The role of dental professionals in identifying patients with a suspected primary Sjögren's syndrome and suggestions for prevention and treatment of oral complications: a narrative review

Objectives To improve the identification and management of undiagnosed primary Sjögren Syndrome (pSS) in daily practice. Data, sources, study selection We conducted a literature search in PubMed on the etiology, medical diagnosis, oral characteristics, oral health-related quality of life, treatment of oral diseases, and oral rehabilitation of patients with pSS, with a special focus on those who experience dry mouth. Observational studies, clinical trials, and systematic reviews in English, without limitation as to year of publication, were retrieved and reviewed. Results pSS is an auto-immune disease characterized by the association of a triad of symptoms (dryness, pain, and fatigue), with systemic involvement in approximately 30 % of patients. Dry mouth, especially if associated with a severe clinical picture (severe caries, tooth wear, gingival inflammation, candidiasis), should be a red flag for dentists and dental hygienists, prompting them to apply a specific diagnostic procedure, as we proposed according to our clinical experience, and to refer the patient to the appropriate medical team. In addition, the implementation of appropriate preventive strategies (mainly hydration, fluoridation) and the treatment of oral diseases aim to increase salivary flow, restore oral health, prevent the recurrence of oral diseases, and improve the comfort of these patients. Together, early detection, prevention and appropriate treatment are essential to improve patients' quality of life, which is severely impaired in primary Sjögren syndrome. Conclusion and clinical significance Dentists and dental hygienists have a key role to play in identifying patients with undiagnosed primary Sjogren's syndrome by being alert to the oral characteristics of patients with dry mouth and analyzing them as part of the patients' overall clinical picture. Early detection of pSS is crucial, given the negative impact of this syndrome on patients' health and quality of life.