Background/Purpose: Salivary dysfunction in Sjögren’s (SS) can lead to serious and costly oral complications including accelerated caries and, in some cases, loss of dentition. Clinical Practice Guidelines for oral disease management were developed to improve the quality and consistency of care.  

Methods: Following the principles of AGREE as well as ACR and ADA recommendations for guidelines development, a national panel of oral medicine experts with representation from other specialties convened to define clinically significant oral care issues for guidelines recommendations. Clinical questions were developed in a PICO (Population, Intervention, Comparison and Outcomes) format for the first overarching topic in oral management of Caries Prevention and included use of fluoride, antimicrobials, salivary stimulants, and non-fluoride remineralizing agents. A systematic literature search was conducted on articles from January 1991 to April, 2015 selected according to pre-established parameters. Data were extracted by at least two members and evidence rated by the full group. Evidence grading and strength of the recommendations were based on a variation of GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Recommendations were finalized following a Delphi consensus panel process involving at least 40 dentists and dental hygienists from academia and community-based practice and other healthcare professionals with a minimum of 75% agreement required for consensus. Revision of guidelines that failed to achieve consensus was permitted up to 3 rounds before the recommendation was discarded.

Results: Final recommendations include: 1) Topical fluoride SHOULD BE USED in all Sjögren’s patients with dry mouth (Strong); 2) Chlorhexidine administered by varnish, gel or rinse MAY BE CONSIDERED in SS patients with dry mouth and high root caries rate (Weak); 3) While no studies link improved salivary flow to caries prevention, it is generally accepted by the oral health community that increasing saliva may contribute to decreased caries incidence. Therefore, in SS patients with dry mouth, increasing saliva through gustatory, masticatory or pharmaceutical stimulation (e.g. sugar-free lozenges or chewing gum, pilocarpine or cevimeline) MAY BE CONSIDERED (Weak); and 4) Non-fluoride remineralizing agents MAY BE CONSIDERED as an adjunct therapy in Sjögren’s patients with dry mouth and a high root caries rate. (Moderate).

Conclusion: The incidence of caries in SS patients can be lessened with the use of topical fluoride and other preventative strategies. Development of guidelines for caries management, restoration and oral mucosal management are currently in progress.

The Sjögren’s Syndrome Foundation (SSF) Clinical Practice Guidelines are fully supported by the SSF with no pharmaceutical support.  No compensation was paid to any author. All participating authors completed Conflict of Interest forms of the American College of Rheumatology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sjgrens-syndrome-foundation-clinical-practice-guidelines-for-oral-disease-management-caries-prevention/