It seems that sonic vibrations are capable of stimulating
salivary flow in Sj?gren`s Syndrome patients.
Trisha E. O`Hehir, RDH, BS
Many of our patients have dry mouth associated with various medications, chemotherapy, or radiation therapy. Others may be suffering from Sj?gren`s Syndrome, a condition seen more often in middle-aged women at a rate of 9-1 over men. Sj?gren`s Syndrome is an autoimmune disease, characterized by the abnormal production of antibodies directed against epithelium and connective tissues of the eyes and salivary glands.
In 1930, Dr. Henrik Sj?gren, an ophthalmologist in Sweden, described five cases of dry eyes with unusual changes in the epithelium. In 1933, he presented a thesis that included case reports of 19 patients with reduced tear and salivary flow. To separate the reduced tear flow cases from those associated with vitamin A deficiency, it was called keratoconjunctivitis sicca. The term, "Sj?gren`s Syndrome," appeared during World War II, as more work was done with patients suffering from both dry eyes and dry mouth problems.
Dr. Sj?gren`s thesis was translated into English in 1943. In 1951, Dr. Sj?gren published a study of another 80 cases. Only the Mayo Clinic had seen more cases.
Four main symptoms mark primary Sj?gren`s Syndrome. These symptoms include: tiredness, dry eyes, dry mouth, and joint pain in the hands and fingers. Sometimes, the joints may be swollen, thus mimicking rheumatoid arthritis. Diagnosis requires a close collaboration among three specialties: ophthalmology, dentistry, and rheumatology. The dental tests include verifying hypofunction of the salivary glands and a lower-lip biopsy. Blood samples are sometimes taken to check for abnormal cellular blood elements and for immunoglobulins and antibodies.
Treatment is divided into systemic and local. Of the systemic treatments tried, bromhexine (Bisolvon) and gammalinolenic acid have been successful in increasing lacrimal and salivary flow and to some extent, reducing tiredness. Cyclosporin A and hydroxychlorokin have been tried, but they usually are no better than placebo in reducing dryness symptoms. Larger clinical placebo-controlled trials are planned.
Pregnant patients with primary Sj?gren`s Syndrome should have a fetal ECG in late pregnancy, since there is an increased risk that the baby might be born with a complete heart block, resulting in a reduced pulse rate of 60, instead of 120-130. Roughly one in 40 pregnancies among mothers with primary Sj?gren`s Syndrome have this complication. Most of these children develop normally, despite the low heart-rate frequency, and most do not require a pacemaker. In the general population, complete congenital heart block occurs at a rate of only 1 in 20,000.
The exact cause of Sj?gren Syndrome is not known. But there is growing scientific support for a genetic link. This illness is sometimes found in other family members and is also commonly found in families with other autoimmune diseases, such as systemic lupus erythematosus, autoimmune thyroid disease, and juvenile diabetes.
Unlike patients who have undergone radiation therapy, Sj?gren`s Syndrome patients do have functioning salivary glands. However, the salivary flow is reduced due to the presence of lymphoid cells. Researchers in Greece compared three groups of patients with dry mouth symptoms: Sj?gren`s patients; those with other autoimmune diseases; and those suffering dry mouth, but with no underlying systemic disease.
All study participants complained of reduced salivary flow. Comparisons were made to see if the dry mouth associated with Sj?gren`s Syndrome resulted in different clinical outcomes than other forms of dry mouth. All patients had been referred to the hospital clinic for minor salivary-gland biopsies.
Comparisons of dental and periodontal records showed no significant differences between the three groups. All showed reduced salivary flow, similar caries rates, and similar periodontal conditions. Xerostomia, no matter what the cause, results in increased caries levels. It is unclear whether reduced salivary flow also leads to increased periodontal disease.
Another study done by Dr. Athena Papas at Tufts University in Boston showed an increase in salivary flow with use of the Sonicare(r) toothbrush. It seems the sonic vibrations are capable of stimulating salivary flow in Sj?gren`s Syndrome patients. Salivary flow rates were measured at 15-minute intervals after Sonicare brushing by patients in one group and manual brushing by patients in the other group.
Measurements continued for 45 minutes. After two months of the assigned brushing, the test groups were reversed and the study was repeated. In both tests, the Sonicare(r) toothbrush demonstrated increased salivary flow up to 20 times over the manual brush. This is both a statistically and clinically significant outcome. In a questionnaire, 92 percent of the study subjects felt the Sonicare(r) toothbrush increased saliva flow. So, in addition to artificial saliva and other products, we also now have the sonic toothbrush.
Xerostomia may result from causes other than medications. Careful questioning of the patient will determine an accurate understanding of the situation.
Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. She can be reached by phone at (800) 374-4290 and by e-mail at trisha@