Dental perspective on Sjögren’s syndrome: literature review

  • Jesús Israel Rodríguez Facultad de Odontología, Universidad Autónoma de Nuevo León.
  • Gloria Martínez Facultad de Odontología, Universidad Autónoma de Nuevo León.
  • Norma Idalia Rodríguez Facultad de Odontología, Universidad Autónoma de Nuevo León.
  • María Gabriela Achapa Facultad de Odontología, Universidad Autónoma de Nuevo León.
  • Juan Manuel Solis Facultad de Odontología, Universidad Autónoma de Nuevo León.


The human releases around 500-600 mL saliva daily, however the values ​​found from 0.1 to 0.2 mL / min of resting saliva a condition called Hyposalivation or hyposialia is presented, which can be expressed by a large number of conditions systemic, including Sjögren's syndrome, which is a chronic autoimmune disease present at between 0.1 and 3% of the world population and is characterized by salivary glands exocrinopathy leading to the glandular hypofunction and thus decreasing the normal salivary flow. Saliva is part of innate immunity, when appearing a decrease in protein secretion, are triggered a numerous oral manifestations, such as dental caries, candidiasis, gingival disease, angular cheilitis, lymphomas of the salivary glands, dysphagia, erythematous and fissured tongue, among others. Currently there is no defined dental treatment, however there are alternative treatments by sialogogues and salivary substitutes, plus non-pharmacological therapies, which seek to maintain the ecology and oral conditions stable, in addition to preventive and restorative dental treatment for injuries already established as a consequence of the disease. The aim of this study is to perform a review of literature on the characteristics, classification, oral manifestations and the dental management of Sjögren’s syndrome.


1. Yoshimoto K, Fujimoto T, Itaya A, Miyaoka T, Sakuramoto S, Yamauchi A, Takeda M, Kasai T, Nakagawara K, Nonomura A, Takasawa S. Involvement of autoimmunity to REG, a regeneration factor, in patients with primary Sjögren’s syndrome. Clin Exp Immunol. 2013;174(1):1–9.
2. Aframian D, Helcer M, Livni D, Robinson S, Markitziu A, Nadler C. Pilocarpine treatment in a mixed cohort of xerostomic patients. Oral Dis. 2007;13(1):88–92.
3. Hopcraft M, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010;55(3):238–44.
4. Napeñas JJ, Brennan MT, Fox PC. Diagnosis and treatment of xerostomia (dry mouth). Odontology 2009;97(2):76–83.
5. Guiñales J, Martorell V, Sanchez R, del Castillo JL, Burgueño M. Síndrome de Sjögren: criterios diagnósticos mediante resonancia magnética. Rev Esp Cir Oral Maxilofac. 2012;34(4):186–7.
6. Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska K. Sjögren’s syndrome: still not fully understood disease. Rheumatol Int. 2015;35(2):233-41.
7. Goldblatt F, O’Neill SG. Clinical aspects of autoimmune rheumatic diseases. Lancet 2013;382(9894):797–808.
8. González S, Sung H, Sepúlveda D, González M, Molina C. Oral manifestations and their treatment in Sjögren′s syndrome. Oral Dis. 2014;20(2):153–61.
9. Mathews SA, Kurien BT, Scofield RH. Oral manifestations of Sjögren’s syndrome. J Dent Res. 2008;87(4):308–18.
10. Shahane A, Patel R. The epidemiology of Sjögren's syndrome. Clin Epidemiol. 2014;6(1):247-255.
11. Manoussakis MN, Georgopoulou C, Zintzaras E, Spyropoulou M, Stavropoulou A, Skopouli FN, Moutsopoulos HM. Sjögren’s syndrome associated with systemic lupus erythematosus: Clinical and laboratory profiles and comparison with primary Sjögren’s syndrome. Arthritis Rheum. 2004;50(3):882–91.
