Thread by @joannamarco

Some highlights from #Sjogrens Syndrome: Dental and Ocular Perspectives (a thread)

With Dr. Athena Papas and Dr. Esen Akpak

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Reduced salivary production leads to more than just the symptom of dry mouth!
💠Decreased lubrication ➡️ difficulty speaking and swallowing
💠Loss of remineralizing saliva ➡️ cavities and tooth decay
💠Increased infections, including candidiasis and periodontal disease

Prevent cavities and tooth decay:
🦷Prescription fluoride varnish every 3 months
🦷High fluoride toothpastes (1.1%) once a day
🦷Remineralizing rinses like Caphosol or NeutraSal
🦷Chlorhexidine if any periodontal/gingival disease

Stimulate salivary flow:
💧Xylitol gum
💧Pilocarpine
💧Cevimeline
💧?Green tea

Other ways to lubricate the mouth:
💠Vitamin E (break the capsules open to get to the oil)
💠Mineral oil
💠Numerous OTC rinses, gels, and lozenges

Now for the eyes! Again, dry eyes in Sjogren's go way beyond an annoying symptom:
-Dry eyes actually decrease visual acuity and can interfere with activities like reading
-Chronic conjunctivitis
-Keratitis, which can lead to corneal melt/perforation and/or scarring

Decreased Schirmer testing tends to be a later finding (and cutoff of 5 mm is a little arbitrary), so send your patients to the ophthalmologist early for tear breakup time testing and/or ocular surface staining

🚨Lacrimal gland enlargement is a RARE finding in #Sjogrens.🚨 Dr. Akpak says in 20 years of being a Sjogren's ophthalmologist, she has NEVER seen it. Instead think:
👉Sarcoidosis
👉Lymphoma
👉IgG4RD
👉Thyroid eye disease

How to treat dry eye in Sjogren's:
👀Eliminate offending systemic/topical meds
👀Ocular lubricants (artificial tears should be preservative free!)
👀Lid hygiene, warm compresses
👀Overnight treatments like ointments/gels or moisture chamber devices
👀Pilocarpine or cevimeline

Treatments Ophtho can offer:
👁️Punctal occlusion
👁️Topical treatments like cyclosporine eyedrops
👁️Treat other contributing conditions, like ocular rosacea
👁️Autologous serum eye drops
👁️Scleral lenses
And more!

These talks were great reminders of how multidisciplinary care can be a huge asset to Sjogren's patients. Give your patients the advantage of having not just a smart rheumatologist, but a smart dentist and ophthalmologist as well!

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