OMFS-0119Salivary gland diseasesSalivary GlandintermediateParotid and submandibular glands

Dry mouth and bilateral parotid enlargement

54-year-old female

Draft — educational study aid, pending faculty review.

§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)

Sjögren Syndrome — clinical image: Hyperbaric_Treatment_Sjogren's_Syndrome — Fig. 1Hyperbaric_Treatment_Sjogren's_Syndrome
“Hyperbaric Treatment Sjogren's Syndrome” · Intermedichbo · CC BY-SA 3.0 · Wikimedia Commons

Sjögren Syndrome — clinical image: Secondary Raynaud's in Sjögren's syndrome — 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

Sjogren syndromeDry eyes and mouth, autoantibodies, focal lymphocytic sialadenitis

SialosisPainless enlargement with alcoholism, diabetes, bulimia; no dryness

IgG4-related diseaseRaised serum IgG4, storiform fibrosis

Drug-induced xerostomiaTemporal relation to a xerogenic drug

§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.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L2 · Guideline — 1
L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

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Current Classification