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Oral and Dental Manifestations of Sjögren’s Syndrome: Current Approaches to Diagnostics and Therapy

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Sjögren’s Syndrome

Abstract

Saliva plays a detrimental role in oral health and disease. The quality and the quantity of saliva are determined by the glands it is secreted from, the sampling method, and whether secretion is stimulated or not (stimulated or resting saliva). Mucin-rich saliva lubricates the oral tissues, and lactoferrin, peroxidase, histatin, and a range of other substances provide anti-microbial, anti-viral, and anti-mycotic properties. Symptoms related to xerostomia as in Sjögren’s syndrome (SS) are burning sensation of the oral mucosa and tongue, impaired taste, dry lips, oral soreness and ulcers, difficulties in speaking and chewing dry foods, and difficulties in wearing removable dentures. Clinically, the mucosa is dry and sticky and the examination mirror may adhere to the buccal mucosa. In addition depapillation of the tongue, explosive development of cavities (dental caries), and fungal/yeast infections (oral candidiasis) of the mouth and pharynx may occur. An objective measure of oral dryness can be achieved by sialometry of unstimulated and/or stimulated whole saliva. The possibility of using saliva as a fluid for biomarkers and its potential benefit in SS patient diagnosis and patient follow-up are elaborated. Finally, current approaches to relief of xerostomia and prevention/treatment of dry mouth-induced complications such as dental caries and oral candidiasis are presented.

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References

  1. Van Nieuw Amerongen A, Bolscher JG, Veerman EC. Salivary proteins: protective and diagnostic value in cariology? Caries Res. 2004;38(3):247–53.

    PubMed  Google Scholar 

  2. Dale BA, Fredericks LP. Antimicrobial peptides in the oral environment: expression and function in health and disease. Curr Issues Mol Biol. 2005;7(2):119–33.

    PubMed  CAS  Google Scholar 

  3. Edgar MW, Dawes C, O’Mullane D. Saliva and oral health. 3rd ed. British Dental Association. London: BDJ Books; 2004.

    Google Scholar 

  4. Bardow A, Lagerlöf F, Nauntofte B, Tenuvuo J. The role of saliva. In: Fejerskov O, Kidd E, editors. Dental Caries. The Disease and Its Clinical Management. 2nd ed. Oxford: Blackwell Munksgaard; 2008, pp. 189–208.

    Google Scholar 

  5. Nieuw Amerongen AV, Ligtenberg AJ, Veerman EC. Implications for diagnostics in the biochemistry and physiology of saliva. Ann NY Acad Sci. 2007;1098:1–6.

    PubMed  Google Scholar 

  6. de Almeida Pdel V, Gregio AM, Machado MA, de Lima AA, Azevedo LR. Saliva composition and functions: a comprehensive review. J Contemp Dent Pract. 2008;9(3):72–80.

    PubMed  Google Scholar 

  7. Levine MJ, Reddy MS, Tabak LA, et al. Structural aspects of salivary glycoproteins. J Dent Res. 1987;66(2):436–41.

    PubMed  CAS  Google Scholar 

  8. Reitamo S, Konttinen YT, Segerberg-Konttinen M. Distribution of lactoferrin in human salivary glands. Histochemistry. 1980;66(3):285–91.

    PubMed  CAS  Google Scholar 

  9. Valenti P, Antonini G. Lactoferrin: an important host defence against microbial and viral attack. Cell Mol Life Sci. 2005;62(22):2576–87.

    PubMed  CAS  Google Scholar 

  10. Levine MJ. Development of artificial salivas. Crit Rev Oral Biol Med. 1993;4(3–4):279–86.

    PubMed  CAS  Google Scholar 

  11. Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque. J Bacteriol. 2001;183(12):3770–83.

    PubMed  CAS  Google Scholar 

  12. Beighton D. The complex oral microflora of high-risk individuals and groups and its role in the caries process. Community Dent Oral Epidemiol. 2005;33(4):248–55.

    PubMed  Google Scholar 

  13. Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol. 2005;43(11):5721–32.

    PubMed  Google Scholar 

  14. Scully C, el-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med. 1994;5(2):125–57.

    PubMed  CAS  Google Scholar 

  15. Pedersen AM, Bardow A, Nauntofte B. Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjögren’s syndrome. BMC Clin Pathol. 2005;5(1):4.

