Implants in Patients with Sjogren’s Syndrome?

Dr. G. asks:
I have a 62 year old female patient with Sjogren’s syndrome, an autoimmune disease where the flow of tears and saliva are greatly reduced due to inflammation of the lacrimal and salivary glands. Has anyone had the experience placing implants into people with Sjogren’s syndrome ( mostly women are affected)? If so what are the pitfalls to look out for? What kinds of implant restorations would be contraindicated in a patient presenting with this condition?

Editor’s Note:
Sjögren’s syndrome is a chronic disorder that causes insufficient moisture production in certain glands of the body. Sjögren’s syndrome occurs when a person’s normally protective immune system attacks and destroys moisture-producing glands, including salivary (saliva-producing) glands and lacrimal (tear-producing) glands.

44 thoughts on “Implants in Patients with Sjogren’s Syndrome?

  1. Well in such a case- ask not “the pit falls of implants in Sjogren’s sicca syndome patient”-but ask ye “what are the pit falls of a complete denture in a patient with no saliva”!

    My guess ( not based on experience or research) would point to a weak collagen bundle lay out , remember such patients often have associated joint disorders.The connective tissues seem to be adversly affected. So checking out serum Calcium and other Bone calcification parameters under care of an experienced MD is obvious basic necessity. Discuss thouroughly the patients medical condition and it’s acuteness as well it’s reversibilty ( one of my patient has had reversal ) as well as the nature of the patient’s bone matrix and calcification quality.

    Any negative report should not stop you from implantation but only to help you warn the patient of possible failures.

    To improve probablity of osseo integration, you may place many implants of which, a couple of implants, may not integate.

    But my wild guess is that Implant supported complete denture would be a better option than a denture in a dry mouth.

    Removable prosthesis is out of question for the patient. Tooth supported or implant supported prosthesis may be planned, of course, both with guarded prognosis. Life ain’t fair espcially for Sjogren’s patient’s. You win some you loose some.

    You have a Hobson’s choice my friend. Between the devil and the deep sea! try and keep the patients spirits high and make her see the positive side of implant therapy. Best wishes!

  2. Haven’t place implants in Sjogrens patients but conventional restorative is tough… they accumalate plaque very quickly and though root caries isn’t an issue with implants I would imagine maintenance of peri-implant soft tissue health would be equally fraught with problems.

  3. I currently have a pt. that I have placed a couple in without problems and will be placing a couple more this month. I think it is the best treatment for her. No caries issue.

  4. I have placed two implants in a Sjogrens patient, on two separate occasions, healing was not problematic. As mentioned, I would agree removable pros will be a challenge, due to the lack of tissue lubrication. Obviously, implant restorations are very suitable for patients with high caries, so they can work well in these patients.

  5. I have a patient with Sjogrens who has an “all on 5″ configuration in the mandible with a Procera implant bridge incorporating acrylic teeth. She in now entering her third year and all in well so far. Removeable was out of the question as it would have been far to bulky and she can only tolerate something smaller.

  6. There is nothing in the way of literature support one way or another on a protocol for using implants in the Sjogrens patient that I have come across. I myself have placed and restored implants in three patients diagnosed with Sjogrens and have not had any problem whatsoever. Two cases were non removable and one case was a two implant assisted retention of a maxillary partial denture. The removable case is approximately five years old and is working well.

  7. When I carried out my implant masters (around 10 years ago) my prof placed a hundred implants in Sjogrens pts. Success rate was 85%. I have placed many since success rate aout 90%, so a little down on “the norm”, but benefits well outweigh the risks

  8. I have had a Sjogrens patient under periodontal maintenance care for the past 24 years. She is now 83 years old and in otherwise good health. For the first 6 to 8 years she had her natural teeth and we battled recurrent caries with frequent recall, fluorides in office and at home, crown lengthening and new restorations. Ultimately both the upper and lower dentitions failed and all teeth were extracted. Of course dentures were intolerable so 8 upper and 6 lower “Brannemark” implants were placed successfully. Porcelin fused to gold alloy superstructures were made to sit onto individual implant supported copings. These appliances are removable and there is minimal or no tissue contact. This has been an extremely successful treatment for which the patient has been totally grateful over a period of about 16 years.

