Introduction to Sjogren's Syndrome

Dry Mouth in Sjogren's Syndrome

Three pairs of bilateral salivary glands (one pair on each side of the face) are responsible for the production of 90% of the approximately 1.5 liters of saliva that we produce daily. These glands are:

  • Parotid glands - these glands are located in front of the ears and extend downward to beneath the earlobes along the border of the lower jaw. They produce up to 70% of the saliva as a result of stimulation (i.e., chewing or eating). This is known as stimulated saliva.
  • Submandibular glands (also called submaxillary) - walnut sized glands located under the lower jaw. These glands produce up to 80% of the saliva at rest, also called unstimulated saliva.
  • Sublingual glands - these glands are located beneath the floor of the tongue and also contribute to saliva production.

There are also many tiny salivary glands located in the lips, inner cheek area, and other linings in the mouth and throat that produce the remaining 10% of our saliva.

Role of Saliva

Normal salivary function originates in specialized glandular cells called muscarinic M3 receptor cells and when they are stimulated, saliva is produced. Saliva is a clear watery fluid which is slightly viscous and originates in the salivary glands. The primary component is water (up to 98%) and the remainder is a combination of enzymes, proteins, antibodies, and other substances which perform many important functions including:

  • Cleansing and lubricating the oral cavity
  • Initiating the breakdown of food for digestion
  • Facilitating eating (chewing, swallowing)
  • Improving taste
  • Removing food debris from the mouth
  • Preventing growth and development of viral, bacterial, and fungal infection (anti-microbial protection)
  • Controlling the pH level in the mouth (level of acid)
  • Facilitating speech
  • Protecting the health of the tongue

Patients with Sjogren's syndrome who suffer from dry mouth may have several oral-related problems, including:

  • Cavities
  • Periodontal (gum) disease
  • Oral infections
  • Weakened jaw bone and resulting tooth loss
  • Difficulty with articulation of words (tongue may stick to roof of mouth)
  • Chewing and swallowing
  • Halitosis (bad breath)
  • Constant sore throat
  • Hoarseness
  • Burning sensation in the mouth
  • Dry nasal passages
  • Frequent oral infections, especially candidiasis