    PubMed  Google Scholar 

  16. Leung KC, McMillan AS, Cheung BP, Leung WK. Sjögren’s syndrome sufferers have increased oral yeast levels despite regular dental care. Oral Dis. 2008;14(2):163–73.

    PubMed  CAS  Google Scholar 

  17. Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Crit Rev Oral Biol Med. 1995;6(2):161–75.

    PubMed  CAS  Google Scholar 

  18. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American–European Consensus Group. Ann Rheum Dis. 2002;61(6):554–8.

    PubMed  CAS  Google Scholar 

  19. Brosky ME. The role of saliva in oral health: strategies for prevention and management of xerostomia. J Support Oncol. 2007;5(5):215–25.

    PubMed  CAS  Google Scholar 

  20. Bergdahl M. Salivary flow and oral complaints in adult dental patients. Community Dent Oral Epidemiol. 2000;28(1):59–66.

    PubMed  CAS  Google Scholar 

  21. Rhodus NL. Sjögren’s syndrome. Quintessence Int. 1999;30(10):689–99.

    PubMed  CAS  Google Scholar 

  22. Fox PC, Bowman SJ, Segal B, et al. Oral involvement in primary Sjögren syndrome. J Am Dent Assoc. 2008;139(12):1592–601.

    PubMed  Google Scholar 

  23. Scully C, Felix DH. Oral medicine—update for the dental practitioner: dry mouth and disorders of salivation. Br Dent J. 2005;199(7):423–7.

    PubMed  CAS  Google Scholar 

  24. Sanchez-Guerrero J, Aguirre-Garcia E, Perez-Dosal MR, et al. The wafer test: a semi-quantitative test to screen for xerostomia. Rheumatology. 2002;41(4):381–9.

    PubMed  CAS  Google Scholar 

  25. Fox PC. Xerostomia: recognition and management. Dent Assist. 2008;77(5):18,20,44–8; quiz 50–1.

    Google Scholar 

  26. Young W, Khan F, Brandt R, Savage N, Razek AA, Huang Q. Syndromes with salivary dysfunction predispose to tooth wear: case reports of congenital dysfunction of major salivary glands, Prader–Willi, congenital rubella, and Sjögren’s syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(1):38–48.

    PubMed  CAS  Google Scholar 

  27. Lindvall AM, Jonsson R. The salivary gland component of Sjögren’s syndrome: an evaluation of diagnostic methods. Oral Surg Oral Med Oral Pathol. 1986;62(1):32–42.

    PubMed  CAS  Google Scholar 

  28. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38(3):236–40.

    PubMed  CAS  Google Scholar 

  29. Brun JG, Jacobsen H, Kloster R, et al. Use of sicca symptoms questionnaire for the identification of patients with Sjögren’s syndrome in a heterogeneous hospital population with various rheumatic diseases. Clin Exp Rheumatol. 1994;12(6):649–52.

    PubMed  CAS  Google Scholar 

  30. Brun JG, Madland TM, Gjesdal CB, Bertelsen LT. Sjögren’s syndrome in an out-patient clinic: classification of patients according to the preliminary European criteria and the proposed modified European criteria. Rheumatology. 2002;41(3):301–4.

    PubMed  CAS  Google Scholar 

  31. Atkinson JC, Travis WD, Pillemer SR, Bermudez D, Wolff A, Fox PC. Major salivary gland function in primary Sjögren’s syndrome and its relationship to clinical features. J Rheumatol. 1990;17(3):318–22.

    PubMed  CAS  Google Scholar 

  32. Atkinson JC. The role of salivary measurements in the diagnosis of salivary autoimmune diseases. Ann NY Acad Sci. 1993;694:238–51.

    PubMed  CAS  Google Scholar 

  33. Haldorsen K, Moen K, Jacobsen H, Jonsson R, Brun JG. Exocrine function in primary Sjögren syndrome: natural course and prognostic factors. Ann Rheum Dis. 2008;67(7):949–54.

    PubMed  CAS  Google Scholar 

  34. Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(1):28–46.

    PubMed  CAS  Google Scholar 

  35. Balboni I, Chan SM, Kattah M, Tenenbaum JD, Butte AJ, Utz PJ. Multiplexed protein array platforms for analysis of autoimmune diseases. Annu Rev Immunol. 2006;24:391–418.