  9. In sjogren syndrom the flow of saliva may be near normal or completely absent…
    the bone quality is not affected by the syndrom but the maintenance of the implant is much more difficult and increase when the saliva is less. Bacteria are much more so strict hygiene is important…
    If i have such case i would prefer a crown restoration with the limits placed supra gingival to allow maximum possibility for cleaning if ecthetics may allow that…

  10. Sjogren’s syndrome is a chronic, autoimmune, inflammatory connective tissue disorder, with women being the majority of the patients afflicted. It is mostly diagnosed in the fourth or fifth decade of life. It is an autoimmune exocrinopathy characterized by lymphocytic infiltration of exocrine glands in multiple sites causing salivary and lacrimal gland dysfunction that leads to secretory hypofunction and the sequela of xerostomia and keratoconjunctivitis sicca, due to the production of autoantibodies. The involvement of lacrimal and salivary glands results in the typical features of KCS and salivary dysfunction; however, about one third of the patients also present with extraglandular manifestations. Sjogren’s syndrome can be seen alone (primary), or in association with another autoimmune rheumatic disease(secondary), usually rheumatoid arthritis, but also including systemic lupus erythematosus or other autoimmune connective tissue diseases. It sometimes leads to enlargement of the parotid and submandibular salivary glands, which may be associated with reduced salivary flow and symptoms of fatigue and arthralgias as well as oral complications including dental caries located at the gingival margins, incisal edges,and cusp tips; candidal infections; and difficulties with eating, swallowing, and speaking. Both primary and secondary Sjogren patients face reduced salivary function and suffer from xerostomia. Patients with primary type of the disease have an increased risk of developing non-Hodgkin lymphoma, and for them, there is also a frequent occurrence of autoimmune thyroiditis. Primary Sjogren syndrome is in most cases associated with extraglandular manifestations such as autoimmune hepatitis, interstitial lung disease, and interstitial nephritis. Patients with the secondary disease entity may also get involved with rheumatoid arthritis or systemic lupus erythematosus.Sjogren syndrome is a strict contraindication for implant placement, not only because of xerostomia that predisposes mucosal or gingival inflammation leading to peri-implantitis and failure, but because these patients are receiving large doses of steroids to suppress the illness. This corticosteroid regimen as a very serious impact on the systemic and local defense mechanisms and the most sophisticated form of the healing process; the magnificent OSSEOINTEGRATION.

  11. So Sorry for the error on the last sentence, hereby it is corrected:
    (This corticosteroid regimen has a very serious impact on the systemic and local defense mechanisms and the most sophisticated form of the healing process; the magnificent OSSEOINTEGRATION.)

  12. Dr Mehdi don’t you think that the patient is faced with little choices? Sjogren’s patient becomes edentulous eventually. Edentulism on one hand and potential risk of failure of implant on the other hand. If the patient is well informed then where is the problem. Steriods may cause a problem as steriod may worsen loss of calcium from bone collagen bundle forming and lower immunity. But these patients can’t even wear regular dentures. It’s a Hobson’s choice, damned if you do, damned if you don’t.

    What would your take be on this situation?

  13. With all due respect sir, I,ll go for a transitional full denture instead of prostheses supported by implants. The denture’s base can be covered by soft liners or tissue conditioners to avoid any hardness to the highly irritated oral mucosa, and its removing from the mouth and cleansing would be more feasible. After the situatation gets better and salivary flow goes back to normal or/and steroids are discontinued, implant therapy can be considered upon the situation on the ground.

  14. Thanks for the reply! You suggest the transitional denture should be Implant supported? is it so?

  15. Dr. Jafari, you have given a very nice and worthwhile review of the Sjogrens condition but you have stated that Sjogens is a strict contraindication for placing dental implants. While I agree that there may be some contraindication, I am inclined to state it as being a relative contraindication and not a strict one. There is not a lot of publication on this matter, but there are a some (including some positive comments posted here) which have shown that dental implants can be a very valuable and for the most part, a successful treatment for Sjogrens patients who tend to suffer quite a bit from having to endure tissue borne prosthetics.

  16. Dr. Nimchuk,sir, If you have paid attention to my reply to Dr.SDJ, I have stated that I recommend implants for Sjogren’s syndrome patients, only after the situation is totally resolved and there is no need for steroid therapy.This statement puts sjogren’s syndrome in the list of relative contra-indications of dental implants automatically.As you see, there is no conflict of opinions.

