Oral dryness is a common and impactful manifestation of Sjögren syndrome. The recommended first-line approach to this symptom depends directly on the degree of residual salivary gland function. This protocol applies to patients in whom salivary gland dysfunction is classified as mild.
Sjögren syndrome with oral dryness and mild salivary gland dysfunction, characterised by preserved — though reduced — glandular output.
Mild dysfunction: unstimulated whole salivary flow ≥ 0.1 mL/min; or unstimulated flow < 0.1 mL/min with stimulated whole salivary flow > 0.7 mL/min.The degree of salivary gland function determines which therapeutic strategy is appropriate. For mild dysfunction, the preferred approach differs from those used in moderate or severe presentations.
For patients with mild salivary gland dysfunction, current evidence-based recommendations favour non-pharmacological glandular stimulation as the preferred first-line strategy — an approach that takes advantage of the glandular function still present. The specific types of stimulation included in the regimen, and the full structured protocol, are available via the link below.
DOI: 10.1136/annrheumdis-2019-216114
In patients with mild glandular dysfunction, we recommend non-pharmacological glandular stimulation as the preferred first-line therapeutic approach, using gustatory stimulants (sugar-free acidic candies, lozenges, xylitol) and/or mechanical stimulants (sugar-free chewing gum) since, in these patients, glandular function can be stimulated.
The preferred first therapeutic approach for oral dryness according to salivary gland function may be: Non-pharmacological stimulation for mild dysfunction; pharmacological stimulation for moderate dysfunction; saliva substitution for severe dysfunction.
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