    PubMed  CAS  Google Scholar 

  36. Lescuyer P, Hochstrasser D, Rabilloud T. How shall we use the proteomics toolbox for biomarker discovery? J Proteome Res. 2007;6(9):3371–6.

    PubMed  CAS  Google Scholar 

  37. Wong DT. Salivary diagnostics powered by nanotechnologies, proteomics and genomics. J Am Dent Assoc. 2006;137(3):313–21.

    PubMed  CAS  Google Scholar 

  38. Sahingur SE, Cohen RE. Analysis of host responses and risk for disease progression. Periodontol 2000. 2004;34:57–83.

    PubMed  Google Scholar 

  39. Kaufman E, Lamster IB. The diagnostic applications of saliva—a review. Crit Rev Oral Biol Med. 2002;13(2):197–212.

    PubMed  Google Scholar 

  40. Navazesh M. Methods for collecting saliva. Ann NY Acad Sci. 1993;694:72–7.

    PubMed  CAS  Google Scholar 

  41. Denny P, Hagen FK, Hardt M, et al. The proteomes of human parotid and submandibular/sublingual gland salivas collected as the ductal secretions. J Proteome Res. 2008;7(5):1994–2006.

    PubMed  CAS  Google Scholar 

  42. Li Y, Zhou X, St John MA, Wong DT. RNA profiling of cell-free saliva using microarray technology. J Dent Res. 2004;83(3):199–203.

    PubMed  CAS  Google Scholar 

  43. Crouch DJ. Oral fluid collection: the neglected variable in oral fluid testing. Forensic Sci Int. 2005;150(2–3):165–73.

    PubMed  CAS  Google Scholar 

  44. Gau V, Wong D. Oral fluid nanosensor test (OFNASET) with advanced electrochemical-based molecular analysis platform. Ann NY Acad Sci. 2007;1098:401–10.

    PubMed  CAS  Google Scholar 

  45. Good DM, Thongboonkerd V, Novak J, et al. Body fluid proteomics for biomarker discovery: lessons from the past hold the key to success in the future. J Proteome Res. 2007;6(12):4549–55.

    PubMed  CAS  Google Scholar 

  46. van der Greef J, Martin S, Juhasz P, et al. The art and practice of systems biology in medicine: mapping patterns of relationships. J Proteome Res. 2007 Apr;6(4):1540–59.

    PubMed  Google Scholar 

  47. Lewington S, Whitlock G, Clarke R, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370(9602):1829–39.

    PubMed  Google Scholar 

  48. Delaleu N, Immervoll H, Cornelius J, Jonsson R. Biomarker profiles in serum and saliva of experimental Sjögren’s syndrome: associations with specific autoimmune manifestations. Arthritis Res Ther. 2008;10(1):R22.

    PubMed  Google Scholar 

  49. Malamud D. Oral diagnostic testing for detecting human immunodeficiency virus-1 antibodies: a technology whose time has come. Am J Med. 1997;102(4A):9–14.

    PubMed  CAS  Google Scholar 

  50. Veenstra TD. Global and targeted quantitative proteomics for biomarker discovery. J Chromatogr B Analyt Technol Biomed Life Sci. 2007;847(1):3–11.

    PubMed  CAS  Google Scholar 

  51. Cline MS, Smoot M, Cerami E, et al. Integration of biological networks and gene expression data using cytoscape. Nat Protoc. 2007;2(10):2366–82.

    PubMed  CAS  Google Scholar 

  52. Delaleu N, Jonsson R, Koller MM. Sjögren’s syndrome. Eur J Oral Sci. 2005;113(2):101–13.

    PubMed  CAS  Google Scholar 

  53. Dawson LJ, Fox PC, Smith PM. Sjögrens syndrome—the non-apoptotic model of glandular hypofunction. Rheumatology. 2006;45(7):792–8.

    PubMed  CAS  Google Scholar 

  54. Li Y, St John MA, Zhou X, et al. Salivary transcriptome diagnostics for oral cancer detection. Clin Cancer Res. 2004;10(24):8442–850.

    PubMed  CAS  Google Scholar 

  55. Horsfall AC, Rose LM, Maini RN. Autoantibody synthesis in salivary glands of Sjögren’s syndrome patients. J Autoimmun. 1989;2(4):559–68.

