examination was performed to record the salivary parameters, dental status, candidosis, other mucosal lesions, and oral dysfunction.

Subjectively, dryness was reported by 98%, soreness by 63%, angular lesions by 70%, and mucosal ulcerations by 40% of the patients. Frequent carious lesions were a major subjective complaint. Clinically, the dental status did not differ from that of the Swedish general population except for a somewhat increased number of filled and decayed surfaces, here 3.5 per tooth on the average. Candidosis was present in a total of 30 patients (75%), and angular cheilitis in 14 (35%). Intraoral cultivation of Candida did not correlate with the clinical findings. Very high counts of lactobacilli and mutans streptococci were found in 77% and 47% of the patients, respectively. Decreased unstimulated saliva was significantly correlated to the subjective degree of dryness, while decreased stimulated saliva could be correlated to increased focus scores in labial salivary gland biopsies and to the presence of mucosal candidosis. Statistically significant correlations were also noted between focus scores and the grades of subjective and clinical dryness. Lichenoid lesions were seen in 18% and oral dysfunction in 55% of the 1 degree SS patients.

The impaired salivary function in 1 degree SS can be related to several subjective complaints and clinical disorders. Increased attention to and treatment of the symptoms noted is a necessity for the early diagnosis and relief of oral distress.