Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review
Abstract
:1. Introduction
- Dental caries: xerostomia can increase the risk of dental caries due to the decreased salivary flow, which results in a decreased ability to neutralize acid and wash away bacteria and food particles.
- Oral candidosis: xerostomia can lead to an overgrowth of the fungus Candida, which can cause white, sore patches in the oral cavity, known as oral candidosis.
- Mucositis: Sjögren’s syndrome patients may also have an increased risk of oral mucositis (inflammation and ulceration of the mucous membranes).
- Dysgeusia (distorted sense of taste) and dysphagia (difficulty swallowing).
2. Materials and Methods
2.1. PICO Question
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria for the Selected Studies
2.4. Data Extraction
2.5. Information Structuring and Review Writing
3. Results and Discussion
3.1. Epidemiological Research Data
3.2. Fundamental Research Data
3.3. Clinical Research Data
4. Future Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AECG | American–European Consensus Group | |
Anti-SSA | anti-Sjögren’s syndrome-related antigen A autobodies | |
BAFF | B-cell activating factor | |
BOP | bleeding on probing index | |
CAL | Gingival clinical attachment loss | |
CASP | Caspase | |
DMFT | Decayed, missing, and filled teeth | |
EULAR | Sjögren’s syndrome patient reported index | |
FFA | Free fatty acids | |
GCF | Gingival crevicular fluid | |
GI | Gingival index | |
HLA | Human leukocite antigen | |
IFN | Interferon | |
IL | Interleukin | |
MMP | Matrix-metalloproteinases | |
NSPT | Non-surgical periodontal therapy | |
PCNA | Proliferative activity of cell nuclear antigen | |
PICO | Population Intervention Comparison Outcome | |
PLQ | Dental plaque index | |
PPD | Periodontal pocket depth | |
PRISMA | Preferred Reporting Items for Systematic Review and Meta-Analyses | |
pSS | Primary Sjögren’s syndrome | |
RA | Rheumatoid arthritis | |
SS | Sjögren’s syndrome | |
sSS | Secondary Sjögren’s syndrome | |
TGF | Tumor growth factor | |
TNF | Tumor necrosis factor |
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Database | Keyword Search |
---|---|
PUBMED | (“Sjögren, syndrome”[Mesh]) AND “Periodontitis”[Mesh]; (“Sjögren, syndrome”[Mesh]) AND “Periodontal Diseases”[Mesh]; (“Sjögren, syndrome”[Mesh]) AND “Periodontal Status”[Mesh]; (“Sicca, syndrome”[Mesh]) AND “Periodontitis”[Mesh]; (“dry, mouth”[Mesh]) AND “Periodontitis”[Mesh]; |
Web of Science | TS = (“Sjögren syndrome”) AND TS = (“Periodontal Diseases”); TS = (“Sjögren syndrome”) AND TS = (“Periodontitis”); TS = (“dry mouth”) AND TS = (“Periodontitis”). |
SCOPUS | ALL(“Sjögren syndrome”) AND ALL(“Periodontal Diseases”); ALL(“Sjögren syndrome”) AND ALL(“Periodontitis”); TITLE-ABS-KEY(“Sjögren syndrome”) AND TITLE-ABS-KEY(“Periodontal Diseases”); TITLE-ABS-KEY(“Sjögren syndrome”) AND TITLE-ABS-KEY(“Periodontitis”). |
Reference | Type of Study | SS Group (No.) | Findings |
---|---|---|---|
Highlighted link between periodontitis and SS | |||
Al-Hashimi et al., 2001 [35] | Review | / | Dentists and dental hygienists can help identify early signs and symptoms of SS |
Lin et al., 2019 [33] | Retrospective cohort analysis | 3292 | Patients with periodontitis had a significantly more elevated risk of subsequent SS onset; dental practitioners should be aware of SS risk |
Lu et al., 2014 [34] | Retrospective cohort analysis | 389 | Dental and periodontal care is essential in early recognition of SS signs and symptoms |
Chuang et al., 2020 [27] | Retrospective cohort analysis | 709 | Increased risk for periodontal disease onset in SS patients; rheumatologists should be vigilant for oral health of SS patients |
Najera et al., 1997 [25] | Transversal | 25 | SS patients have a 2.2 times increased risk for developing periodontitis than controls |
Olate et al., 2014 [31] | Transversal | 35 | Increased prevalence of periodontal inflammation (gingival bleeding) in SS patients |
Conde et al., 2021 [30] | Retrospective | 15 | Increased prevalence of periodontitis in children with SS |
No link between periodontitis and SS | |||
Soto-Rojas et al., 2002 [26] | Review | / | No significant difference in periodontal status of SS patients and controls |