12. Isenberg DA. Systemic lupus erythematosus and Sjögren’s syndrome: Historical perspective and ongoing concerns. Arthritis Rheum. 2004;50(3):681–3.
13. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554–8.
14. De Azevedo BB, Bussoloti I. Evaluation of sialometry and minor salivary gland biopsy in classification of Sjögren’s Syndrome patients. Braz J Otorhinolaryngol. 2005;71(3):346–54.
15. Delaleu N, Immervoll H, Cornelius J, Jonsson R. Biomarker profiles in serum and saliva of experimental Sjogren’s syndrome: associations with specific autoimmune manifestations. Arthritis Res Ther. 2008;10(1):1-14.
16. Baldini C, Giusti L, Bazzichi L, Lucacchini A, Bombardieri S. Proteomic analysis of the saliva: A clue for understanding primary from secondary Sjögren’s syndrome? Autoimmun Rev. 2008;7(3):185–91.
17. Avouac J, Sordet C, Depinay C, Ardizonne M, Vacher MC, Sibilia J, Kahan A, Allanore Y. Systemic sclerosis–associated Sjögren’s syndrome and relationship to the limited cutaneous subtype: Results of a prospective study of sicca syndrome in 133 consecutive patients. Arthritis Rheum. 2006;54(7):2243–9.
18. Bikker A, van Woerkom JM, Kruize AA, Wenting M, de Jager W, Bijlsma JW, Lafeber FP, van Roon JA. Increased expression of interleukin-7 in labial salivary glands of patients with primary Sjögren’s syndrome correlates with increased inflammation. Arthritis Rheum. 2010;62(4):969–77.
19. Delaleu N, Jonsson R, Koller MM. Sjögren’s syndrome. Eur J Oral Sci. 2005;113(2):101–13.
20. Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia and salivary gland hypofunction. J Am Dent Assoc. 2014;145(8):867–73.
21. Samarawickrama D. Saliva substitutes: how effective and safe are they?. Oral Dis. 2002;8(4):177–9.
22. Anil S, Vellappally S, Hashem M, Preethanath RS, Patil S, Samaranayake LP. Xerostomia in geriatric patients: a burgeoning global concern. J Investig Clin Dent. 2014;5(2014):1–8.
23. Deepak D, Gopakumar R. Xerostomia, its Association with Oral Manifestation and Ocular Involvement: A Clinical and Biochemical Study. J Indian Acad Oral Med Radiol. 2011;23(4):513–7.
24. Kho H, Park M, Chang J, Kim Y. Yam tuber mucilage as a candidate substance for saliva substitute: in vitro study of its viscosity and influences on lysozyme and peroxidase activities. Gerodontology 2014;31(1):34–41.
25. Kuru B, McCullough MJ, Yilmaz S, Porter SR. Clinical and microbiological studies of periodontal disease in Sjögren’s syndrome patients. J Clin Periodontol. 2002;29(2):92–91.
26. Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV. Periodontal Conditions of Individuals With Sjögren’s Syndrome. J Periodontol. 2009;80(3):429–35.
27. Eveson JW. Xerostomia. Periodontol 2000. 2008;48(1):85–91.
28. Margaix M, Bagán JV, Poveda R, Jiménez Y, Sarrión G. Sjögren’s syndrome of the oral cavity. Review and update. Med Oral Patol Oral Cir Bucal 2009;14(7):325–30.
29. Vishwanath S, Everett S, Shen L, Malyavantham K, Suresh L, Ambrus JL. Xerophthalmia of Sjögren’s Syndrome Diagnosed with Anti-Salivary Gland Protein 1 Antibodies. Case Rep Ophthalmol. 2014;5(2):186–9.
30. Sood S, Anthony R, Pease C. Sjögren’s syndrome. Clin Otolaryngol. 2000;25(5):350–7.
31. Larrarte JPM, Pineda YR. Síndrome de Sjögren. Rev Cubana Med. 2010;49(2):61-76.
32. Van Stein D, Tan J, Bloemena E, van Vugt R, Voskuyl A, Santana N, van der Waal I. The role of a labial salivary gland biopsy in the diagnostic procedure for Sjogren s syndrome; a study of 94 cases. Med Oral Patol Oral Cir Bucal 2014;19(4):372–6.