  17. The term “contraindication” denotes an absloute resolve that the patient should not get the treatment under consideration. There really is no such thing as relative contraindication. One can discuss precautions or warnings of diminished performance under a situation like Sjogren’s sicca. To say something is a strict contraindication, however, suggests that dental implants are never to be considered for these patients. It seems from the comments above there are some cases with early success with using dental implants in these patients. It is likely that the long-term failure rate may be higher than when used in more healthy patients but this diminished performance needs to be considered against the benefits of using these devices.

  18. Taking a more philosopical view of the profession of implant dentistry, the Sjogren’s patient is generally a person who has been sobered by the jolt to his life. A person who is greatful for the small mercies life occasionally shows him. An implant probably won’t last a life time but he isn’t on the death bed, anyway. And is probably, many years away from death. So between today and that last day may have many years to live.

    How can I comfort him? If he can’t chew those food morsels how long can he go on that way. And should I as a doctor be bothered about loss of reputation I suffer if the implant fails or I should I be telling myself” Let him use that Implant for as long as he can atleast I will have abated his suffering for some time.”

    I, as a doctor wouldn’t be affected adversly by a blemish on my track record of strings of succesful implant restorations.

    The Sjogren’s patient eventually figures out the tough spot nature put them in and are generally wise.

    All we have to do as doctors is to put to good use, the art we learnt, and make good the Hypocratic oath.

    If my patient can afford it and is a wise person who fully understands maturely the short and long term implications of his decision, I shall never hesitate to put an implant in a Sjogren’s patient.

  19. There was a study in which 10 patients w/ Sjogrens received Branemark implants. The success rate was very good. I have treated a nurse and performed an full arch extraction/implants/ and immed. load. She did very well. This is an excellent treatment for these patients. It is important to perform the surgery prior to the patient losing significant amounts of bone by serial extractions.

  20. Robert Lemke – Can you link me to the study in which 10 patients w/ Sjogrens received Branemark implants. The success rate was very good. Thank you.

  21. I have a Sojgren’s patient under care who I placed 6 implants in the maxilla, (one which did not integrate) and 4 in the anterior mandible.

    Prior to implants her tissue was always inflamed as a result of her near total lack of saliva and the bacterial infection of her remaining teeth which had all severely decayed. She presented with a lower denture which she could not wear at all and her remaining upper dentition was severely decayed.
    I was able to manage the case by retaining 4 maxillary teeth and fabricating a fixed provisional bridge. the remaining upper teeth were extracted and the area allowed to heal for 5 months prior to fixture placement.

    The upper arch was restored with a screw retained PFG bridge and the lower with a bar supported overdenture. The case has been loaded for 2 1/2 years. She has had a very normal response to therapy and as of May 08, she has had bone loss to no more than about the second thread on any implant.

    Since the case was loaded, and following a strict 3 month recall protocol for hygiene she has done very well. Her tissue response is pretty good except,although not showing classic signs of inflamation, the tissue is always dry and looks redder than normal throughout her mouth.

    I will be following this case closely to see what the long term results of this case will be but I can tell you that as of now, this patient could not have been treated successfully in any other way.

  22. You all are doctors I presume from what I have read. I am searching for information on what I can possibly do regarding my Sjogren’s and my teeth that are exponentially decaying and crumbling. I am heartbroken. My dentist tells me I will never be able to wear regular dentures, at the same time I cannot keep a filling or even a crown at this point. The break off, fall out, and last rarely a month. The cost trying to save my teeth has been astronomical and it is a joke if you were to see how horrid they are decayed you would never believe the money I have spent. Eight crowns and 7 root canals and my teeth look like a meth addicts teeth.
    I am desperately trying to find information (and hope) that maybe implants are a solution. I can no longer effectively chew my food which in turn is destroying my gastrointestinal tract. Sadly my medical insurance seems to think teeth are cosmetic and will not cover help with this. Yet I am losing them due to a medical condition. *sigh* I am 47, and depression is full time fight because of this.

    Thank you for all your posts, it has helped me know what choices I have and the possible risks involved. I am fortunate that I am not on corticosteroid treatment and my life is managed with Plaquenil at this time. I also suffer from lupus and am having a colon resection very soon due to chronic diverticulitis. All of which I feel is exasperated by Sjogren’s.
    Please keep up the great work.

