ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2545

Risk of Cervical Root and Incisal Caries in Patients with Sjogren’s Syndrome

Nicola Berman1, Jonathan S. Dunham2, Joshua Baker3 and Frederick B. Vivino4, 1Medicine, Pennsylvania Hospital, Philadelphia, PA, 2Rheumatology, Univ of Pennsylvania, Philadelphia, PA, 3Medicine/Rheumatology, Philadelphia VA Medical Center, Philadelphia, PA, 4Medicine, Penn Presbyt Med Ctr, Philadelphia, PA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Sjogren's Syndrome: Clinical Science

Session Type: Abstract Submissions (ACR)

Risk of Cervical Root and Incisal Caries in Patients with Sjogren’s Syndrome

Background/Purpose

Pathologic (cervical root and incisal caries) cause significant morbidity in patients with Sjogren’s syndrome (SS). Identifying risk factors for pathologic caries may facilitate prevention strategies for dental complications in this population. We assessed whether primary (pSS) and secondary Sjogren’s syndrome (sSS) were associated with an increased risk of pathologic caries compared with subjects with non-Sjogren’s related xerostomia. We also evaluated risk factors for pathologic caries amongst SS patients with and without dental complications.

Methods

We retrospectively reviewed medical records of 225 consecutive patients with sicca symptoms who were evaluated at the Penn Sjogren’s center.  Subjects underwent complete physical examination, minor salivary gland biopsies, objective tests for dry eyes/dry mouth, serologic testing, and Technetium99 pertechnetate salivary scintigraphy. Prevalence of pathologic caries was determined by retrospective review of dental records. SS patients were diagnosed based on 2002 AECG Criteria.  Subjects with Sjogren’s syndrome (pSS and sSS) were compared to non-Sjogrens subjects (nSS).  Patients who did not meet criteria included those with chronic sialadenitis, sclerosing chronic sialadenitis, non-specific chronic inflammation, undifferentiated connective tissue disease, or medication-induced xerostomia. We used t-tests, Wilcoxon rank sum tests and chi-squared tests to evaluate group differences. We further evaluated independent associations with pathologic caries using parsimonious multivariable logistic regression models.

Results

Compared with nSS, patients with SS were more likely to have pathological caries (57.7% vs 42.1%, p=0.02), abnormal scintigraphy (63.8% vs 38.6, p=0.02), and lower median  unstimulated flow rates [0.46 (0.24, 1.06) vs 0.85 (0.30, 1.49) p=0.005]. There was no difference in stimulated salivary flow rates between the groups (Table 1).  In multivariable logistic regression models adjusting for age and differences in unstimulated salivary flow, SS was associated with increased odds of pathologic caries [OR 1.81 (1.06, 3.12) p=0.03]. Among SS patients, only greater age was significantly associated with a greater risk pathologic caries (p=0.03).

Conclusion

SS is associated with an increased risk of pathologic caries compared to other causes of dry mouth. SS patients had significantly reduced unstimulated salivary flow rates and abnormal salivary scintigraphy compared with nSS patients. However, differences in caries prevalence in SS patients were not explained by differences in flow rates.   Qualitative differences in saliva may be a more important cause of pathologic caries in SS than quantitative differences in flow. Further study is needed to optimize prevention strategies for caries in this group.

Table 1: Characteristics of subjects with and without Sjogren’s syndrome.
Sjogen’s Syndrome

 Non-Sjogrens

 P Value
Number of Subjects

 104

 121
Age                                            

53.8 (13.7)

 51.9 (13.2)

 0.3
Female

 86.4%

 90.7%

 0.3
Current Smoking

 5.8%

 5.0%

 0.8
Median Duration of Dry Mouth

 36 (12, 93)

 36 (14, 91)

 0.8
Median Duration of Dry Eye

48 (19.5, 117.5)

 48 (22, 111)

 0.8
SJOGREN’S TESTS
  ANA/RF+ Positive

 11.5%

 2.5%

 0.01
  SSB/SSB+ Positive

 65.4%

 15.7%

 <0.001
  Schirmer <5mm/5min

41.4%

 38.8%

 0.7
  Focus Score

0.9 (0, 2.0)

 0 (0, 0)

 <0.001
DRUG USE
  Anticholinergic drugs 

 51.9%

 57.0

 0.4
  Cholinomimetic drugs

 22.1%

 19.0%

 0.6
DENTAL OUTCOMES
  Median number of pathologic caries

 0 (0, 2)

 0 (0, 0)

 0.002
  Any pathologic caries (%)

 57.7%

 42.1%

 0.02
  Presence of Dentures (%)

 10.6%

 9.1%

 0.7
  Patients with Missing Teeth (%)

 59.6%

 47.1%

 0.06
 SALIVARY FLOW
  Median Unstimulated SFR (mL/min)

 0.46 (0.24, 1.06)

 0.85 (0.30, 1.49)

 0.005
  Abnormal USFR*

 12.5%

 9.1%

 0.4
  Median Stimulated SFR

 0 (0, 0)

 0 (0,0)

 0.1
  Abnormal Stimulated SFR**

 74.0%

 70%

 0.5
  Abnormal scintigraphy***  (N=90)                              

 63.8%

 38.6%

 0.02
Data presented as mean (standard deviation) or median (inter-quartile range) for skewed data.

*  Abnormal flow rate <0.1 mL/min defined as abnormal

** Abnormal stimulated flow rate defined as <0.150 ml/min *** Defective uptake or resting/stimulated discharge

Disclosure:

N. Berman,
None;

J. S. Dunham,
None;

J. Baker,
None;

F. B. Vivino,

Andrea Cavitolo Foundation,

2,

NiCox Inc.,

5,

Immco, Inc.,

5,

Norartis, Inc.,

5,

Biogen Idec,

5,

Takeda, Inc,

5.

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