33. Gyöngyösi M, Pokorny G, Jambrik Z, Kovacs L, Kovacs A, Makula E, Csanády M. Cardiac manifestations in primary Sjögren’s syndrome. Ann Rheum Dis. 1996;55(7):450–4.
34. Kittridge A, Routhouska SB, Korman NJ. Dermatologic manifestations of Sjögren syndrome. J Cutan Med Surg. 2011;15(1):8–14.
35. Elaine L. Alezander, Thomas T. Provost. Cutaneous manifestations of Primary Sjögren’s Syndrome: A Reflection of vasculitis and Association with Anti-RO(SSA) Antibodies. J Invest Dermatol. 1983;80(5):386–91.
36. Karnell JL, Mahmoud TI, Herbst R, Ettinger R. Discerning the kinetics of autoimmune manifestations in a model of Sjögren’s syndrome. Mol Immunol. 2014;62(2):277–82.
37. Hu S, Gao K, Pollard R, Arellano M, Zhou H, Zhang L, Elashoff D, Kallenberg CG, Vissink A, Wong DT. Preclinical validation of salivary biomarkers for primary Sjögren’s syndrome. Arthritis Care Res. 2010;62(11):1633–8.
38. Al-Hashimi DI. Xerostomia Secondary to Sjögren’s Syndrome in the Elderly. Drugs Aging. 2012;22(11):887–99.
39. Shiboski SC, Shiboski CH, Criswell LA, Baer AN, Challacombe S, Lanfranchi H, Schiødt M, Umehara H, Vivino F, Zhao Y, Dong Y, Greenspan D, Heidenreich AM, Helin P, Kirkham B, Kitagawa K, Larkin G, Li M, Lietman T, Lindegaard J, McNamara N, Sack K, Shirlaw P, Sugai S, Vollenweider C, Whitcher J, Wu A, Zhang S, Zhang W, Greenspan J, Daniels T. American College of Rheumatology classification criteria for Sjögren’s syndrome: A data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance Cohort. Arthritis Care Res. 2012;64(4):475–87.
40. Colella G, Cannavale R, Vicidomini A, Itro A. Salivary gland biopsy: a comprehensive review of techniques and related complications. Rheumatology 2010;49(11):2117–21.
41. Caporali R, Bonacci E, Epis O, Bobbio F, Morbini P, Montecucco C. Safety and usefulness of minor salivary gland biopsy: Retrospective analysis of 502 procedures performed at a single center. Arthritis Rheum. 2008;59(5):714–20.
42. Lida Santiago M, Seisdedos MR, García Salinas RN, Secco A, Marino Claverie L, Techera L, Takashima L, Aicardi P, Sandi MA, Knobel E. Frecuencia de complicaciones y rédito de la biopsia de glándula salival menor. Reumatol Clin. 2012;8(5):255–8.
43. Lawrence HP. Salivary markers of systemic disease: noninvasive diagnosis of disease and monitoring of general health. J Can Dent Assoc. 2002;68(3):170–5.
44. Issaq HJ, Veenstra TD. The role of electrophoresis in disease biomarker discovery. Electrophoresis. 2007;28(12):1980–8.
45. Loos BG, Tjoa S. Host-derived diagnostic markers for periodontitis: do they exist in gingival crevice fluid?. Periodontol 2000. 2005;39(1):53–72.
46. Giannobile WV, Beikler T, Kinney JS, Ramseier CA, Morelli T, Wong DT. Saliva as a diagnostic tool for periodontal disease: current state and future directions. Periodontol 2000. 2009;50(1):52–64.
47. Sreebny LM, Zhu WX. The use of whole saliva in the differential diagnosis of Sjögren’s syndrome. Adv Dent Res. 1996;10(1):17–24.