  23. Mini implant stabilized removables work. Easy to clean. No more decay. Patient can eat and speak comfortably. Simple and relatively easy to fabricate. I have done only one case like this for Sjogren patient, but wouldn’t hesitate to do it again. She did lose one implant after a year, I replaced it with a larger diameter mini. Next time I will use all 2.5mm diameter in the first place. Bone resorbtion seemed more than normal, but a simple reline after one year solved the problem. Patient is thrilled with result. If she could afford it she would do the upper as well with six minis and no palate on the denture. I still don’t get the logic of major implant surgury on most cases of this type. Mini implant dentistry allows immediate loading, nice aesthetics, minimal pain, should be far less expensive for the patient, and the dentist still makes a nice income. The only thing you don’t get is a thirty year history of success, and we have to wait another 25 years for that.

  24. Hi Karen,…. I felt so badly when I read your post about your poor health that I did some research. On one of the internet forums, I found a post from a lady who has Sjogren’s and had found great help holistically. I contacted her regarding her program and she kindly wrote me back the next day. Some of the info she gave me was indeed eye-opening and since her diagnosis of 10 years ago, for the past 4 or 5 she has basically been fine. If you are interested, please feel free to email me at: palacie@sbcglobal.net and I will be happy to forward to you all the information she sent me.

  25. Sjogrens has played havoc with my teeth. I am 76, retired, and have spent tens of thousands on my teeth in the last 8 years. I now have 4 implants upper front, and 2 molar implants. I have had many, many crowns and root canals, which all fail rapidly. I have a new 8-tooth lower fixed bridge (I’m praying it last longer than the 6-tooth bridge it replaced) Next week, I am having surgery to extract both canines (These have 2yr old root canals – infected) and other grafting of tissue and bone to begin work to get implants for the canines. There are many, many tooth problems I have suffered, but I just wanted to say, I am so happy with the implants (I’m knocking on wood they last), and I wanted to let people know. I am 76 years old, and I am almost certain I would have great difficulty with the usual dentures. I am praying tha I can get by during the time I have left with implants on the top and bridges on the bottom. Also praying I can find the money to keep on getting implants as needed!

  26. I suspect that since the initial post in May, nobody will read this, but here goes anyway. Unlike most of you, I am not a dental professional; however, I have had Sjogren’s Syndrome for more than twelve years. In 2007 it progressed to Non Hodgkin’s Lymphoma (NHL). Like Karen, while I took great care of my teeth, my cavities grew exponentially and I made the decision to have my teeth removed and replaced with implants on the bottom with an attachable/removable denture. Initially, my plan was to have implants on the top as well; however, because two of the cancerous lymph nodes were in each cheek, it could be that I will need radiation at some point, so I decided against upper implants. I have had my implants for more than a year now.
    My father, 88, also has sjogren’s and developed NHL at the age of 83. His teeth were removed shortly before manifestations of sjogren’s – I don’t know if they had implants in 1965. He now only wears an upper denture. Like me he has limitations in what food he can eat – no acidic or spicy foods. Thankfully, he and I understand our limitations.
    Back to the implants. I am very pleased that I made the choice to have my teeth removed and replaced with implants and dentures. Is it perfect? No. I must rince my dentures and mouth out after eating, which requires privacy…not always available. Additionally, I find that my tongue, (I believe in an attempt to stimuate the salivary glands) continues to play with both upper and lower dentures. However, on balance, it was the right decision.
    Just as an aside, one of the physicians indicated that at some stage the sjogren’s corrects itself. I have never heard of this; everything I know about the disease indicates that it is progressive, at varying rates.

  27. I am 63,have Sjogren’s Sydrome and have worn full dentures since I was 17 due to some familial tendency to rapid decay in both primary and secondary teeth. I manage them well, except that I can no longer find a dentist willing to make a new set of dentures (which I desperately need) as I am having trouble chewing due to wear down of my lower jaw, and I suspect some TMJ problems are starting. It seems that my only hope is an implant supported lower denture. So far the SS has caused dry eyes and arthritis, but the oral mucosa doesn’t seem to be affected. I also have hypothyroidism. I take Plaquenil and Armour thyroid replacement. Are mini-implants possible or would they be too likely to fail?

