Oral Burden of Sjögren Disease: A Systematic Review and Meta-analysis

Primary Sjögren disease (pSjD) is associated with a wide range of oral manifestations, including mucosal alterations such as oral ulcers, stomatitis, angular cheilitis, papillary atrophy, and tongue fissuration, as well as oral sequelae of sicca symptoms, including dysphagia, dysgeusia, and chewing difficulties. In addition to these oral findings, pSjD also presents with systemic manifestations such as arthritis, cutaneous vasculitis, and involvement of internal organs. This systematic review and meta-analysis aimed to assess the risk of oral disorders and differences in cariological and periodontal indices in pSjD patients compared with controls. The systematic search was conducted in PubMed, EMBASE, and CENTRAL on November 8, 2024 (PROSPERO: CRD42024608240). Studies meeting the eligibility criteria included adult patients with pSjD. Primary outcomes included the odds ratio (OR) and prevalence of oral disorders as well as the mean difference (MD) and single mean values of dental indices. Meta-analyses were performed using random-effects models to calculate pooled outcome measures and corresponding 95% confidence intervals (CIs). Seventy-five studies were included in the systematic review, with 49 eligible for meta-analysis. The following oral disorders showed increased risk: candidiasis (OR: 10.5; CI: 6.99 to 15.79), dysphagia (OR: 26.78; CI: 20.94 to 34.25), dysgeusia (OR: 17; CI: 4.52 to 63.96), stomatitis (OR: 2.65; CI: 2.17 to 3.23), angular cheilitis (OR: 6.31; CI: 1.94 to 20.53), papillary atrophy (OR: 6.68; CI: 1.12 to 42.16), and fissured tongue (OR: 11.72; CI: 3.42 to 40.18). Patients with pSjD were found to have fewer teeth (MD: -2.16; CI: -4.27 to -0.05) and a higher decayed, missing, filled teeth (MD: 4.72; CI: 3.01 to 6.43) and decayed, missing, filled surfaces (MD: 20.45; CI: 10.16 to 30.74) scores. Furthermore, periodontal parameters showed no significant differences. Patients with pSjD have up to a 30-fold higher risk of developing various oral disorders, emphasizing the need for preventive dental care and early recognition.