48. Taylor JJ. Protein Biomarkers of Periodontitis in Saliva. ISRN Inflamm. 2014; 2014(2014):1–18.
49. Younes R, Yousfi M, Ghorra C, Khalife S, Igondjo S, Willig C, Senni K, Charpiot P, Naaman N, Godeau G. The defensive role of lysozyme in human gingiva in inflammatory periodontal disease. J Periodontal Res. 2009;44(5):578–87.
50. Padma TP, Deepa MS, Nanda K. Salivary proteomic biomarkers in the diagnosis of periodontal diseases. Health Sci. 2014;1(3):1-15.
51. Riva A, Puxeddu P, Del Fiacco M, Testa F. Ultrastructural localization of endogenous peroxidase in human parotid and submandibular glands. J Anat. 1978;127(1):181-191.
52. Sang Goo Lee, Hyung Il Kim, Hong Seop Kho. Influences of peroxidase on lysozyme activity. Oral Med. 2008;33(1):1–8.
53. Murakami Y, Nagata H, Amano A, Takagaki M, Shizukuishi S, Tsunemitsu A, Aimoto S. Inhibitory effects of human salivary histatins and lysozyme on coaggregation between Porphyromonas gingivalis and Streptococcus mitis. Infect Immun. 1991;59(9):3284–6.
54. Löfgren CD, Wickström C, Sonesson M, Lagunas PT, Christersson C. A systematic review of methods to diagnose oral dryness and salivary gland function. BMC Oral Health. 2012;12(1):12-29.
55. Denny P, Hagen FK, Hardt M, Liao L, Yan W, Arellanno M, Bassillian S, Bedi GS, Boontheung P, Cociorva D, Delahunty CM, Denny T, Dunsmore J, Faull KF, Gilligan J, González M, Halgand F, Hall SC, Han X, Henson B, Hewel J, Hu S, Jeffrey S, Jiang J, Loo JA, Ogorzalek RR, Malamud D, Melvin JE, Miroshnychenko O, Navazesh M, Niles R, Park SK, Prakobphol A, Ramachadran P, Richert M, Robinson S, Sondej M, Souda P, Sullivan MA Takashima J, Than S, Wang J, Whitelegge JP, Witkowska HE, Wolinsky L, Xie Y, Xu T, Yu W, Ytterberg J, Wong DT, Yates JR, Fisher SJ. The Proteomes of Human Parotid and Submandibular/Sublingual Gland Salivas Collected as the Ductal Secretions. J Proteome Res. 2008;7(5):1994–2006.
56. Proctor GB, Carpenter GH. Regulation of salivary gland function by autonomic nerves. Auton Neurosci. 2007;133(1):3–18.
57. Banderas JA, González M, Sánchez M, Millán E, López A, Vilchis A. Flujo y concentración de proteínas en saliva total humana. Salud Publica Mex. 1997;39(5):433–43.
58. Falcão DP, Mota LMH da, Pires AL, Bezerra ACB. Sialometry: aspects of clinical interest. Rev Bras Reumatol. 2013;53(6):525–31.
59. Tenovuo J. Antimicrobial agents in saliva—protection for the whole body. J Dent Res. 2002;81(12):807–9.
60. Chapa G, Garza B, Garza M, Martínez G. Hiposalivación y xerostomía; diagnóstico, modalidades de tratamiento en la actualidad: Aplicación de neuroelectroestimulación. Rev Mex Periodontol. 2012;3(1):38–46.
61. Silvestre F, Miralles L, Martínez V. Tratamiento de la boca seca: puesta al día. Med Oral. 2004;9(1):273–9.
62. Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch CA, Nair RG, Napeñas JJ, Nogueira A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010;18(8):1061–79.
63. van Den Berg I, Pijpe J, Vissink A. Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia. Eur J Oral Sci. 2007;115(2):97–102.
