Background/Purpose: In addition to xerostomia symptoms, patients with Sjögren’s syndrome (SS) experience pain and discomfort in the oral cavity, and difficulties in speaking and eating, due to refractory stomatitis, oral ulcer, glossitis, atrophy in the oral mucosa and tongue, and increased carious teeth. These dry mouth symptoms cause not only intraoral problems but also psychological and social problems; therefore, oral health-related quality of life (OHRQoL) is broadly deteriorated in SS patients. However, no previous reports have documented changes in OHRQoL evaluated over time in SS patients. In this study, we evaluated OHRQoL in SS patients and identified their specific troubles. Furthermore, we monitored OHRQoL over time in the same SS patients, and revealed changes in the troubles and the relationship with their clinical conditions.

Methods: Thirty-five SS patients (22 with primary SS and 13 with secondary SS; 32 women and 3 men; mean age, 56.2 ± 13.2 years; mean disease duration, 5.8 ± 3.7 years) and 23 non-SS (control) individuals (18 women and 5 men; mean age, 56.1 ± 17.4 years) participated in this study. All SS patients met the 2012 American College of Rheumatology classification criteria for SS. Individuals with factors affecting intraoral lesion formation, saliva secretion, or OHRQoL were excluded. OHRQoL was quantitatively evaluated with the Japanese version of shortened Oral Health Impact Profile (OHIP-14), which is a self-administered questionnaire (maximum possible score, 56 points). Saliva secretion was measured by the chewing gum test method. Twenty-two SS patients and 14 non-SS individuals completed 3-year follow-up, and underwent the OHIP-14 survey and saliva secretion measurement again three years after the first evaluation.

Results: The SS group had a significantly higher OHIP-14 score (i.e., lower OHRQoL) than the non-SS group (11.3 ± 9.4 vs 7.1 ± 7.6; p=0.027). The high-score SS group was significantly more advanced in age (61.5 ± 10.4 vs 52.7 ± 14.0; p=0.026) and had a significantly smaller amount of saliva secretion (6.9 ± 4.2 vs 9.3 ± 4.4 ml/ 10min; p=0.047) compared to the low-score SS group. Among individual items in OHIP-14, scores for “Trouble pronouncing words,” “Uncomfortable to eat,” “Self-conscious,” and “Diet unsatisfactory” were significantly higher in the SS group than in the non-SS group. In the SS group, the OHIP-14 score significantly increased over 3 years (10.2 ± 8.8 vs 12.6 ± 9.2; p=0.040), while the score remained unchanged in the non-SS group. A negative correlation was found between the change rate of saliva secretion amount and the OHIP-14 score change over 3 years in the SS group (r_s=−0.418, p=0.027). Among individual OHIP-14 items, scores for “Irritable with others,” “Difficulty doing jobs,” “Life unsatisfying,” and “Unable to function” significantly increased in 3 years, and scores for other items remained comparable with baseline scores.

Conclusion: In SS patients, a decrease in OHRQoL occurred over 3 years and was associated with a decrease in saliva secretion. Moreover, SS patients’ troubles in social life and mental aspect were found to intensify over time.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-changes-in-oral-health-related-quality-of-life-over-time-in-patients-with-sjogrens-syndrome/