<p>The severity of the oral and ocular manifestations of Sjögren’s disease (SjD) is often underrecognized. Several presentations at the recent <strong>ACR Convergence 2025</strong> meeting addressed this issue of underrecognition and its clinical significance.</p> <p> </p> <p><em>Following these presentations, featured expert Nancy Carteron, MD, FACR, was interviewed by</em> Conference Reporter <em>Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Carteron on these findings are presented here.</em></p>

It was terrific to have a session covering the oral manifestations of SjD and their treatment at ACR Convergence 2025. As Andrew Leask, PhD, and Natalia Trehan, DMD, noted in their presentations during the session titled “Say Cheese: Oral Health in Scleroderma and Sjögren’s Disease,” there is probably still an underrecognition of the severity of dry mouth and dental decay in patients with SjD, as well as an unmet need to start patients on topical fluoride to prevent dental caries even before they are under the care of a dentist.

 

I see patients with SjD while in the presence of an oral medicine colleague, so I can defer to a more expert level. However, even before I had the opportunity to work in this setting, I learned that just basic preventive dental care with more frequent deeper cleanings is important. Additionally, patients should be counseled on the need to decrease the amount of sugar products they are consuming and to confirm that any of the oral moisture products they are using are sugar free and contain xylitol or another similar product instead to help reduce the risk of dental decay. It is really a balance between frequent water intake and consuming agents that work to increase moisture in the mouth.

 

Of course, the first-line prevention of dental caries is clearly topical fluoride, not only the use of fluoride toothpaste but also the application of fluoride gel or varnish. In patients with SjD, dental caries can develop at the gumline, and topical chlorhexidine or other agents that can be applied locally to this area can prevent the progression of dental caries and the need for more aggressive dental work.

 

Additionally, salivary flow plays a basic role in oral comfort. You do not have to be an oral specialist or a dentist to measure a patient’s salivary flow, and there are guidelines on how to do this. If a patient with SjD has particularly low salivary flow, they can be a candidate for a prescription secretagogue such as pilocarpine or cevimeline. In my experience, you have to start low and work your way up because of side effects such as sweating. Another product that many patients like for oral comfort is a slow-release form of xylitol that can adhere to the mucosa. Compared with sprays and gels, it can be used at night and during the day. Chewing gum—even sugar-free gum—should be avoided because its use can translate into more temporomandibular joint issues.

 

So, it is important to be aware of anything unusual or anything that has changed for the patient in terms of dry mouth, dental caries, or swelling of the parotid, salivary, and/or submandibular glands. If so, a rheumatology referral is warranted. Ideally, oral medicine specialists and dentists should know that the pattern of seeing unusual amounts of dental decay in uncommon locations is very different from what you would see in the normal population and is suggestive of SjD. If a patient is experiencing an increase in dental caries at the gumline, which is very unusual, that alone should be enough to trigger asking the following question: Could this be SjD? There are some validated questions about dry mouth in the context of SjD that dentists can quickly ask patients, such as, “Can you eat a cracker without the use of liquids?” Another question they can ask patients is, “Are you having any other symptoms outside of your mouth, like joint pain, fatigue, or other health issues?” However, practitioners need to know that not all rheumatologists are equally experienced with the entire spectrum of SjD, and they should not be deterred if the first rheumatologist they refer a patient to is not particularly knowledgeable about the disease.

 

A study by Alejandro Gómez Gómez, MD, PhD, and colleagues presented at the ACR meeting focused on the ocular manifestations of SjD (poster 2291). The presentation highlighted the importance of the Ocular Staining Score (OSS), which is the gold standard for diagnosing the ocular component of SjD. I would advocate that anyone who is caring for a patient with SjD should have them seen by someone who is knowledgeable about dry eye and, hopefully, SjD. The examination does not always have to be tailored specifically to SjD but should include a full ocular evaluation, not just an evaluation aimed at managing dry eye symptoms. This is important because there are data showing that patients with SjD can have ocular surface damage without many symptoms, and, if that is not recognized, the ability to intervene to prevent progressive damage is lost.

 

This is why I think that it is most important to get across to colleagues that their patients should be seen by an ocular specialist who will perform additional testing with the OSS, not just the Schirmer’s test, because the OSS can show abnormalities before the Schirmer’s test does. Dr Gómez’s presentation at the ACR Convergence 2025 meeting also focused on the need for a test that is more accessible than the OSS. However, I would not want anyone’s takeaway from this talk to be that any of these other, less comprehensive tests are adequate for evaluating SjD.