64. Piboonniyom S, Suwantuntula T, Thaweboon S, Mitrirattanakul S, Chomkhakhai U, Khovidhunkit W. Xerostomia, Hyposalivation, and Oral Microbiota in Type 2 Diabetic Patients: A Preliminary Study. J Med Assoc Thai. 2009;92(9):1220–8.
65. Navazesh M, Mulligan R, Komaroff E, Redford M, Greenspan D, Pkelan J. The Prevalence of Xerostomia and Salivary Gland Hypofunction in a Cohort of HIV-positive and At-risk Women. J Dent Res. 2000;79(7):1502–7.
66. Jiménez DJ. Aspectos clínicos y tratamiento de la xerostomía. Acta Otorrinolaringol Cir Cabeza Cuello. 2005;33(1):14–20.
67. Gallardo J. Xerostomía. Rev Med Inst Mex Seguro Soc. 2008;46(1):109–16.
68. Alpöz E, Çankaya H, Güneri P, Epstein JB, Boyacioglu H, Kabasakal Y, Ocakci PT. Impact of Buccotherm® on xerostomia: a single blind study. Spec Care Dentist. 2015;35(1):1–7.
69. Looström H, Åkerman S, Ericson D, Tobin G, Götrick B. Tramadol-induced oral dryness and pilocarpine treatment: Effects on total protein and IgA. Arch Oral Biol. 2011;56(4):395–400.
70. Rodríguez J, Sánchez R, Garza M, Nakagoshi M, Solís J, Arévalo K, Garza E. Physicochemical and antimicrobial evaluation of chitosan and hydroxypropyl methylcellulose films for prolonged release of pilocarpine. J Oral Res. 2015;4(1):25–31.
71. Pers J, d’ Arbonneau F, Devauchelle V, Saraux A, Pennec Y, Youinou P. Is periodontal disease mediated by salivary baff in Sjögren’s syndrome?. Arthritis Rheum. 2005;52(8):2411–4.
72. Jordan RC, Speight PM. Lymphoma in Sjögren’s syndrome. From histopathology to molecular pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(3):308–20.
73. Keszler A, Adler LI, Gandolfo MS, Bisio PM, Smith AC, Vollenweider CF, Heidenreich AM, de Stefano G, Kambo MV, Cox DP, Narbaitz M, Lanfranchi HE. MALT lymphoma in labial salivary gland biopsy from Sjögren syndrome: importance of follow-up in early detection. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(3):28–33.
74. Kovács L, Szodoray P, Kiss E. Secondary tumours in Sjögren’s syndrome. Autoimmun Rev. 2010;9(4):203–6.
75. Mariette X. Lymphomas complicating Sjögren’s syndrome and hepatitis C virus infection may share a common pathogenesis: chronic stimulation of rheumatoid factor B cells. Ann Rheum Dis. 2001;60(11):1007–10.
76. Dong L, Chen Y, Masaki Y, Okazaki T, Umehara H. Possible Mechanisms of Lymphoma Development in Sjögren’s Syndrome. Curr Immunol Rev. 2013;9(1):13–22.
77. Van NM. B cell MALT lymphoma diagnosed by labial minor salivary gland biopsy in patients screened for Sjogren’s syndrome. Ann Rheum Dis. 2004;64(3):471–3.
78. Jordan R, Diss TC, Lench NJ, Isaacson PG, Speight PM. Immunoglobulin gene rearrangements in lymphoplasmacytic infiltrates of labial salivary glands in Sjögren’s syndrome. A possible predictor of lymphoma development. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(6):723–9.
79. De Mendonça M, Finger A, Vale G, Naval MÂ, Soares AA, Compagnoni M. Management of Sjogren’s Syndrome Patient: A Case Report of Prosthetic Rehabilitation with 6-Year Follow-Up. Case Rep Dent. 2014;2014(2014):1-5.
80. Rivera H, Valero L, Escalona L, Roja F, Ríos MP. Manejo Multidisciplinario del paciente diagnosticado con el Síndrome de Sjögren. Acta Odontolol Venez. 2009;47(3):122–30.
