Xerostomia secondary to Sjogren's syndrome in the elderly - Recognition and management

Xerostomia is a common symptom in the elderly population. Studies have suggested that the underlying cause of approximately 40% of xerostomia in the elderly is Sjogren's syndrome. Although it is highly prevalent among middle-aged individuals, elderly patients account for up to 20% of Sjogren's syndrome cases. Sjogren's syndrome is a multisystem exocrinopathy characterised by dry mouth and dry eyes with wide-ranging extraglandular involvement. The exocrine manifestations of Sjogren's syndrome affect the mouth, eyes, nose, ears, skin, vagina and the entire respiratory and gastrointestinal systems. The nonexocrine involvement may include the joints, thyroid gland, liver, kidneys and the musculoskeletal, vascular and central nervous systems. Currently, the mechanism(s) of development and progression of Sjogren s syndrome is/are not clear. Inflammation and lymphocytic infiltration of the exocrine glands is a classical feature of Sjogren's syndrome. During the progression of the disease, the acinar cells of the exocrine glands are replaced by fibrosis rendering the lands nonfunctional Sjogren's syndrome remains one of the most underdiagnosed conditions, particularly in the elderly population, because the cardinal sicca symptoms, which are the hallmark of the disease, are frequently attributed to aging and/or medications, which consequently delays the diagnosis. This delay in diagnosis imposes significant physical, psychological and economic burdens on elderly patients. The diagnosis of Sjogren's syndrome requires evaluation of both the exocrine and nonexocrine components of the disease. Management of Sjogren's syndrome requires collaboration by the primary-care physician, rheumatologist, ophthalmologist and dentist. This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjogren's syndrome with special emphasis on the oral component of the disease.