Introduction, Diagnostic Criteria, Pharmacotherapy, and Dental Management

The focus of this chapter is to present the basic clinical signs and symptoms, diagnostic strategies, and management approaches of SS for the oral health team. As the disease spectrum for SS is wide and quite variable, diagnosis can be challenging. This chapter will present evidence-based diagnostic and management strategies in a sequential fashion. More specifically, these include published diagnostic criteria, signs and symptoms, selected chairside patient questions suggestive of SS, and distinctions between xerostomia and hyposalivation. Chairside procedures to measure salivary flow rates and perform labial salivary gland biopsies are presented as well. Essential serological screening tests for diagnosis of SS and the subsequent need for interprofessional involvement are reviewed. Pharmacologic and non-pharmacologic treatments provided by the oral health care team for SS are detailed. These include products to relieve dry mouth, caries prevention agents, and medications to manage the oral manifestations SS. The dental management section includes patient counseling, caries management, discussion of TMD symptoms, association of SS and periodontal disease, and implant therapy. A positive and supportive approach to managing SS patients will empower them to take an active role in their oral health and improve their quality of life. Any patient presenting with xerostomia should receive a thorough evaluation. Of significance, the dentist and/or dental hygienist may be the first health care professional to suspect and facilitate the diagnosis of SS. This chapter will sequentially present the key elements in the management of patients with xerostomia, hyposalivation, and rheumatic diseases such as SS. This clinical-based approach will serve as a valuable reference for the oral health team as well as the interprofessional medical team consisting of (at a minimum) rheumatologists, ophthalmologists, and primary care physicians.