Leung et al., 2004 [28] | Transversal | 51 | SS patients appear not to be at increased risk for periodontal disease than controls; periodontal parameters cannot be used for SS detection |
Schiødt et al., 2001 [29] | Transversal | 57 | Periodontal disease has similar prevalence among SS and control participants |
Boutsi et al., 2000 [32] | Transversal | 24 | No significant difference in periodontal status in SS patients compared to control group |
Reference | Type of Study | SS Group (No.) | Findings |
---|---|---|---|
Highlighted link between periodontitis and SS | |||
Maciejczyk et al., 2016 [40] | Review | / | MMP-2 and MMP-9 involvement in SS pathogenesis |
Bunte et al., 2019 [38] | Review | / | IL-17 has important role in the pathogenesis of SS and periodontitis |
Sommakia et al., 2016 [45] | Review | / | Lipid mediators’ saliva levels could be an additional tool for study of SS and periodontitis etiology, development, and treatment |
Shikama et al., 2017 [46] | Review | / | Common involvement of free fatty acids in the pathogenesis of periodontitis and SS |
Nibali et al., 2012 [39] | Review | / | Association between SS and periodontitis, mediated by IL-6, end-stage effector cytokine in the inflammatory reaction |
De Luca et al., 2019 [48] | Review | / | Increased levels of Streptococcus spp. and Veillonella spp. in SS patients |
M. Rodriguez et al., 2020 [36] | Review | / | Increased levels of relevant pro-inflammatory mediators in saliva of SS patients |
Martins et al., 2022 [54] | Prospective | 52 | Primary dental care promoted improvement in salivary flow rates in SS patients |
Pers et al., 2005 [47] | Transversal | 15 | B-cells could contribute to periodontal complications through up-regulation of BAFF in saliva of SS patients |
Lungoja et al., 2016 [49] | Transversal | 39 | Increased P. denticola antibody levels in SS patients, identification of potential bacterial triggers |
Marton et al., 2006 [43] | Case–control | 49 | Oral health status of SS patients may be associated with the general autoimmune process (anti-SSA/SSB antibodies) |
Moreno et al., 2020 [37] | Case–control | 36 | IL-6 expressed elevated levels in saliva of SS patients; this cytokine could be useful in the diagnosis and follow-up of SS patients |
Celenligil et al., 1998 [50] | Case–control | 17 | SS may affect bacterial colonization in dental biofilm and contribute to elevation of periodontitis risk |
Celenligil et al., 2003 [51] | Case–control | 18 | Inflammation causes increased proliferative activity, but this positive effect is downregulated by the reduced saliva flow in SS |
Scardina et al., 2010 [53] | Case–control | 25 | Evident alterations to the capillaries and typical conformation of the interdental papilla microcirculation in SS patients |
Singh et al., 2021 [55] | Case–control | 57 | Saliva is a major controlling factor for oral biofilm (impact of V. parvula in SS patients) |
Nayar et al., 2016 [52] | Experimental | / | The role of micro-RNA in modulating the development of SS offers plausible mechanisms for association with periodontitis |
No link between periodontitis and SS | |||
Ozcaka et al., 2018 [41] | Case–control | 44 | No significant difference in periodontal status and GCF levels of TNF-alpha and IFN-gamma between SS patients and controls |
Tervahartiala et al., 1995 [44] | Comparative | 8 | Periodontal pockets development is not affected by involvement of glandular tissue (lower collagenase and elastase activity in SS) |
Depinoy et al., 2021 [56] | Prospective cohort | 19 | Treatment with pilocarpine showed no improvement in periodontal parameters in SS patients |
Hsu et al., 2019 [57] | Prospective cohort | 487 | Pilocarpine may have no protective effect on dental caries and periodontitis in SS patients |
Reference | Type of Study | SS Group (No.) | Findings |
---|---|---|---|
Highlighted link between periodontitis and SS | |||
Chatzistavrianou et al., 2016 [77] | Review | / | The clinical advantages proved by implant prosthodontics outpace the slightly lower overall implant success rate in SS patients |
Fox et al., 1986 [65] | Review | / | Patients with SS present specific therapeutic problems: increased oral infections and periodontitis |
Albrecht et al., 2016 [80] | Observational cohort | 205 | Majority of SS patients were satisfied with dental implants and would recommend them to others |
