Dry mouth and bilateral parotid enlargement
54-year-old female
§Chief complaint
Persistent dry mouth and gritty eyes for 2 years
§Medical & dental history
- 01Rheumatoid arthritis on methotrexate
- 02No radiotherapy, no anticholinergic drugs
- 03Rampant cervical caries despite good brushing
- 04Difficulty wearing a denture
§Clinical examination
- 01Bilateral diffuse, non-tender parotid enlargement
- 02Dry, lobulated, erythematous tongue; mirror sticks to the mucosa
- 03Frothy saliva, minimal pooling in the floor of mouth
- 04Cervical caries on multiple teeth; oral candidiasis present
§ figuresFigures (4)
Fig. 1Hyperbaric_Treatment_Sjogren's_Syndrome
“Hyperbaric Treatment Sjogren's Syndrome” · Intermedichbo · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2Secondary Raynaud's in Sjögren's syndrome
“Secondary Raynaud's in Sjögren's syndrome 2” · Intermedichbo · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Sjögren Syndrome figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Primary Sjogren syndrome with secondary caries and candidiasis
Objective dryness with positive anti-Ro/SSA and focal lymphocytic sialadenitis on labial gland biopsy meets classification criteria. Sialosis and drug-induced dryness lack autoantibodies and focus scores.
§Investigations
- 01Unstimulated whole salivary flow — 0.06 mL/min (reduced)
- 02Schirmer test positive; ocular staining score raised
- 03Anti-Ro/SSA and anti-La/SSB positive, ANA positive, raised ESR
- 04Labial minor salivary gland biopsy — focus score 2 per 4 mm2
- 05Ultrasound of major glands showing heterogeneity
§Treatment plan
- 01Saliva substitutes and frequent sips of water; pilocarpine if tolerated
- 02Topical high-fluoride toothpaste, 3-monthly recall, dietary advice
- 03Antifungal treatment for candidiasis
- 04Rheumatology co-management; lymphoma surveillance
§Follow-up & outcome
- 01Caries rate controlled at 12 months on high-fluoride regimen
- 02Annual gland examination; persistent unilateral hard swelling would prompt lymphoma workup
§Clinical pearls / learning points
- 01Sjogren carries a markedly increased risk of MALT lymphoma — a persistently enlarged single gland needs imaging and biopsy.
- 02Xerostomia is the symptom; hyposalivation is the sign. Measure flow.
- 03Prevention beats restoration: these patients need the most intensive caries prevention available.
§References
- Shiboski CH et al. 2016 ACR/EULAR classification criteria for primary Sjogren syndrome.
§Similar cases
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