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Patient with tongue complaints related to Sjogren's. So called "Sjogren's tongue" is related to chronic dry mouth.

Sjogren’s Tongue? Understanding Tongue Problems in Sjogren’s Patients

Are the terms “Sjogren’s tongue” or “burning mouth syndrome” familiar? You may have heard or used these phrases when counseling patients dealing with Sjogren’s. An autoimmune disease, Sjogren’s causes a range of oral complications. So, what conditions do these terms describe and how do they affect our patients.

Sjogren’s Tongue: A Collective of Symptoms

While not a medical term or diagnosis, the phrase “Sjogren’s tongue” may be used by suffers to describe general tongue discomfort, often in conjunction with severe dry mouth. The appearance of the tongue may be dry, cracked, red, swollen, and raw. A white appearance may indicate the potential presence of a fungal infection. Consistent dryness of the oral cavity may in turn cause inflamed taste buds and more general inflammation of the tongue. Over time, Sjogren’s syndrome can cause taste disorders including hypogeusia (diminished taste), dysgeusia (altered taste), or ageusia (a complete loss of taste). It is also not uncommon for Sjogren’s sufferers to deal with aphthous ulcers on the tongue (e.g., canker sores). Finally, many Sjogren’s patients report an overall tingling or general burning of the tongue and, or mouth. A combination of these afflictions and sensations are what many patients refer to as “Sjogren’s tongue”.  While the term itself may not be a specific clinical diagnosis, the condition is painful and can often be alleviated with treatment.

Burning Mouth Syndrome and Sjogren’s

Another common diagnosis made for patients suffering from Sjogren’s is burning mouth syndrome (alternatively burning tongue). Burning mouth syndrome (BMS) is defined as ongoing or recurrent burning in the mouth with no obvious reason. This condition is also called glossodynia. Burning mouth may affect more than the tongue; other parts of the mouth may be affected as well, including the lips, the inside of the cheeks, and the palate. When the condition can’t be attributed to another underlying medical problem, burning mouth is referred to as primary BMS. When the origin of burning mouth has an identifiable cause like Sjogren’s Syndrome, it is classified as secondary BMS. Other medical conditions which can lead to secondary BMS include diabetes, thyroid disease, medications, radiation therapy and nutritional deficiencies. Interestingly, chronic dry mouth itself (xerostomia), is cited on the Mayo Clinic website as a cause of secondary BMS. Perhaps burning mouth is linked to so many underlying medical conditions precisely because xerostomia is a prominent symptom of those same conditions.

Xerostomia Tongue? Dry Mouth Treatment as a Common Denominator

What should we look to when we are presenting options for patients to relieve pain and discomfort from “Sjogren’s tongue”, or burning mouth? I believe it stands to reason that addressing xerostomia, may relieve the discomfort of burning mouth regardless of the fundamental cause. Perhaps we should coin a new term, “xerostomia tongue”, which might be more useful in defining our protocols to help the broadest population of patients, including those with Sjogren’s. Whether the underlying condition remains a mystery, is chronic (like Sjogren’s), or is permanent as is sometimes the case after radiation or surgery for head and neck cancer, a generalized mindset to treat xerostomia may cut to the chase in offering relief.

As a hygienist and an educator on xerostomia protocols, I believe we have an obligation to our patients to understand these conditions and what is available out there to provide relief.  As a person dealing with my own Sjogren’s condition, and the oral complications that come with it, I know firsthand that replenishing moisture to the oral cavity can be a game changer. It not only relieves discomfort, and prevents or delays dental complications, but it also greatly improves overall quality of life when issues like eating, drinking, or speaking are compromised.

Providing Support and Discussion Options

 Setting expectations is the starting point for helping Sjogren’s suffers with their oral health issues. As clinicians, we need to impress upon these patients, that beyond xerostomia, they have an elevated risk of complications such as root and incisal caries. This realization sets the stage for more frequent recall appointments. Patient’s with Sjogren’s also need to understand that finding an effective home care regimen is important not only to relieve the uncomfortable symptoms they’re having today, but also to prevent further dental issues down the road.  We need to counsel them that finding what works best for them will be a process. They should know that one product or device alone may not completely resolve all symptoms – the goal is lessening discomfort with a combination of treatments if necessary. Dealing with what is often a chronic and episodic condition can be frustrating, so setting expectations properly improves compliance and positions patients for success over the long haul.

When it comes to recommending the best products for treating xerostomia, in my experience there is no one thing that works for everyone, all the time. Options that exist currently come in various forms including gum, sprays, gels, and lozenges. While there are many good OTC products, some of the brands that I’ve found most effective personally are listed below:

  • Elevate’s AllDay Spray
  • XyliMelts
  • Any sugar free gum with Xylitol
  • FluoriMax 5000 Toothpaste with Xylitol
  • GC America’s MIPaste

I use prescription strength toothpaste morning and night day and night.

Most recently I have added Voutia to my arsenal. Voutia is great because I can wear it 24/7 and still use my XyliMelts for the Xylitol exposure. Voutia provides all day moisture which helps with comfort and is a great adjunct therapy to my regular routine. It is particularly helpful because I can wear it when exercising, especially for outdoor things like walking.

Tongue-Tied No Longer

When that patient in your chair presents with symptoms or complaints consistent with Sjogren’s tongue or burning mouth syndrome be ready to respond. Educate and set expectations first. Introduce them to your xerostomia treatment protocol and advise on available products. Your intervention and advice will put them on the path to finding near-term relief, and better oral health in the long run.

If you would like more information on xerostomia treatment protocols, product solutions for treating dry mouth, or providing better oral health and support for Sjogren’s patients please feel free to reach out to me at brookecrouchdentalconsulting@gmail.com or follow me at Brooke Crouch, RDH on LinkedIn or visit my website at brookecrouchrdh.com