81. Al-Hashimi I. The management of Sjoögren’s syndrome in dental practice. J Am Dent Assoc. 2001;132(10):1409–17.
82. Oh D, Lee J, Kim Y, Kho H. Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia. Int J Oral Maxillofac Surg. 2008;37(11):1027–31.
83. Dirix P, Nuyts S, Van den Bogaert W. Radiation-induced xerostomia in patients with head and neck cancer: A literature review. Cancer. 2006;107(11):2525–34.
84. Jellema AP, Langendijk H, Bergenhenegouwen L, van der Reijden W, Leemans R, Smeele L, Slotman BJ. The efficacy of Xialine® in patients with xerostomia resulting from radiotherapy for head and neck cancer: a pilot-study. Radiother Oncol. 2001;59(2):157–60.
85. Babaee N, Zahedpasha S, Zamaninejad S, Gholizadehpasha A, Moghadamnia Y, Moghadamnia A. Effects of milk curd on saliva secretion in healthy volunteer compared to baseline, 2% pilocarpine and equivalent pH adjusted acetic acid solutions. Indian J Dent Res. 2011;22(4):547-551.
86. Bernardi R, Perin C, Becker FL, Ramos GZ, Gheno GZ, Lopes LR, Pires M, Barros HM. Effect of pilocarpine mouthwash on salivary flow. Braz J Med Biol Res. 2002;35(1):105-10.
87. Nakamura N, Sasano N, Yamashita H, Igaki H, Shiraishi K, Terahara A, Asakage T, Nakao K, Ebihara Y, Ohtomo K, Nakagawa K. Oral pilocarpine (5mg t.i.d.) used for xerostomia causes adverse effects in Japanese. Auris Nasus Larynx. 2009;36(3):310–3.
88. Hua LV, Kawasaki P, Pokala VN, Hayes J. An Interprofessional Study of the Effects of Topical Pilocarpine on Oral and Visual Function. Health Interprofessional Pract. 2012;1(3):1-10.
89. Wall GC, Magarity ML, Jundt JW. Pharmacotherapy of xerostomia in primary Sjögren’s syndrome. Pharmacotheraphy 2002;22(5):621–9.
90. Brimhall J, Jhaveri MA, Yepes JF. Efficacy of cevimeline vs. pilocarpine in the secretion of saliva: a pilot study. Spec Care Dentist. 2013;33(3):123–7.
91. Noaiseh G, Baker JF, Vivino FB. Comparison of the discontinuation rates and side-effect profiles of pilocarpine and cevimeline for xerostomia in primary Sjögren’s syndrome. Clin Exp Rheumatol. 2014;32(4):575–7.
92. Rodríguez J, Sánchez R, Garza M, Nakagoshi M, Solis J, Arévalo K, Garza E. Salivary stimulation by prolonged release of pilocarpine using films in diabetic rats. J Oral Res. 2015;4(2):103–8.
93. Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 2013. 2013:1(9):1-49.
94. Cho JH, Chung WK, Kang W, Choi SM, Cho CK, Son CG. Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med. 2008;14(5):523–6.
95. O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 2010;28(4):191–9.
96. Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha R, Shah J, Vickers AJ. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28(15):2565–70.
97. Lončar B, Stipetić MM, Baričević M, Risović D. The effect of low-level laser therapy on salivary glands in patients with xerostomia. Photomed Laser Surg. 2011;29(3):171–5.
How to Cite
RODRÍGUEZ, Jesús Israel et al. Dental perspective on Sjögren’s syndrome: literature review. Journal of Oral Research, [S.l.], v. 4, n. 3, p. 211-222, may 2015. ISSN 0719-2479. Available at: <>. Date accessed: 30 nov. 2020. doi:


Sjögren’s Syndrome; Hiposalivation; Xerostomia; Hyposialia; dental management.

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