Salivary Glands and Periodontal Changes in a Population of Sjögren's and Sicca Syndrome Treated by Pilocarpine: A Pilot Study

Dental needs in patients with Sjögren's disease compared to the general population: A cross-sectional study

OBJECTIVES

To describe the dental health status of patients with Sjögren's disease (SD), particularly as concerns care needs, coronal restoration quality, the prevalence of caries and wear lesions, relative to the general population from the RESTO DATA study.

MATERIALS AND METHODS

Thirty-eight patients with SD were recruited during specialist consultations at Brest University Hospital and Charles Foix Hospital in Paris between December 2020 and December 2021. A questionnaire was used to record data for dental risk factors. Dental health status was assessed with the DMF-T index, ICDAS score, and the BEWE coding system, and oral health-related quality of life was assessed with the OHIP-14. The Xerostomia Inventory was used to evaluate xerostomia symptoms. Unstimulated and stimulated salivary flows were measured, together with saliva pH and buffering capacity.

RESULTS

The SD patients had more visible heavy dental plaque on teeth, a high prevalence of non-cavitated carious lesions, a large number of restored teeth, a high prevalence of cervical lesions, secondary caries, restoration failure, and a high percentage of wear lesions, despite regular attendance and correct eating habits. In the SD population, the characteristics of carious and wear lesions and the status of restorations were influenced by salivary flows. The SD population had a significantly poorer oral quality of life.

CONCLUSIONS

These results confirm that SD is associated with oral health issues, with increases in the risks of carious lesions, wear lesions, and restoration failures. These findings could serve as early warning signs for oral healthcare professionals in the context of Sjögren's disease diagnosis.

Bidirectional two-sample Mendelian randomization study of atrial fibrillation and breast cancer

Background

Observational studies have shown an association between Breast Cancer (BC) and Atrial Fibrillation (AF). However, due to confounding factors and reverse causality, the causal role between BC and AF remains unclear. In this study, bidirectional two-sample Mendelian randomization (MR) combined with meta-analysis was used to evaluate the causal association between BC and AF.

Methods

Based on the Genome-Wide Association Studies (GWAS) summary data sets, the Inverse variance weighted (IVW) method was used as the main method, the weighted median method and MR-Egger method were used for Bidirectional Two-Sample Mendelian Randomization, and the Egger intercept test was used to detect horizontal pleiotropy. Heterogeneity was tested by Cochran's Q test, and sensitivity analysis was performed by "leave-one-out". GWAS data for AF and BC were obtained from three separate databases (FinnGen, UKBiobank, GWAScatalog) for European individuals. Finally, meta-analysis was performed on the MR Analysis results from different databases.

Results

The pooled IVW results showed no evidence of an effect of BC on the risk of AF (IVW: OR = 0.9994; 95% CI = 0.9967-1.0022). There was also no evidence of an effect of AF on BC risk (IVW: OR = 0.9970; 95% CI = 0.9154-1.0859).

Conclusion

The results of the Bidirectional Two-Sample Mendelian Randomization study show that there is no causal relationship between BC and AF.

Improvement of active salivary gland ultrasonography findings in Sjögren's syndrome in response to short-term glucocorticoid treatment: A case report and review of the literature

Salivary gland ultrasonography is a non-invasive imaging technique that helps in the diagnosis and assessment of disease activity in Sjögren's syndrome. However, it remains unclear whether the salivary gland ultrasonography findings are reversible in response to treatment. We present a case of a woman in her 20s who presented with parotid swelling and pain lasting for 3 months. The patient was diagnosed with anti-SS-A antibody-positive Sjögren's syndrome with active sialadenitis, and short-term glucocorticoid treatment resulted in resolution of clinical symptoms and improvement of salivary gland ultrasonography findings by the Outcome Measures in Rheumatology Clinical Trials scoring system. Notably, the anechoic/hypoechoic foci and vascular signals in the parotid and submandibular glands were reduced after treatment. Furthermore, peak systolic blood flow velocity of the facial artery entering the submandibular gland was decreased. Our case highlights that the findings of 'inflammatory' structural changes and vascularisation on salivary gland ultrasonography, including the Outcome Measures in Rheumatology Clinical Trials scoring system, reflect the disease active of Sjögren's syndrome and are reversible with treatment. Salivary gland ultrasonography has the potential to be a useful tool for monitoring treatment response and stratifying patients by disease activity in Sjögren's syndrome; therefore, further research is needed on the relationship of salivary gland ultrasonography findings with the pathophysiological mechanisms of sialadenitis and long-term clinical outcomes.

