Nutrition and Oral Medicine (Nutrition and Health)

Chapter 14 / Autoimmune Diseases 2574.3.4. TREATMENTThere is no cure for SS, and treatment focuses largely on minimizing the symptoms.Artificial tears help protect the eyes. Saliva substitutes are available but are not easyto use or particularly effective. When there is evidence of remaining gland function,sialagogue medications (pilocarpine, cevimeline) can be very effective in producingmore saliva. Steroid and NSAIDs have not shown any benefit in saliva or tear production.4.3.5. ORAL HEALTH AND NUTRITION COMPLICATIONS AND MANAGEMENT4.3.5.1. Oral Complications and ManagementThe oral complications of SS can be serious and can dramatically affect quality oflife (39). Xerostomia leading to rampant caries can be very difficult to treat and resultin infection, pain, loss of teeth, and inability to chew properly. Removable prosthesesare not tolerated because of the dry mucosa, irritation, and lack of retention. Candidiasiscan occur because of xerostomia (see Table 4 for treatment). Every effort shouldbe made to prevent disease and promote health. Fluoride and frequent evaluation areessential. Diet evaluation and referral to an RD are critical elements of comprehensivecare to minimize caries risk and optimize nutritional value of foods when eating abilityis impaired.4.3.5.2. Nutritional ManagementNutrition management of the patient with SS is challenged by insufficient or totallack of saliva, which serves to moisten food and facilitate mastication of foods, movementof foods in the oral cavity, and swallowing. Depending on the degree of salivaryfunction remaining, eating ability is compromised. Dietary guidelines for xerostomiaare provided in Appendix E. Patients should be instructed to always carry a water bottle,drink fluids with meals, increase fluidity of mealtime foods (gravies, sauces, soups),and avoid “coarse” foods that may irritate the mucosa such as hard bread crusts. Temperatefoods with spices and seasonings adjusted to fit individual tolerances should bepromoted. Small frequent meals are often preferable as eating time may be prolonged.When patients complain of altered taste, simple taste testing in the office to determinetolerable tastes (sweet, salt, bitter, sour) can be done, and those tastes that are bettertolerated can be emphasized. If dairy products are not tolerated, alternative calciumsources should be identified or a calcium supplement should be recommended.5. SUMMARYPatients with autoimmune disorders present significant challenges to oral and nutritionalhealth. Both the disease itself and its medical management can have profoundimpact on oral health and nutrition status, biting, chewing and swallowing ability, diet,and quality of life. Optimal patient management requires coordination and collaborationbetween medical, dental, and nutrition health care providers to minimize risk for disease,manage active disease, and improve quality of life.