Pharmacotherapy of Xerostomia in Primary Sjogren's Syndrome

Pharmacotherapy of Xerostomia in Primary Sjogren's Syndrome
We reviewed the current literature concerning the treatment of dry mouth in patients with primary Sjögren's syndrome (SJS). Computerized MEDLINE search engines were used with the terms Sjögren, xerostomia, dry mouth, and treatment. References from key articles were searched, and all pertinent articles were procured and reviewed. Primary SJS is an uncommon but serious disorder. Dry mouth caused by SJS can lead to dental erosion, dysphagia, oral infections, and discomfort. Preventing these complications is of paramount importance. Pharmacotherapy is limited to topical saliva substitutes, which are considered first, followed by muscarinic stimulators such as pilocarpine or cevimeline, if required. Immunosuppressive therapy is being investigated. Patients should have regular oral and dental examinations to detect complications. Satisfaction with the efficacy and tolerability of treatment should be monitored frequently. The clinician may have to use a trial-and-error approach to determine a successful regimen.

Sjögren's syndrome (SJS) is an immune-mediated disorder of exocrine glands. The most common symptoms are dry eyes (kerato-conjunctivitis sicca) and dry mouth (xerostomia). The two forms of the disease are the primary form, which is not associated with another underlying autoimmune disorder, and secondary SJS, which is associated with a connective tissue disease such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis, and primary biliary cirrhosis. The pathogenic relationship between the types appears to depend on the associated disease. In secondary SJS, symptoms may not occur for years after the underlying disease is diagnosed. This may change the symptoms; for example, in rheumatoid arthritis, ocular involve-ment is more prevalent than oral symptoms.

Oral discomfort, difficulty eating, tooth decay, and oral infections occur frequently in patients with SJS. Fortunately, therapeutic options are available that may help reduce the morbidity associated with xerostomia.