Sjogren syndrome is an autoimmune disorder causing conditions such as xerostomia and Xerophthalmia. It was first discovered by Henrick Sjogren. The symptoms associated with this disorder are often chronic and occur due to damage or impairment of the exocrine glands caused due to the lymphocytic infiltrates and hypersensitivity reactions. The onset of Sjogren syndrome predominantly occurs in the region of salivary glands and lacrimal glands. The primary form of Sjogren syndrome is generally associated with external glandular symptoms such as dry eyes and dry mouth without any connective tissue damage. The secondary form of the Sjogren syndrome usually occurs because of preexisting autoimmune disorders.
Clinical manifestations of Sjogren syndrome
Sjogren syndrome usually occurs in the older age group; however exceptions have been reported on it affecting younger persons. The factors causing Sjogren syndrome are predominantly genetical or environmental. Neuro-endocrine impairment plays a significant role in the onset of the Sjogren syndrome. HLA-DR genotype is the predominant factor in the genetic propagation of the disease.
Sjogren syndrome is associated with a cascade of symptoms related to many organ systems and their functions. The affected regions are ocular, oral, ontological, laryngeal, vascular, neurologic and endocrine systems respectively. The effect of the Sjogren syndrome is mainly on the head and neck region and hence the sense organs are affected to a larger extent. Other clinical conditions include loss of hearing, arthralgia, myalgia and also frequent epistaxis. Sjogren syndrome if not treated, can lead to serious conditions such as lymphoma and renal failure.
Diagnosis and treatment of Sjogren syndrome
Sjogren syndrome is diagnosed by using radiological, pathological and serological analysis. Schirmer's test is used in the diagnosis of Xerophthalmia. It is used to estimate the tear secretion level of patients suffering with dry eye conditions. The decreased levels or absence of tear secretion indicates probability of Sjogren syndrome. Salivary biopsy is advised for patients suffering xerostomia. The pathological analysis of the salivary glands also reveals underlying infiltration and damage caused to the exocrine glands. Serological analysis of the Sjogren syndrome are generally associated with low WBC counts, increased erythrocyte sedimentation rates, elevated levels of protein and hyper-gammaglobulinemia of IgM. Careful clinical study of the diagnostic parameters along with symptoms is necessary to rule out false positive results.
The treatment of Sjogren syndrome is generally a slow process because it is an autoimmune disorder. Immunosuppressive drugs and salivary substitutions are some of the methods administered to manage Sjogren syndrome. Pilocarpine an FDA approved tear stimulating drug is widely used for the treatment of dry eyes.
Most often, dry eyes are due to Blepharitis (inflammation of the eyelid) , Sjogren syndrome, aging, eye infections, corneal ulcers or other factors. Schirmer's Test is done to check for dry eyes or even severely watering eyes. A special strip of paper is placed inside the lower eyelids for about 5 minutes. The paper strips are then checked for level of moisture to determine the eye's ability to produce tears. How far down the tears reach on the paper strips is also noticed. In some cases, anaesthetic drops are applied prior to administering this test. Another alternative to the Schirmer's Test is the Phenol Red Thread test wherein red strips of special thread are used instead of special paper strips. Remove contact lenses before this test and do not wear for a couple of hours after it.
Burning mouth syndrome
Burning mouth syndrome (BMS) occurs predominantly in middle aged men and women. It is also called glossodynia or stomatodynia. This syndrome occurs in the oral cavity affecting the gums, lips and the tongue. In severe cases, the tongue becomes scalded and has a bruised appearance. Burning mouth syndrome can occur because of preexisting medical and dental conditions such as menopause, oral thrush caused by yeast infection and also some forms of allergies. The exact cause of the burning mouth syndrome is not identified, however when it is diagnosed it becomes absolutely necessary to evaluate the underlying conditions associated with its cause.
Burning mouth syndrome is high among post-menopausal women. Patients often complain of metallic taste; followed by numbness in the oral cavity. The chronic pain caused due to burning mouth syndrome gradually increases and persists. Some patients complain of these symptoms after undergoing a dental procedure. In case of burning sensation, the tongue becomes scalded and patches on the tongue can be seen. The scalded patch is usually 6-9 cm.
Another important condition associated with burning mouth syndrome is xerostomia which is also called dry mouth. In this condition, the salivary flow to the mouth is reduced to a large extent and the person experiences taste aberrations such as metallic taste or bitter taste in the mouth. Studies indicate that this syndrome is caused because of changes associated with neurotransmitter molecules of the central nervous system. Some clinical findings reveal that the major factor associated with BMS is stress. Stressful conditions often release neurotransmitters as a hormonal response. Any changes or insufficiency in these neurotransmitters can lead to BMS.
Diagnosing Burning Mouth Syndrome
Burning mouth syndrome can be treated effectively by working up a diagnostic pattern. The diagnostic measures taken are associated with the patient's history of underlying medical conditions, stress and lifestyle patterns. Patients who undergo cancer treatment and antimicrobial therapies have greater chances of BMS. In addition these factors, BMS is also caused due to trauma to the nervous system in the oral region.
Patients who suffer BMS are treated with an anesthetic mouthwash to reduce the pain and burning sensation. If the pain persists then the salivary glands are carefully examined. This enables detection of a neurological condition called Sjogren syndrome which is associated with salivary gland flow functionality. Patients are tested for their taste patterns and salivary flow analysis is done to assess the type of treatment required. Other patients who have normal taste patterns and BMS are examined for history of reflux disease and previous dental procedures.
Treating Burning Mouth Syndrome
Many patients are counseled to avoid stress as it plays a major role in the onset of BMS. Antidepressant drugs such as clonazepam are recommended for some patients. In case of dry mouth, patients are advised to drink plenty of water or even use sugar free chewing gum to facilitate the salivary flow. Many dietary recommendations are also given to patients suffering with BMS. Patients are advised to avid spicy food, carbonated drinks, acidic juices and also chewing of tobacco. Adequate protein intake along with fiber is recommended to avoid gastrointestinal reflux related BMS and malnutrition associated BMS.