Treatment of Sjögren Syndrome with Oral Dryness and Mild Salivary Gland Dysfunction

In Sjögren syndrome, the management of oral dryness is stratified by the degree of residual salivary gland function. When dysfunction is mild, specific first-line strategies apply — distinct from those used in more severe presentations.

Clinical scenario

Sjögren syndrome with oral dryness and mild salivary gland dysfunction, defined as an unstimulated whole salivary flow ≥ 0.1 mL/min — or an unstimulated flow < 0.1 mL/min together with a stimulated whole salivary flow > 0.7 mL/min.

Therapeutic approach (partial overview)

In mild dysfunction, the preferred initial strategy involves stimulating residual glandular function through non-pharmacological means. For patients who do not respond or who prefer an alternative, a pharmacological approach with a muscarinic agonist is an option outlined in the protocol.

Drug selection, sequencing, and the full titration algorithm are contained in the structured protocol — see below.

Instant Access to Structured Evidence-Based Regimens

References

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.

We recommend offering a trial of muscarinic agonists to patients with moderate glandular dysfunction (or in those with mild dysfunction who are refractory or who do not wish to use non-pharmacological stimulation).

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