Salivary duct treatment eases dry mouth in Sjögren’s disease: Study
Minimally invasive procedure irrigates salivary glands with corticosteroids
A minimally invasive treatment that involves irrigating the major salivary glands with corticosteroids, a type of anti-inflammatory medication, significantly reduced both objective and subjective measures of dry mouth in people with Sjögren’s disease, a small study showed.
Greater benefits were observed among those with a higher symptom burden before treatment, and among those undergoing a higher number of irrigations, according to the data.
“This minimally invasive protocol appears safe, well tolerated, and particularly beneficial in patients with early or less [scarred] glandular involvement,” researchers wrote. “Further … controlled studies [following patients over time] are warranted to optimize treatment protocols and patient selection.”
The study, “Corticosteroid irrigation of parotid glands for oral dryness in Sjögren’s and non-Sjögren’s sicca disease: a longitudinal study,” was published in the journal Clinical Rheumatology.
Sjögren’s affects glands responsible for producing saliva, tears
Sjögren’s disease is an autoimmune condition that primarily affects the glands responsible for producing saliva and tears, resulting in persistent dry mouth (xerostomia) and dry eyes.
In the mouth, this dryness develops because self-reactive antibodies and pro-inflammatory molecules interfere with the cellular processes necessary for normal saliva production.
Structural problems, such as blockages, in the tubes that transport saliva can also further block saliva flow. These abnormalities, combined with inflammation-induced tissue scarring, contribute to reduced saliva production, recurrent gland swelling, and progressive damage to the glands.
Traditional treatment for salivary gland problems has focused chiefly on easing symptoms with air humidifiers, moisture substitutes, or medications that stimulate saliva, “with variable efficacy and tolerability,” the researchers wrote.
More recently, minimally invasive procedures combining sialendoscopy and corticosteroid irrigation of the salivary ducts have shown promise in improving gland function in people with Sjögren’s or other dryness disorders. In sialendoscopy, clinicians use a very thin, flexible camera to examine the inside of the salivary gland tubes and remove blockages or deliver medications.
However, “further studies are needed to validate this approach and provide a consistent therapy protocol,” the researchers wrote.
Study participants had Sjögren’s or sicca syndrome
In this study, a team of researchers in Portugal assessed the efficacy and safety of sialendoscopy combined with corticosteroid irrigation of the parotid glands, the largest of the salivary glands, in easing dry mouth in people suspected of having Sjögren’s.
They retrospectively reviewed data from 13 patients, all of them women, who underwent the procedure between January 2020 and January 2022 at a single Portuguese center and had complete follow-up data.
“Subsequent irrigations were conducted based on clinical indications, including persistent or recurrent xerostomia symptoms, evidence of ongoing ductal obstruction or inflammation, and incomplete symptom improvement,” the team wrote.
Participants’ mean age was 67.3 years. Nine had confirmed Sjögren’s syndrome, while the remaining individuals had sicca syndrome, or chronic dryness affecting the eyes and mouth, unrelated to Sjögren’s syndrome. Most women (77.8%) had normal unstimulated salivary flow.
A total of 54 parathyroid irrigation procedures were performed, averaging about five sessions per person. Treatments were conducted 6.2 weeks apart.
The results showed that the procedure was generally well-tolerated, with no adverse events reported.
Patients with more severe dry mouth at study’s start tended to benefit most
Efficacy was assessed via changes in the Clinical Oral Dryness Score (CODS) and the Xerostomia Inventory (XI) score. CODS is a 10-point scale used by clinicians to objectively assess the severity of dry mouth based on visual and tactile signs. The XI is a patient-filled questionnaire to assess dry mouth severity. In both measures, higher scores indicate more severe xerostomia.
The data demonstrated that treatment results in reduced oral dryness for most participants, based on both objective (69.2%) and subjective measures (76.9%). This was associated with significant reductions of a mean of 1.15 points in the CODS and a mean of 5.62 points in the XI score.
Women reporting more severe dry mouth at the study’s start, or baseline, tended to benefit the most, with higher baseline XI scores being significantly associated with greater reductions in CODS and XI scores after treatment.
Corticosteroid irrigation of the parotid glands resulted in a significant decrease in subjective complaints and clinical manifestations of dry mouth.
A higher number of irrigation sessions was significantly associated with a greater decrease in XI scores, but not in CODS. Also, women with fewer salivary gland abnormalities underwent more irrigations, possibly suggesting that “patients with more advanced salivary gland disease may be less responsive to this approach,” the researchers wrote.
“Corticosteroid irrigation of the parotid glands resulted in a significant decrease in subjective complaints and clinical manifestations of dry mouth,” the researchers wrote. “These findings align with prior reports that highlight the role of ductal obstruction and inflammatory changes as central mechanisms in salivary gland dysfunction, particularly in early [Sjögren’s disease].”
The researchers added that more studies are needed.
“Larger, controlled trials with longer-term assessment are warranted to confirm these promising results and define the optimal treatment protocol, particularly further identifying the patients who benefit the most, as well as the timing for multiple interventions,” they wrote.
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