Rhodus et al., 2005 [68] | Case–control | 10 | SS patients have significantly more gingival recession and GCF flow than healthy controls |
Ergun et al., 2010 [64] | Case–control | 37 | SS patients could have a higher risk for periodontitis |
Gambino et al., 2017 [82] | Randomized control trial | 22 | Gingival status of SS patients improved after non-surgical periodontal therapy, as well as salivary flow |
Lucchese et al., 2018 [59] | Clinical Trial | 52 | Significant decrease in biofilm deposits and gingival inflammation before and after dental care of SS patients |
Johansson et al., 2001 [85] | Clinical trial | 22 | Observed positive effects on symptoms in patients with SS after use of chlorhexidine |
Antoniazzi et al., 2009 [60] | Comparative | 19 | SS negatively affects the periodontal status and increased gingival inflammation in patients with SS |
Pedersen et al., 2002 [72] | Comparative | 20 | SS predisposes to more systemic disease, increased medication intake, and poor general health, risk factors for periodontitis |
Le Gall et al., 2016 [63] | Prospective | 31 | More severe periodontal conditions in SS patients than non-SS due to impaired salivary gland function and reduced buffer capacity |
Marton et al., 2008 [61] | Transversal | / | Increased biofilm deposits and gingival bleeding in a hyposalivation scenario |
Weinlander et al., 2010 [79] | Retrospective | 5 | Major peri-implant soft tissue alterations in patients with SS |
Jadhav et al., 2015 [83] | Case report | / | Need for symptomatic treatment in SS patients to prevent periodontal disease |
Lins et al., 2014 [84] | Case report | / | Appropriate dental care in SS patients may prevent periodontitis, improving the patient’s quality of life |
No link between periodontitis and SS | |||
Wu et al., 2021 [62] | Meta-analysis | 198 | Clinical attachment loss and pocket depth were similar in SS patients and healthy controls; need for well-designed observational studies |
Maarse et al., 2019 [74] | Meta-analysis | / | No evidence of a higher periodontitis risk in patients with SS |
Bolstad et al., 2016 [76] | Review | / | SS does not seem to contribute to more periodontal disease than in healthy persons |
Goubis et al., 2016 [78] | Review | / | Implant therapy is advisable and offers acceptable success rates in SS patients |
Napenas et al., 2014 [66] | Review | / | No increase in incidence and severity of periodontitis in SS patients; no consistent relationship between saliva flow and periodontitis |
De Goes-Soares et al., 2018 [58] | Review | 518 | No strong evidence that the periodontal status is influenced by SS |
Ambrosio et al., 2017 [81] | Longitudinal prospective | 28 | SS patients have similar periodontal status to controls at baseline and after non-surgical periodontal therapy |
Pedersen et al., 2005 [73] | Case–control | 20 | Presence of periodontal disease is not substantially increased in SS patients |
Ravald et al., 1998 [71] | Case–control | 21 | The periodontal conditions are similar in SS patients to those found in the general population |
Tseng et al., 1991 [75] | Comparative | 14 | SS has no observable influence on the assessed periodontal indexes |
Kuru et al., 2002 [70] | Comparative | 18 | Periodontal status does not differ significantly between SS patients and age–gender-matched controls |
Jorkjund et al., 2003 [69] | Case–control | 33 | SS patients are not specifically at risk of periodontitis |
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Gheorghe, D.N.; Popescu, D.M.; Dinescu, S.C.; Silaghi, M.; Surlin, P.; Ciurea, P.L. Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review. Diagnostics 2023, 13, 1401. https://doi.org/10.3390/diagnostics13081401
Gheorghe DN, Popescu DM, Dinescu SC, Silaghi M, Surlin P, Ciurea PL. Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review. Diagnostics. 2023; 13(8):1401. https://doi.org/10.3390/diagnostics13081401
Chicago/Turabian StyleGheorghe, Dorin Nicolae, Dora Maria Popescu, Stefan Cristian Dinescu, Margarita Silaghi, Petra Surlin, and Paulina Lucia Ciurea. 2023. "Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review" Diagnostics 13, no. 8: 1401. https://doi.org/10.3390/diagnostics13081401