  28. I am a sufferer of Sjogren’s, currently 34 years old, and I wasn’t diagnosed until I last year. My dental caries, multiple root canals and restorative crowns started about 10 years ago. I thought I just had unbelievably bad fortune until I started having joint pain two years ago, now it all makes sense.

    Please to those dental practitioners out there, PUBLISH YOUR WORK! I am concerned about myself and all other Sjogren’s patients out there which will be given substandard treatment because there is little IF ANY studies published on this topic.

    For the DDS above who says implants are a strict contraindication, please do not submit to forums about this topic any longer. To assume that all/most Sjogren’s patients are on high dose corticosteroids is a beginner’s mistake. You should not make these assumptions, and I recommend you refer your Sjogren’s patients out to another DDS, or shadow a Rheumatologist awhile. The goal is NOT to be on prednisone. I believe that there should be a specialty certificate in Dentistry for autoimmune diseases; it is very difficult to get good consistent care. I personally drive 2 1/2 hours to a teaching hospital.

  29. I was diagnosed with Primary Sjogren’s at age 67, though clearly I have had the disease for years. Since my early thirties, I seem to have had nerve death in my teeth, resulting in root canal after root canal. I mention this because most of the dental information I have researched talks about caries. My caries are few for some reason, though I have dry mouth, but my root canals are many. I am wondering, if anyone knows, how the nerve death is connected with the Sjogren’s disease. I have had both primary nerve death, with and without infection and nerve death following the replacement of fillings. What causes the root nerve to die? From other posts I gather that other Sjogren’s sufferers have the same problem and I’m curious, though innured to root canals on the few remaining teeth that don’t have them. Thank you for the information on implants – it will problably come in handy in the not so distant future.

  30. I am 56 years old..I have had Sjorgens for a little over 13 years..I lost all my teeth to this disease 2 years ago and have tried a upper plate-I have tried a lower plate but due to quick bone loss from the beginning I cannot wear a lower plate..I get sores from the upper plate this is even using vaseline..
    I constanty am swallowing and now look older than I am..Due to the severe dryness I have a hard time with foods and must drink warm to hot drinks such as tea in able to eat small portions..Unfortuantely the foods that I can eat are not always the best so I have gained weight and am in process of working on this as well..I constantly am drinking water as my tongue will stick to roof of mouth due to the dryness..
    I don’t understand why insurance does not see this as a medical condition in helping people with diseases that affect the mouth..Why not help us get the implants..In the long run the implants would save money as people could eat better and live better..
    I am now on Methotrexate to help with arthritis and pain..I see a Ophthalmologist regularly due to the sjorgens and my lids sticking to my eye balls.. Am I to be denied implants something that could help me physically and mentally?

  31. I am a 58-yr-old female with recently diagnosed secondary Sjogren’s. My teeth are rapidly just falling out of my mouth (4 in the last year), but due to lack of insurance I receive no dental care. The Sjogren’s is secondary to Psoriatic Arthritis, and both are being treated by Methotrexate and Enbrel, NOT by corticosteroids. The comment about a goal being to have patients NOT on steroids is absolutely accurate.
    I came to this forum to see what the facts are regarding Sjogren’s and tooth replacement (by implant or removable denture). I have been enlightened by the information here, and I encourage all of you to continue posting. It never occurred to me that I would not be able to use removable dentures, so this is extremely eye opening.
    Thank you all for your posts.

  32. I am 39 and was diagnosed with sjogrens 2001 after all my teeth were removed and a submanibular gland which had been playing up for many years started to excrete yellow pus – The dentist in the oral and maxillofacial unit in Adelaide answered ALOT of questions that I had for years about these strange ‘unrelated’ aches, pains and dryness (dry skin, mouth and vagina) with his diagnosis and told me that the reason all my teeth ‘fell to pieces’ in four years is Sjogrens.
    I noticed above in the comments repeatedly that Sjogrens patients cannot wear a full denture and I have in fact been wearing one since 2000. I will admit that it is uncomfortable and sometimes if I am very dry it causes ulcers and slices into my gums when eating – I have only once been offered implants and was told to start saving now and maybe you can afford them someday…. someday never seems to come!

