Study helps clinicians identify Sjögren’s syndrome

Iveta Ramonaite, Dental Tribune International

Fri. 1. September 2023

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Indianapolis, US: Sjögren’s syndrome is a chronic autoimmune disease that can affect the entire body including the teeth. Since diagnosing the disease can be challenging owing to its numerous symptoms which often overlap with those of other conditions, a recent study has linked the electronic health and dental records of patients with Sjögren’s syndrome. The study may help provide better care and outcomes for individuals with the condition and may have implications for other systemic autoimmune diseases.

According to information in the National Library of Medicine, between 400,000 and 3.1 million adults have Sjögren’s syndrome. The condition is frequently associated with other autoimmune disorders, including rheumatoid arthritis and systemic lupus erythematosus.

Since there is no single test for Sjögren’s syndrome, doctors typically ask about symptoms such as dry mouth, dry eyes, dental caries and fatigue and ask the patients to undergo a series of tests. According to the Sjögren’s Foundation, it takes approximately three years to diagnose the disease from the time the symptoms first appear, which is a regrettably long time to allow the disease to progress without treatment.

Since dental and medical care records are typically kept separate or medical records are not readily made available to dental providers, dental professionals often have no information on a patient’s medical background, including the presence of any diseases, and depend on their patients to communicate their diagnosis. Consequently, dentists usually identify the patient’s condition at a late stage in the progression of the disease, often coinciding with the appearance of caries.

Senior author Dr Thankam P. Thyvalikakath. (Image: Regenstrief Institute)

Using data from the Indiana Network for Patient Care, researchers at the Regenstrief Institute and the Indiana University School of Dentistry have recently linked electronic health and dental records of individuals with Sjögren’s syndrome. They found that fewer than one-third of the patients who were diagnosed by their physicians had informed their dental providers about the diagnosis, thus depriving their dental care providers of the chance to provide early treatment that could help preserve teeth.

Senior author Dr Thankam P. Thyvalikakath, the founding director of dental informatics at the Indiana University School of Dentistry and the Regenstrief Institute, explained that the motivation for undertaking the research stems from the significant oral health challenges faced by individuals with Sjögren’s syndrome, which often lead to premature tooth loss during the middle-age years.

“In spite of the fact that patients with Sjögren’s syndrome typically have a high level of awareness regarding their health, because they don’t inform their dentist, they end up losing their teeth, which can have a huge impact on their quality of life. They may be unable to hold full-time jobs because they have a lot of dental decay and have missing or damaged teeth. Without the information from the patient’s electronic medical record, dentists don’t have a complete picture and don’t know [how] to evaluate treatment which could preserve teeth,” she explained.

“We believe the methods we developed in this study and our results can lead to more large-scale studies to understand the disease over time, which may have the potential to topple silos and for earlier diagnosis than the current three-year lag and for earlier treatment,” she added. “We are thinking beyond dentistry. We are thinking about an inclusive healthcare system, not one in which dentistry, like mental health, is considered a stepchild.”

“We are thinking about an inclusive healthcare system, not one in which dentistry, like mental health, is considered a stepchild”—Dr Thankam P. Thyvalikakath, Regenstrief Institute

“Dentists see many patients, especially women, with non-specific symptoms, like joint pain and fatigue, but it’s very difficult for a dental professional to know about their patient’s complete list of medical conditions,” said lead author Dr Grace Gomez Felix Gomez, assistant research professor at the Indiana University School of Dentistry. She suggested that, if the patient who has not been diagnosed with Sjögren’s mentioned symptoms such as dry mouth, the dental professional could do some preliminary salivary flow tests to help identify the cause. If the patient has Sjögren’s syndrome, the dental professional could then refer the patient to a rheumatologist or other medical specialist to rule out underlying conditions, she suggested, and refer the patient to oral medicine or oral pathology specialists to further confirm the diagnosis.

“Unfortunately, Medicare and many health insurances do not pay for tests and treatments performed in dental offices, which makes working together with physicians more difficult for oral health providers. Screening and awareness of Sjögren’s and its symptoms should be spread through educational programmes targeting women to encourage them to talk to both medical and dental clinicians,” Dr Gomez commented.

The study, titled “Characterizing clinical findings of Sjögren’s disease patients in community practices using matched electronic dental-health record data”, was published on 31 July 2023 in PLOS One.