Oral Health of Primary Sjögren’s Patients Seen as Similar to That of Healthy Controls in Small Study

The oral health of patients with primary Sjögren’s syndrome is similar to that of patients with rheumatoid arthritis or healthy individuals, a small study suggests.

The study, “Clinical periodontal status and inflammatory cytokines in primary sjogren syndrome and rheumatoid artritis,” was published in The Journal of Periodontology.

Primary Sjögren’s syndrome (pSS) patients have defects in the glands that produce saliva and tears, resulting in dry mouth and dry eyes. The loss of normal saliva production in these patients disturbs their oral microbial environment, often creating conditions for tooth decay (cavities) and a fungal infection called candidiasis.

Some studies suggest that gingival inflammation in these patients could fuel a systemic inflammatory environment that promotes the progression of primary Sjögren’s syndrome symptoms.

But while “a number of studies evaluating the periodontal disease of patients with pSS have been reported, the results have not always been concordant, and there is still little definitive evidence that such patients have an increased liability to periodontal destruction,” the investigators wrote.

Researchers evaluated gum health and the levels of systemic markers of inflammation in primary Sjögren’s patients and in healthy controls. They also examined patients with rheumatoid arthritis (RA), an inflammatory autoimmune disease that primarily affects joints.

They recruited a total of 113 people, including 44 with pSS, 39 with RA, and 30 controls. Participants were followed at the Rheumatology clinic of Medical Faculty of Ege University, in Turkey, from March 2014 to June 2015.

All pSS patients were receiving corticosteroid and immunosuppressive treatments, and continued to do so during the study.

A specialist in gums, called a periodontist, evaluated participants’ oral health. Researchers also examined both gingival crevicular fluid – a fluid collected at the margins of gums – and the blood for markers of inflammation.

Oral health was similar across the three groups, investigators found, with patients showing similar scores in clinical parameters and in the number of teeth.

In the gingival fluid, the levels of interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-a) were similar among all three groups. However, interleukin-1-beta (IL-1b) — a proinflammatory cytokine protein — was significantly higher in primary Sjögren’s patients compared to healthy subjects, and caspase-1 — an enzyme that cleaves other proteins — was significantly lower than that of RA patients.

Similarly, pSS patients had higher amounts of IL-1b in the blood compared to the two other groups.

Overall, “the results of the present study reveal that the periodontal status of patients with pSS does not differ from systemically healthy subjects,” the study concluded.