Association between Sjögren's Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review

In recent decades, researchers have investigated the bidirectional links between periodontal disease and systemic diseases, and the results have allowed the development of the concept of periodontal medicine. This concept incorporates and analyzes the mutually influential interactions that can occur between periodontitis and systemic diseases such as diabetes mellitus or cardiovascular diseases. Sjögren's syndrome (SS) is a chronic autoimmune disorder that targets the exocrine glands of the body, such as the lacrimal and salivary glands. The amount of saliva produced may gradually decrease with the progression of the disease, which can have an impact on the structures within the oral cavity. Although the reduction in saliva flow produces negative effects in the oral cavity, a direct association between Sjögren's syndrome and periodontal disease has not yet been demonstrated. Available studies on this topic have not identified significant differences in the periodontal status of patients with Sjögren's syndrome and control groups at the clinical and bacteriological levels. On the other hand, other studies on this topic consider that patients with periodontitis have a higher risk of developing Sjögren's syndrome than the general population. Therefore, the results remain inconclusive, highlighting the need for further complementary studies.

Efficacy of sofpironium bromide gel on clozapine-induced hypersalivation in patients with treatment-resistant schizophrenia: double-blind, controlled crossover study

BACKGROUND

Hypersalivation is a major side-effect of clozapine in patients with treatment-resistant schizophrenia.

AIMS

We investigated the efficacy of topical anticholinergic formulation sofpironium bromide gel for improving hypersalivation in patients with treatment-resistant schizophrenia receiving clozapine.

METHOD

A double-blind, controlled crossover study was conducted with sofpironium bromide gel and a placebo gel to treat clozapine-induced hypersalivation in 16 patients with treatment-resistant schizophrenia. Patients were randomly divided between groups A and B (each n = 8). Group A was treated with sofpironium bromide gel for 6 weeks, followed by a 2-week washout period and 6 weeks of placebo gel, after which they were observed for another 2 weeks. In contrast, group B was treated with placebo gel for 6 weeks, followed by a 2-week washout period, 6 weeks of sofpironium bromide gel and a 2-week observation period. One-minute saliva volume, objective salivation ratings (Drooling Severity and Frequency Scale and Nocturnal Hypersalivation Rating Scale) and subjective salivation ratings (Visual Analogue Scale) were assessed every 2 weeks.

RESULTS

All patients completed the trials. Three patients reported mild, spontaneously resolved skin itching. Compared with baseline values, the 1-min saliva volumes of both groups were significantly decreased by approximately 30% at the second week of sofpironium bromide gel treatment (P < 0.001), and significantly decreased by >40% at the fourth and sixth weeks of treatment (P < 0.001). The effects were maintained for over 2 weeks even after the treatment was discontinued.

CONCLUSIONS

We suggest that sofpironium bromide gel is effective in treating clozapine-induced hypersalivation in patients with treatment-resistant schizophrenia.

Treatment of Sjögren's Syndrome with Mesenchymal Stem Cells: A Systematic Review

Mesenchymal stem cells (MSCs) are ubiquitous in the human body. Mesenchymal stem cells were initially isolated from bone marrow and later from other organs such as fatty tissues, umbilical cords, and gingiva. Their secretory capacities give them interesting immunomodulatory properties in cell therapy. Some studies have explored the use of MSCs to treat Sjögren's syndrome (SS), a chronic inflammatory autoimmune disease that mainly affects exocrine glands, including salivary and lacrimal glands, although current treatments are only palliative. This systematic review summarizes the current data about the application of MSCs in SS. Reports show improvements in salivary secretions and a decrease in lymphocytic infiltration in salivary glands in patients and mice with SS after intravenous or infra-peritoneal injections of MSCs. MSC injections led to a decrease in inflammatory cytokines and an increase in anti-inflammatory cytokines. However, the intrinsic mechanism of action of these MSCs currently remains unknown.