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Salivary Flow Rate and Oral Status in Patients with Primary Sjögren's Syndrome and Diffuse Cutaneous Systemic Sclerosis: A Cross-Sectional Study

Background. Sjögren’s syndrome (SjS) and systemic sclerosis (SSc) are systemic autoimmune diseases that may have their manifestations in the oral cavity. Objectives. Determine salivary flow rates and oral status in patients with primary Sjögren Syndrome (pSjS) and diffuse cutaneous systemic sclerosis (dcSSc) and comparison to control subjects. Subjects and methods. This single-center, cross- sectional study included 31 patients with pSjS, 28 patients with dcSSc, and 28 control subjects. There were no significant differences between the groups with regards to age and gender. Unstimulated whole salivary flow rate (UWSFR) and stimulated whole salivary flow rate (SWSFR), pH value of saliva, DMFT index, periodontal pocket depth (PPD), clinical attachment level (CAL), interincisal distance were analyzed in all three groups of subjects. Results. Patients with pSjS and dcSSc had statistically significant lower values of UWSFR (0.20 ; 0.38 vs. 0.91 ml/min) and SWSFR (0.56 ; 0.70 vs. 1.64 ml/min) compared to control subjects (p<0.001, Mann-Witney U-test ; t-test). The pH values of saliva in patients with pSjS and dcSSc were lower with statistical significance compared to control subjects (6.0 ; 6.25 vs. 7.0) (p<0.001, Mann-Whitney U-test). The DMFT index of patients with dcSSc was higher (28.50) with statistical significance compared to control subjects (20.00) (p=0.01). The prevalnece of periodontitis was equal in patients with pSjS, dcSSc, and control subjects (p=0.384, λ2 test). Patients with pSjS and dcSSc had a statistically significant decreased interincisal distance compared to control subjects (4.38 ; 3.80 vs. 4.80) (p=0.003 and p<0.001, respectively ; t-test). Conclusions. Patients with pSjS and dcSSc show decreased UWSFR and SWSFR, pH values of saliva closer to an acidic medium, higher DMFT index, higher prevalence of periodontitis, decreased interincisal distance, i.e. poor oral and periodontal health. The results of our study indicate the importance of including various dental specialists (oral medicine specialist, periodontist) in the protocols of systemic autoimmune diseases such as pSjS and SSc.

Sjögren's syndrome ; diffuse cutaneous systemic sclerosis ; dental caries ; periodontal diseases ; oral health

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