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The signs and symptoms of Sjogren's syndrome may be grouped as follows:

• Oral manifestations
• Ocular manifestations
• Systemic manifestations

Oral Manifestations

The major oral manifestation of Sjogren's syndrome is dry mouth (xerostomia) resulting in a parched, dry sensation in the mouth and throat. It has been reported that approximately 94% of patients with Sjogren's syndrome experience dry mouth.

Swallowing flushes out the mouth by clearing the oral cavity of saliva, food debris and microorganisms. When this process is interrupted, as occurs in Sjogren's syndrome, there is an increase in many types of microorganisms in the mouth which lead to dental caries (cavities), periodontal disease, and infection.

The mouth may appear moist in the early stages of Sjogren's syndrome, but as the disease progresses, the dryness becomes more pronounced as saliva ceases to pool at the bottom of the mouth and extreme dryness sets in. This may cause the tongue to stick to the roof of the mouth and as a result affects speech clarity and/or may cause a clicking dimension to speech.

Other oral manifestations of the disorder may include:

• Tongue

  • Dry, red, or painful tongue (glossodynia)
  • Ulcers on the tongue
  • Taste buds do not function properly
  • Tongue adheres to palate affecting speaking and eating

• Eating function

  • Difficulty chewing and swallowing food, especially dry, crumbly foods such as crackers
  • Changes in the ability to taste food (dysgeusia)
  • Food adheres to dental surfaces

• Oral mucosa

  • Fungal infections such as chronic erythematous candidiasis (causes red patches and thinning of mucosa on the palate and inner lining of the cheeks and lips) may affect up to 30% of patients
  • Cracked lips with fissures (cheilitis)
  • Angular cheilitis - a painful cracking and soreness that develops at the corners of the mouth
  • Fissures of the inner tissue lining the mouth and cheek

• Oral cavity

  • Severe dryness
  • Burning or tingling sensation in the mouth or soreness
  • Unpleasant taste in the mouth
  • Halitosis (bad breath)
  • Tooth decay - first appears at the margins with the gums and then progresses further into the mouth. This affects about 70% of Sjogren's patients.
  • Cavities
  • Difficulty anchoring dentures in the gums
  • Gum sores due to dentures
  • Voice alterations such as hoarseness, coarse voice

• Swelling of the salivary glands (particularly the parotid gland) - this occurs in approximately one third of patients with primary Sjogren's syndrome. It may begin on one side only and then develop into bilateral swelling. The enlargement may be chronic or episodic and leads to loss of function of the gland which results in a further decrease of salivary production and flow rates.

Ocular Manifestations

The most common ocular (eye) feature of Sjogren's syndrome is dry eye, also known as xerophthalmia and keratoconjunctivitis sicca. Approximately 65% of patients diagnosed with Sjogren's syndrome complain of dry eyes.

Other ocular manifestations of Sjogren's syndrome include:

• Redness, soreness, burning, or itching
• Foreign body sensation in eyes - sometimes described by patients as "grains of sand in eyes"
• Difficulty tolerating contact lenses
• Photophobia - avoidance of light
• Eye fatigue - particularly when reading or watching television