    Good luck to you all in your endeavour to porvide the best care for the Sjogrenites out there – I don’t get a lot of understanding in my plight and my doctors usually have to sit there with a book to consult so I have no confidence most of the time :) it is good to see that you guys do care :)

  33. I myself have placed and restored implants in several with Sjogrens and have not had any problem. Studies show that the success of dental implant are slightly lower in this group, however.

  34. I am a sjogrens patient who had implants done pre diagnosis. I haven’t had any toruble with them. I was 18 when they were implanted and am 34 now with no replacement/ recrowning to date.

  35. The comment left by KAREN WHITLOCK Sept. 5th 2008 is nearly a mirror image of my situation. I’m 44 and my teeth have fallen to pieces as well. I’ve had a partial gastrectomy and 2 resections. I have Lupus, Sjogrens, RA, hypothyroidism, massive weight LOSS, eye ulcers, tiny leg ulcers, chronic pain and fatigue, dry mouth and eyes and a mouth full of broken crumbling teeth most are snapped off at the gum line. I am undoubtedly depressed. I live with a mouth full of abscesses. The pain OMG! Need I say more. It happened SO FAST! I always took such care to safeguard my teeth. They were beautiful. I am now a total agoraphobe. My social anxiety is paralyzing. I have no life because the shame I suffer when I have to speak to someone is mind numbing. I have real medical issues and all are covered by my medical insurance EXCEPT: Removing my decayed teeth that are causing me to have abscesses and major sinus, ear and other systemic infections. I run a fever constantly. They will pay to heal eye ulcers, skin ulcers, skin infections but they won’t cut my teeth from my gums!!! I’m supposed to come up with $4000.00 just to take them out! Then I’m left toothless. This should be covered by medical insurance. They paid to remove the abscesses from my intestines. They are both life threatening at this stage. I’m just venting. I don’t know where to go or what to do. I’d give anything to have the chance to get implants. This was not neglect or bad hygiene. It came about as an autoimmune disease process.

    I feel that I will die LONGING to gaze into my husbands eyes (nose to nose) breathing his breath whispering in the dark and kissing his mouth. I can’t do that with this mess in my mouth. A big part of my life is just over. I miss him and need him so much. He’s in pain as well and we cry sometimes because we need that closeness. I just can’t bring myself to subject anyone to the bacteria brewing in my gums. It would not be safe! Our whole family suffers with me. It is serious. My quality of life is GONE!!!
    Warmest regards to all. Thanks for being my sounding board! Tia

  36. To the dentists who do implants:

    Those of you that read the post from Tia (above) surely feel compassion and sadness for her. If she were able to have implants successfully it obviously would make a major impact on her life. Since we still do not have a health care system in this country we are relying on insurance companies (if we can even AFFORD insurance) and the meager number of dentists and doctors who seem to truly want to help people in need. I realize many of you are tied into medical/dental organizations that restrict you from doing implants for free or even give a substantial discount to an individual JUST BECAUSE IT’S THE RIGHT THING TO DO. I’m just hoping that somewhere there are a few of you that will stop and think about this and make some sort of effort to help those truly in need. Thank you for your time. Deb

  37. I am 44 and recently found out I had Primary Sjogrens but yet I have had the condition for years but not diagnosed. I never heard of it until I was diagnosed.
    From 1994 to 2001 I was sensitive to tanning beds and sunlight. Break out with a rash head to toe what ever was exposed. I guess its dormant. I have Fibromyalgia, anemia, Raynauds, Bulging from C4-C8, 5 episodes of swelling of the parotid gland (Painful), chronic fatigue syndrome, depression.
    My teeth are all crumbling out, gum line cavities, sores in my mouth(have not had candidais in mouth. I hate brushing what teeth I have left which are all decayed, broken, cavities. I didn’t go to my last dental appointment because I don’t want another needle stuck in my mouth. I just want them all out.
    Insurance will not pay for anything unless it is medically necessary. Why is not this medically necessary? This puts me in deeper depression that I miss life. Afraid of getting a job because of the whispers or never getting the call for the position even though your qualified. I hate this desease and the medical industry is so unfair. I have a 3 and 5 year old to take care of yet, why is this no a medical problem…….THE MEDICAL PROBLEM CAUSED IT and THIS PROBLEM IS CAUSING MORE MEDICAL PROBLEMS. Not only do I need me but my family needs me more.