    PubMed  CAS  Google Scholar 

  56. Sreebny L, Zhu WX. Whole saliva and the diagnosis of Sjögren’s syndrome: an evaluation of patients who complain of dry mouth and dry eyes. Part 2: immunologic findings. Gerodontology. 1996;13(1):44–8.

    PubMed  CAS  Google Scholar 

  57. Tengner P, Halse AK, Haga HJ, Jonsson R, Wahren-Herlenius M. Detection of anti-Ro/SSA and anti-La/SSB autoantibody-producing cells in salivary glands from patients with Sjögren’s syndrome. Arthritis Rheum. 1998;41(12):2238–48.

    PubMed  CAS  Google Scholar 

  58. Hu S, Wang J, Meijer J, et al. Salivary proteomic and genomic biomarkers for primary Sjögren’s syndrome. Arthritis Rheum. 2007;56(11):3588–600.

    PubMed  CAS  Google Scholar 

  59. Baldini C, Giusti L, Bazzichi L, Lucacchini A, Bombardieri S. Proteomic analysis of the saliva: a clue for understanding primary from secondary Sjögren’s syndrome? Autoimmun Rev. 2008;7(3):185–91.

    PubMed  CAS  Google Scholar 

  60. Delaleu N, Madureira AC, Immervoll H, Jonsson R. Inhibition of experimental Sjögren’s syndrome through immunization with HSP60 and its peptide amino acids 437–460. Arthritis Rheum. 2008;58(8):2318–28.

    PubMed  CAS  Google Scholar 

  61. Ryu OH, Atkinson JC, Hoehn GT, Illei GG, Hart TC. Identification of parotid salivary biomarkers in Sjögren’s syndrome by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry and two-dimensional difference gel electrophoresis. Rheumatology. 2006;45(9):1077–86.

    PubMed  CAS  Google Scholar 

  62. Giusti L, Baldini C, Bazzichi L, Ciregia F, Tonazzini I, Mascia G, et al. Proteome analysis of whole saliva: a new tool for rheumatic diseases—the example of Sjögren’s syndrome. Proteomics. 2007;7(10):1634–43.

    PubMed  CAS  Google Scholar 

  63. Peluso G, De Santis M, Inzitari R, et al. Proteomic study of salivary peptides and proteins in patients with Sjögren’s syndrome before and after pilocarpine treatment. Arthritis Rheum. 2007;56(7):2216–22.

    PubMed  CAS  Google Scholar 

  64. Fejerskov O, Nyvad B, Kidd EAM. Pathology of dental caries. In: Fejerskov O, Kidd E, editors. Dental caries. The disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard; 2008, pp. 19–48.

    Google Scholar 

  65. Fejerskov O, Manji F. Reactor paper: risk assessment in dental caries. In: Bader JD, editor. Risk assessment in dentistry. Chapel Hill: University of North Carolina Dental Ecology; 1990, pp. 215–7.

    Google Scholar 

  66. Bardow A, Hofer E, Nyvad B, et al. Effect of saliva composition on experimental root caries. Caries Res. 2005;39(1):71–7.

    PubMed  CAS  Google Scholar 

  67. Dawes C. A mathematical model of salivary clearance of sugar from the oral cavity. Caries Res. 1983;17(4):321–34.

    PubMed  CAS  Google Scholar 

  68. Radfar L, Shea Y, Fischer SH, et al. Fungal load and candidiasis in Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(3):283–7.

    PubMed  Google Scholar 

  69. Ellepola AN, Samaranayake LP. Oral candidal infections and antimycotics. Crit Rev Oral Biol Med. 2000;11(2):172–98.

    PubMed  CAS  Google Scholar 

  70. Kidd EAM, Nyvad B, Espelid I. Caries control for the individual patient. In: Fejerskov O, Kidd E, editors. Dental caries. The disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard; 2008, pp. 487–504.

    Google Scholar 

  71. Atkinson JC, Fox PC. Sjögren’s syndrome: oral and dental considerations. J Am Dent Assoc. 1993;124(3):74–6, 78–82, 84–6.

    PubMed  CAS  Google Scholar 

  72. Neppelberg E, Costea DE, Vintermyr OK, Johannessen AC. Dual effects of sodium lauryl sulphate on human oral epithelial structure. Exp Dermatol. 2007;16(7):574–9.

