The oral cavity, as the starting part of the digestive tract, contains teeth, tongue, oral mucosa, etc. Some symptoms of systemic diseases may appear in the oral cavity at the earliest. Clinically, some patients have good oral hygiene, but repeatedly have dental caries, then as a dentist need to consider whether there is a possible dry syndrome.
Dry syndrome, also known as Schegren’s syndrome, is an autoimmune disease, its pathogenesis is still not completely clear, mostly seen in middle-aged women above 40 years old, but in recent years there is a trend of early age of onset, the prevalence rate in our population is 0.3% to 0.7%, and the prevalence rate in the elderly population is 3% to 4%. The disease is more common in women, with a male to female ratio of 1:9-20. The age of onset is mostly 40 to 50 years old. It is also seen in children, and its clinical symptoms are diverse, with a single symptom or multiple symptoms
1.Local manifestation
(1) Dry mouth: due to salivary gland lesions, the lack of salivary mucin causes the following common symptoms.
(1) Most patients complain of dry mouth, and in severe cases, the oral mucosa, teeth and tongue become sticky, so that they need to drink water frequently when they speak, and when they eat solid food, they need to send it down with water or liquid food.
②Rampant dental caries is one of the characteristics of this disease. It shows that the oral hygiene is good, but the caries is frequent and difficult to control.
(③Adult mumps, manifesting as recurrent enlargement of parotid area and reduced saliva secretion.
④The tongue presents with painful tongue, dry and cracked tongue, and atrophied and smooth tongue papillae.
⑤ The oral mucosa appears to be ulcerated or secondary to infection.
(2) Dry keratoconjunctivitis: This is due to the decrease of mucin secretion from the lacrimal gland and symptoms such as dry eyes, foreign body sensation, few tears, and in severe cases, painful crying without tears. Some patients have recurrent purulent infection of the eyelid margin, conjunctivitis, keratitis, etc.
(3) Other: superficial areas such as nose, hard palate, trachea and its branches, digestive tract mucosa, and exocrine glands of vaginal mucosa can be involved, resulting in less secretion and corresponding symptoms.
2.Systemic manifestations
In addition to dry mouth and eyes, patients may also have systemic symptoms, such as weakness and low fever. About 2/3 of patients have systemic damage.
(1) Skin: Allergic purpura-like rash may appear, mostly on the lower limbs.
(2) Joints: swelling and pain may occur.
(3) Kidney: about half of the patients have renal damage, with clinical manifestations of massive proteinuria, hypoalbuminemia, and even renal insufficiency.
(4) Lung: Most patients have no respiratory symptoms. The main pathology of the lung is interstitial lesions.
(5) digestive system: non-specific symptoms such as atrophic gastritis, decreased gastric acid and dyspepsia may occur
(6) Nerve: a few involve the nervous system. Peripheral nerve damage is the most common
(7) Hematological system: the disease may present with reduced white blood cell count or (and) thrombocytopenia, and bleeding may occur in severe cases of low platelets.
If you encounter a patient with multiple caries but good oral hygiene, you need to be alert and further check to exclude dry syndrome.