  38. Thank goodness I found this site. No ne seems to know anything where I live. I am a professional artist with SS and 4 other autoimmune diseases. I have never taken steroids, and may be allergic to everything they ever tried to give me. Today, I sat in the chair of a new dentist, while he counted hundreds of new cavities along my gum lines. I am 56. Then he gave ma a lecture and scolded me, and he didn’t even know how to say Sjogrens or much about the disease. Faced with needing thousands of dollars of dental work, failing health, and a failing art market, horrific deprression, and insomia because of SS, I just started to sob. Don’t preach to me about Fluoride, it makes me sick, too. My bones are falling apart, too. But at least this dentist was kind enough to refer me to a specialist. I have spent the past 5 years fighting candida infections in my mouth, althouh drs look in there and say, “It looks fine to me”. It is not only dentists who don’t know this disease, even rhuematologists seem ignorant. My eyes are now begining to not focus from the dryness. How will I see to paint? I am a world-famous artist and my work is all I have. Hiowver it is not bacterial infection that is eating away at me, it is candida. The fact is, it seems to be me that the candida is the big ptolbem fro most people, which is not the same as other types of bacterial infections. Am I correct in saying that?? Ironically, the one thing we do to help us- drinking lot so fluids, continously, I think cause us to wash away what little saliva we have to protect our teeth. I can assure anyone here, that with my history of fighting the candida, anything that is removable that I must wear in my mouth , will make the candida very happy to go on living in my mouth. The more I read about implants, the more hope I have that this is the way to go. And, by the way, all these autoimmune diseases are likely to have repeated flare ups with steroids alwasy a possible treatment, again and again. There is no ” resolved’ It never goes away.
    Thank you dentists for writing here and for caring. I go to art whos embarressed because my collecotrs have beautiful teeth and mine look like a drug addict’s teeth. Unfortunately, yes, the medical ins company doesn’t care if we need teeth to eat or maintain the shape of our faces. We want more info!

  39. To June – the artist – I just visited your beautiful website and saw your lovely artwork. I don’t understand your plight, however. If you can afford to buy an apartment in Tuscany and make improvements and fly over there with art equipment and everything – then why can’t you afford to fix your teeth? I am confused by that.

    I am 48 – nearly 49. I was diagnosed last year (2010) right about now – with Sjogren’s Syndrome. I have Primary SS along with Fibromyagia and PHN (Post Herpetic Neuralgia) from a very debilitating case of Shingles I had last year – and that is how they diagnosed the SS that I apparently have had for years. I never even had a cavity until I was 34 and I had braces when I was a teenager. I took care of my teeth – but in the past two years they have decayed terribly and rapidly – moreso in the past year. If it wasn’t for the Neurontin I take for the PHN pain – I would probably have gone completely crazy with pain – as the Neurontin helps the teeth pain. I currently have no income, no insurance and a Social Security case pending – I also have a bad back, hip, knee and a large bone spur on my shoulder that has the PHN and bone spurs on the heels of my feet. Working at most jobs right now is looking pretty impossible for me. I have no tears whatsoever in my eyes, no saliva, terrible teeth, the medication makes me drowsy, lifting and pushing or pulling is out of the question from my shoulder and back problems. I can’t even wear a bra most of the time as it irritates my shoulder too – and I really NEED to wear a bra in public. Driving for long periods of time irritates my shoulder and my hip too.

    If I had the money that you have from one or two of you beautiful paintings – I could probably get my teeth pulled and some dentures or implants put in and my life would be a great deal more bearable. Maybe I should take up art and auction off a few pieces for a good cause…my TEETH!! I wish I could find some dentists that actually did some charity work for Sjogren’s patients. Anyone know any in Oklahoma? I can’t find one. I did find a lot of valuable information here and I wish everyone the Best of Luck!
    Michele

