Oral problems in patients with Sjögren's syndrome.

Minor salivary gland biopsies are important in confirming the diagnosis of Sjögren's syndrome (SS) and in understanding its pathogenesis. Biopsies should be obtained through clinically intact mucosa and contain at least 4 evaluable lobules. Immunohistologic studies using monoclonal antibodies demonstrated that the majority of infiltrating lymphocytes are T cells (CD3+) of the helper/inducer (CD4+) subset. Transmission electron microscopy (EM) and scanning EM emphasize the presence of high endothelial venules in SS biopsis and do not reveal immune complexes at the basement membranes. Taken together, these results suggest that T cell mediated immune mechanisms are responsible for salivary gland destruction. Patients with SS present specific therapeutic problems. First, their decreased saliva production predisposes them to increased oral infections and periodontal disease. These causes of increased oral pain must be distinguished from flares of the underlying disease including vasculitis and from medication side effects. Difficulty in eating solid foods may contribute to poor nutrition and to stress in social situations. In certain patients, dental restorations and prosthetic implants may improve cosmetic appearance and oral function.