    PubMed  CAS  Google Scholar 

  73. Dreizen S, Brown LR, Daly TE, Drane JB. Prevention of xerostomia-related dental caries in irradiated cancer patients. J Dent Res. 1977;56(2):99–104.

    PubMed  CAS  Google Scholar 

  74. Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003(4):CD002782.

    Google Scholar 

  75. Stookey GK. The effect of saliva on dental caries. J Am Dent Assoc. 2008;139 (Suppl):11S–17S.

    PubMed  Google Scholar 

  76. Dawes C. The unstimulated salivary flow rate after prolonged gum chewing. Arch Oral Biol. 2005;50(6):561–3.

    PubMed  CAS  Google Scholar 

  77. Strietzel FP, Martin-Granizo R, Fedele S, et al. Electrostimulating device in the management of xerostomia. Oral Dis. 2007;13(2):206–13.

    PubMed  CAS  Google Scholar 

  78. Vivino FB, Al-Hashimi I, Khan Z, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch Intern Med. 1999;159(2):174–81.

    PubMed  CAS  Google Scholar 

  79. Fife RS, Chase WF, Dore RK, et al. Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial. Arch Intern Med. 2002;162(11):1293–300.

    PubMed  CAS  Google Scholar 

  80. Petrone D, Condemi JJ, Fife R, Gluck O, Cohen S, Dalgin P. A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren’s syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum. 2002;46(3):748–54.

    PubMed  CAS  Google Scholar 

  81. Gibson J, Halliday JA, Ewert K, Robertson S. A controlled release pilocarpine buccal insert in the treatment of Sjögren’s syndrome. Br Dent J. 2007;202(7):E17; discussion 404–5.

    PubMed  CAS  Google Scholar 

  82. Weber J, Keating GM. Cevimeline. Drugs. 2008;68(12):1691–8.

    PubMed  CAS  Google Scholar 

  83. Fox RI. Use of cevimeline, a muscarinic M1 and M3 agonist, in the treatment of Sjögren’s syndrome. Adv Exp Med Biol. 2002;506(Pt B):1107–16.

    PubMed  CAS  Google Scholar 

  84. Blom M, Lundeberg T. Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis. 2000;6(1):15–24.

    PubMed  CAS  Google Scholar 

  85. Grisius MM. Salivary gland dysfunction: a review of systemic therapies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(2):156–62.

    PubMed  CAS  Google Scholar 

  86. Frost-Larsen K, Isager H, Manthorpe R. Sjögren’s syndrome treated with bromhexine: a randomised clinical study. Br Med J. 1978;1(6127):1579–81.

    PubMed  CAS  Google Scholar 

  87. Prause JU, Frost-Larsen K, Hoj L, Isager H, Manthorpe R. Lacrimal and salivary secretion in Sjögren’s syndrome: the effect of systemic treatment with bromhexine. Acta Ophthalmol. 1984;62(3):489–97.

    CAS  Google Scholar 

  88. von Bultzingslöven I, Sollecito TP, Fox PC, et al. Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103 (Suppl):S57 e1–e15.

    Google Scholar 

  89. Christersson CE, Lindh L, Arnebrant T. Film-forming properties and viscosities of saliva substitutes and human whole saliva. Eur J Oral Sci. 2000;108(5):418–25.

    PubMed  CAS  Google Scholar 

  90. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003;134(1):61–9; quiz 118–9.

    PubMed  Google Scholar 

  91. Rhodus NL, Bereuter J. Clinical evaluation of a commercially available oral moisturizer in relieving signs and symptoms of xerostomia in postirradiation head and neck cancer patients and patients with Sjögren’s syndrome. J Otolaryngol. 2000;29(1):28–34.

    PubMed  CAS  Google Scholar 

  92. Warde P, Kroll B, O’Sullivan B, et al. A phase II study of Biotene in the treatment of postradiation xerostomia in patients with head and neck cancer. Support Care Cancer. 2000;8(3):203–8.

    PubMed  CAS  Google Scholar 

  93. Epstein JB, Emerton S, Le ND, Stevenson-Moore P. A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol. 1999;35(2):132–7.

    PubMed  CAS  Google Scholar 

  94. Vissink A, Schaub RM, van Rijn LJ, Gravenmade EJ, Panders AK, Vermey A. The efficacy of mucin-containing artificial saliva in alleviating symptoms of xerostomia. Gerodontology. 1987;6(3):95–101.

