Chemosensory Dysfunction, Oral Disorders and Oral Health-related Quality of Life in Patients With Primary Sjögren's Syndrome: Comparative Cross-sectional Study

Comparative Cross-sectional Study

Mirjana Šijan Gobeljić; Vera Milić; Nada Pejnović; Nemanja Damjanov

Disclosures

BMC Oral Health. 2020;20(187) 

In This Article

Results

Demographical and Clinical Characteristics of Patients With Primary Sjögren's Syndrome and Healthy Controls

The characteristics of patients with pSS and healthy controls are shown in Table 1. The patients with pSS and the healthy controls had a comparable mean age (p = 0.917). The majority of subjects in either group were females (p = 0.244). The two groups did not differ significantly in smoking habits (p = 0.560). In comparison with patients with pSS none of the healthy controls had subjective experience of ocular dryness (< 0.0001), oral dryness (< 0.0001), dysphagia (< 0.0001), nasal dryness (< 0.0001), dyspareunia (< 0.0001), salivary gland enlargement (< 0.0001) or Reynaud phenomenon (< 0.0001). The mean disease duration in patients with pSS was 7.65 ± 5.85 years, ranging from 1 to 22 years. The majority of patients with pSS (43%) had moderate disease activity as estimated by ESSDAI EULAR index of disease activity. More than half of patients (60%) reported that they were not satisfied with their current health status as assessed by EULAR SS Patient Reported Index ESSPRI. The vast majority of patients (more than 88%) had positive salivary gland scintigraphy, salivary gland biopsy and abnormal tear breaking-up time (BUT), Schirmer's test and Rose Bengal score. The majority of patients (71%) were positive for antinuclear antibodies, SS-A autoantibodies (81%) and RF (69%). The mean value for erythrocyte sedimentation rate (ESR) was 25.7 mm/hour and it ranged from 2 to 88 mm/hour. Leucopenia was found in more than half of the patients (62%). Twenty–two patients with pSS (38%) were on corticosteroid therapy, whereas the majority among them (75%) took 10–50 mg of corticosteroids per day. The majority of patients (81%) used artificial tears, while only 4% of patients used artificial saliva, 46% received Chloroquine or Hydroxychloroquine, 3% Azathioprine and 2% Methotrexate. The majority of patients in this study received drugs that are not expected to have significant effect on chemosensory function.

Olfactory Function

The pSS group had a significantly lower mean self-reported smell score on VAS than healthy controls (8.57 ± 2.21 95% CI 7.99 to 9.15 vs. 9.56 ± 0.72 95% CI 9.36 to 9.76; p = 0.016; (Table 2). Similarly, olfactory testing showed that the patients with pSS were significantly more anosmic and hyposmic and significantly fewer of them were normosmic in comparison with healthy controls (χ 2 = 9.9; p = 0.002), as shown in Figure 1.

Figure 1.

Olfactory function in patients with pSS and healthy controls. Significantly higher frequencies of pSS patients with anosmia and hyposmia in comparison with healthy controls (χ2 = 9.9; p = 0.002)

Gustatory Function

The patients with pSS had a significantly lower mean self-reported taste score on VAS than healthy controls (8.48 ± 2.10 95% CI 7.93 to 9.04 vs. 9.54 ± 0.67 95% CI 9.35 to 9.73; p = 0.014). Gustatory testing showed that the pSS patient group had significantly lower mean taste scores than the control group (4.11 ± 1.82 95% CI 3.57 to 6.64 vs. 6.11 ± 1.93 95% CI 5.58 to 6.64; p < 0.0001) (Table 2). Gustatory testing categorized significantly more patients with pSS as ageusic/hypogeusic and significantly fewer with normal sense of taste than in the control group as shown in Table 2. Significantly more patients with pSS had impaired ability to taste sweet (p < 0.0001), sour (p = 0.054), salty (p = 0.018) and bitter (p = 0.001) than healthy controls.

Dysgeusia, Burning Sensation in the Tongue, and Halitosis

Complaints of dysgeusia, BST, and halitosis in the patients with pSS and healthy controls are shown in Table 3. Only five out of 53 healthy controls complained of dysgeusia, while more than half of patients with pSS (53%) reported dysgeusia (χ 2 = 23.6, p < 0.0001). Thirty patients with pSS who complained of dysgeusia described the taste as metallic, sour, bitter, rotten or unpleasant. The majority of patients reported distorted bitter taste (36.7%), while all controls that reported dysgeusia (9.4%) complained of unpleasant taste. Similar proportions of the patients with pSS (77%) and healthy controls (67%) experienced distorted taste as a daily problem.

While none of the controls complained of burning sensation of the tongue (BST), nearly half of patients with pSS reported BST (46%) (χ 2 = 31.6, p < 0.0001). The majority of patients with pSS (38%) experienced burning sensation in the tongue during the meals and 39% of them reported sour taste sensation as a type of BST.

About 32% of patients and 28% of controls complained of halitosis, but the difference between the two groups was not significant (χ 2 = 0.40, p = 0.434). Half of the pSS patients experiencing halitosis complained of halitosis as a persisting daily problem, similarly to the majority of healthy controls (80%) who also reported halitosis as a daily problem (p = 0.328).

Highly significant differences in frequency of self-reported complaints of dysgeusia among patients with pSS and controls and BST were observed, with no differencies in the presence of halitosis as shown in Figure 2.

Figure 2.

Dysgeusia, burning sensations in the tongue (BST), and halitosis in patients with primary Sjögren's syndrome and in healthy controls. Significantly higher frequencies of pSS patients with self-reported complaints of dysgeusia (χ2 = 23.6, p < 0.0001), BST (χ2 = 31.6, p < 0.0001), but not of halitosis (χ2 = 0.40, p = 0.434) in comparison with healthy controls

Odds ratios for the development of dysgeusia, BST and halitosis were determined in patients with SS and healthy controls and the results are given in Table 3. In addition, positive findings of anosmia (40.4%) were significantly higher among patients with primary Sjögren's syndrome than among healthy controls (13.2%) (Odds ratio: 5.2, 95% CI: 1.9–14.3, p < 0.001). The obtained results show that pSS is a risk factor for the development of dysgeusia, BST and anosmia.

The pSS group had a significantly higher mean OHIP-14 sum score than the control group (6.79 ± 7.03; 95% CI − 0.19 to 4.73 vs. 2.27 ± 8.46; 95% CI 4.90 to 8.67, p < 0.001) (Figure 3). Scores in all domains of OHIP-14 (functional limitation, physical limitation, psychological limitation, and social limitation) were higher in pSS patients than in controls. The pSS group had a significantly lower mean VASEQ5D sum score than the control group (6.67 ± 2.02 95% CI 6.13 to 7.22 vs. 8.28 ± 1.02 95% CI 7.99 to 8.57; p < 0.0001).

Figure 3.

Oral health-related quality of life (OHRQoL) in patients with pSS and healthy controls. Patients with pSS had a significantly higher mean OHIP-14 sum score based on the results of a short-form of Oral Health Impact Profile (OHIP-14) questionnaire than healthy controls reflecting poorer OHRQoL (6.79 ± 7.03; 95% CI −0.19 to 4.73 vs. 2.27 ± 8.46; 95% CI 4.90 to 8.67, p < 0.0001; Mann-Whitney U test)

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