  40. I am a bit shocked to read comments left by Sjogren’s sufferers that could have been written by me. I too suffer from Sjogren’s and in just 9 months I have gone from a full mouth of teeth to a train wreck of broken, crumbling teeth. Mine also have broken off at the gumline. It’s very painful as well. The biggest problem is the embarrassment. I try so hard not to smile or open my mouth much while talking because of the broken or missing teeth. I was told recently that I will have to have all of my teeth removed, and that they are too diseased to stay. It was a terrible blow. I too have been extremely depressed about this, and just want to withdraw from others so as not to be so embarrassed. The option I was given was full dentures. The cost of removing the diseased teeth and the dentures was exorbitant. There is no way I can afford that. So I continue to be in pain, and more teeth break away at the gumline. I am not taking any steroid medication and would love to have implants. I have read much conflicting information about whether dentures are appropriate for Sjogren’s patients. Mostly I have read that they are a poor choice for us because of the dry mouth. Now here I read that implants are not a good option for Sjogren’s patients either. What are we supposed to do? Just walk around without teeth? It would be really nice if some doctors or dentists actually cared about Sjogren’s patients and were willing to give us viable options.
    I agree that this should all be a coverable problem. There is no doubt that the Sjogren’s is responsible for what has happened to my teeth in the last 9 months. As such necessary treatment for the mouth should be covered by insurance. We are not talking about dental care. Sjogren’s patients can’t keep their teeth. I’ve read nothing to suggest that such patients have any hope in the long run of keeping their teeth. So whatever treatment they require in their mouth in not dental treatment, per se. It is a necessary medical treatment. There needs to be something there to grind down the food that we eat. As it is I am practically having to eat baby food. I too have chronic stomach problems and just as I am aware of how to handle other symptoms related to autoimmune diseases I understand what is happening to my mouth. I don’t know how much bone loss I have, but I probably have some. I don’t understand the relationship between tooth extraction and bone loss. But I can learn, and I too would like to go to an understanding dentist who doesn’t treat me like a child just because my mouth is full of crumbling teeth. I didn’t do this to myself – I’m still in shock about how quickly it happened.
    Good luck to all, and sorry about the rambling post. It is a very hard time.

  41. I am in Tampa and am in need of a dnetist who can help me through the loss of all teeth for a close relative. Without teeth they are almost unable to eat and life has become a total nightmare. Please help- are dentures possible or are dental implant the only option? Please help!!

  42. I am a 61 year old female. I was diagnosed with Lupus(SLE)36 years ago when I was 25 years old. Along the way, I’ve also been diagnosed with Fibromyalgia, Raynaud’s Phenomenon and with Sjogren’s Syndrome in 2009. As anyone who has any of these, there have been complications along the way. I think Sjogren’s has been the most debibilitating even when compared with the worst Lupus scares and hospitalizations. Like everyone else, I started losing my teeth at the gum lines. All my teeth became black and decayed and eventually were all extracted. I was fitted with dentures right away. Due to the lack of saliva with Sjogren’s, the dentures moved around so much, continuously cutting up my gums, insides of my cheeks and tongue. Sometimes when I’m eating and they move around I’ve choked and had to pull my dentures out so that I can pull the food out of my throat where it’s been shoved by the dentures. It’s the same nightmare as experienced by everyone else above. After 1 1/2 years of failed communications and administrative glitches by my insurance they have finally approved me for whole mouth implants. However my oral surgeon and dentist have failed to explain the entire process and answer my questions. My surgeon is on vacation and I’m hoping someone out there can provide some answers before he returns and I undergo the procedure. The plan is to insert 4 posts with cadaver bone grafts. After 4-6 months, abutments will be placed atop the posts. After another period of time I will be able to attach the dentures to little holes in the abutments. These posts will provide stability and prevent the dentures from moving around. Looks good on paper but does it work in reality? Besides rejection, what other problems could arise? Since the dentures sit atop the abutments, is this realignment visible? Does it affect your normal smile, talking or eating? Am I going to look different than I used to? I might welcome that because right now, the way my dentures fit, my mouth is turned down in the corners and I look like I’m always mad. It’s definitely made me look older. If this procedure doesn’t work for whatever reason, what options are available to me? Would I still have these options after having the procedure I’ve described? In a way I’ve been fortunate in convincing my insurance that Sjogren’s and it’s attributable complications are of a medical kind and not dental. I have taken excellent care of my teeth. My mother was a dental assistant and from the beginning instilled a regimen for proper dental care so I never expected to be faced with something like this. I’m hoping that this procedure will allow me to someday be able to eat the many foods that I can’t eat right now. Is this procedure the best thing recommended for someone like me? Initially I thought that there would be 4 posts implanted and subsequently 8 “false” teeth attached to each post; no dentures at all. Does something like that even exist? I would appreciate any help you can give me. Thank you so much!!!!!!!!!!!!

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