    PubMed  CAS  Google Scholar 

  95. Davies AN. A comparison of artificial saliva and chewing gum in the management of xerostomia in patients with advanced cancer. Palliat Med. 2000;14(3):197–203.

    PubMed  CAS  Google Scholar 

  96. Cassolato SF, Turnbull RS. Xerostomia: clinical aspects and treatment. Gerodontology. 2003;20(2):64–77.

    PubMed  Google Scholar 

  97. Pedersen AM, Andersen TL, Reibel J, Holmstrup P, Nauntofte B. Oral findings in patients with primary Sjögren’s syndrome and oral lichen planus—a preliminary study on the effects of bovine colostrum-containing oral hygiene products. Clin Oral Investig. 2002;6(1):11–20.

    PubMed  CAS  Google Scholar 

  98. Nieuw Amerongen AV, Veerman EC. Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies. Support Care Cancer. 2003;11(4):226–31.

    PubMed  CAS  Google Scholar 

  99. van der Reijden WA, van der Kwaak H, Vissink A, Veerman EC, Amerongen AV. Treatment of xerostomia with polymer-based saliva substitutes in patients with Sjögren’s syndrome. Arthritis Rheum. 1996;39(1):57–63.

    PubMed  Google Scholar 

  100. Almståhl A, Kroneld U, Tarkowski A, Wikström M. Oral microbial flora in Sjögren’s syndrome. J Rheumatol. 1999;26(1):110–14.

    PubMed  Google Scholar 

  101. Kolavic SA, Gibson G, al-Hashimi I, Guo IY. The level of cariogenic micro-organisms in patients with Sjögren’s syndrome. Spec Care Dentist. 1997;17(2):65–9.

    PubMed  CAS  Google Scholar 

  102. Nyvad B. Role of oral hygiene. In: Fejerskov O, Kidd E, eds. Dental Caries. The Disease and Its Clinical Management. 2nd ed. Oxford: Blackwell Munksgaard; 2008:257–64.

    Google Scholar 

  103. Scheie AA, Petersen FC. Antimicrobials in caries control. In: Fejerskov O, Kidd E, ed. Dental Caries. The Disease and Its Clinical Management. 2nd ed. Oxford: Blackwell Munksgaard; 2008:265–78.

    Google Scholar 

  104. Aimutis WR. Bioactive properties of milk proteins with particular focus on anticariogenesis. J Nutr. 2004 Apr;134(4):989S–95S.

    PubMed  CAS  Google Scholar 

  105. Henning DR, Baer RJ, Hassan AN, Dave R. Major advances in concentrated and dry milk products, cheese, and milk fat-based spreads. J Dairy Sci. 2006;89(4):1179–88.

    PubMed  CAS  Google Scholar 

  106. Shaw JH, Ensfield BJ, Wollman DH. Studies on the relation of dairy products to dental caries in caries-susceptible rats. J Nutr. 1959;67(2):253–73.

    PubMed  CAS  Google Scholar 

  107. Harper DS, Osborn JC, Clayton R, Hefferren JJ. Modification of food cariogenicity in rats by mineral-rich concentrates from milk. J Dent Res. 1987;66(1):42–5.

    PubMed  CAS  Google Scholar 

  108. Järvinen VK, Rytömaa, II, Heinonen OP. Risk factors in dental erosion. J Dent Res. 1991;70(6):942–7.

    PubMed  Google Scholar 

  109. Rytömaa I, Järvinen V, Kanerva R, Heinonen OP. Bulimia and tooth erosion. Acta Odontol Scand. 1998;56(1):36–40.

    PubMed  Google Scholar 

  110. Lussi A, Schaffner M. Progression of and risk factors for dental erosion and wedge-shaped defects over a 6-year period. Caries Res. 2000;34(2):182–7.

    PubMed  CAS  Google Scholar 

  111. Soto-Rojas AE, Kraus A. The oral side of Sjögren syndrome. Diagnosis and treatment. A review. Arch Med Res. 2002;33(2):95–106.

    PubMed  Google Scholar 

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Jonsson, M.V., Delaleu, N., Marthinussen, M.C., Jonsson, R. (2011). Oral and Dental Manifestations of Sjögren’s Syndrome: Current Approaches to Diagnostics and Therapy. In: Fox, R., Fox, C. (eds) Sjögren’s Syndrome. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-957-4_14

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