The risk of memory complaints and cognitive decline increases with age, leading to many older adults being referred to memory clinics for cognitive screening including a comprehensive geriatric assessment (CGA). Although CGA covers medical, cognitive and social domains, it commonly omits an assessment of oral health, despite evidence linking poor oral health to cognitive impairment and reduced quality of life. This study assessed the value of incorporating an oral health assessment into the CGA and explored differences in oral health between patients with and without dementia. Patients with memory complaints attending a memory clinic between April 2022 and May 2025 were asked to undergo an oral health assessment and complete an oral health questionnaire alongside the CGA. Patients unable to cooperate or incapacitated to consent were excluded. In total, 144 participants were included. The mean age was 73.7 years; 59.7% were male. Most participants had natural dentition (75%), and most had carious lesions (93.5%) and periodontal pockets (97.3%). Among denture wearers, denture-related problems were common (61.7%). No differences in oral health were observed between patients with and without dementia. All participants had at least one oral health problem, regardless of whether or not they had dementia. Integrating structured oral health assessments into the CGA therefor has value as it offers opportunities for early detection, intervention, and prevention for further decline in overall and oral health.

BackgroundIncreasing numbers of people with multimorbidity and polypharmacy reinforce dentists’ needs to use medical information recorded elsewhere. Dentists want to join health information exchange (HIE) networks but are concerned about usability of these networks. Thus, research is needed that compares HIE networks in the context of functionality for dentists. This study aimed to identify to what extent HIE networks meet the functional needs of dentists.MethodsA qualitative explorative design using semi-structured interviews was performed on two groups of Dutch participants: 1) dentists and other healthcare professionals, 2) information technology (IT) experts from information system vendors and HIE providers of the nationwide network of infrastructures. Recordings were verbatim transcribed by researcher and validated by participants. Transcripts were analysed using qualitative content analysis and deductive coding in line with a guide for qualitative data analysis (QUAGOL).ResultsIn total 33 participants (18 dentists/medical physicians/pharmacists, 15 IT experts) were interviewed, amongst 4 of 5 HIE providers of the nationwide network. The 5th HIE provider had no clue yet how their HIE approach could work for dentists. Dentists revealed that insight in medical history and medication was needed as well as information exchange on (oral) health related care with other healthcare professionals. Three traditional HIE networks were found to be unsuitable to facilitate needs of dentists. The 4th type, a new approach to HIE, met the needs of dentists. Latter HIE was based on a privacy respecting Trust-over-Internet Protocol (ToIP) with no restrictions on content, form of information and exchange patterns.ConclusionOut of 4 types of HIE networks, traditional HIEs were unsuitable. Only HIE based on ToIP is potentially applicable for dentists. The descriptions abstracted from the interviews regarding practice of working and needed information can be used to further design appropriate, scalable and cost-effective solutions for dentists.

Uniform measurement of the salivary flow rate is crucial in diagnosing hyposalivation and hypersalivation. However, there is considerable variation in the methods used to assess salivary flow rates. This variation of collection methods makes it difficult to compare data and to set well-established threshold values for hypo- and hypersalivation. Therefore, there is a need for standardised methods to measure the salivary flow rates in a clinical setting. This study describes the Dutch consensus statement for measuring unstimulated and stimulated salivary flow rates in a clinical setting. This may help in the development of an international standardised protocol for the assessment of salivary flow rates in clinical settings.

Objective The main purpose of this Xeromeds Consortium study was to assess the impact of systemic medications on unstimulated (UWS) and chewing-stimulated whole saliva (SWS) flow rates in patients with Sjögren disease (SjD) using a matched analysis approach. Methods This retrospective cross-sectional study is based on data of patients with SjD involving 6 oral medicine practices in Europe and the United States from January 2000 to April 2014. Institutional review board approval was obtained. Patients underwent sialometry with measurements of UWS and SWS flow rates. Data on general and oral health, systemic diseases, medication intake, social history, and smoking and alcohol habits were collected in a standardized manner. “Unmatched” and “matched” comparison groups controlled for confounding factors including age, biological gender, and concurrent medications. Data from the matched comparison group compared patient's taking versus patient's not taking a specific medication, matched in by the confounding factors. Descriptive statistics included means/standard deviation, medians, and interquartile ranges. Analysis of variance test was used for age differences, and the χ2 test of independence for gender differences. Significant confounding factors were identified by unadjusted linear regression analysis of the entire patient cohort. Analyses were carried out using the SPSS version 25.0 (IBM Corp) and R-language (R Core Team 2020). Results This study included 302 patients; 284 (94%) were female. The mean age was 56.4 (standard deviation 12.9) years. Linear regression analysis demonstrated that UWS flow rate decreased for older patients. Specifically, for each year of advanced age the estimated UWS flow rate decreases by .002 mL/min; P = .005). No systemic medication and medical condition had a statistically significant effect on UWS and SWS flow rate in both unmatched and matched population. Conclusion Systemic medication does not appear to affect UWS or SWS flow rate in patients with SjD. Furthermore, our study confirms that in older SjD patients, with probably a longstanding disease, saliva secretion is reduced more than in younger patients. Limitations of the study include the limited sample size, and the fact that some classes of medications had too small a sample size to allow for a robust statistical analysis.

Background: Oral health is important for preserving oral function, general health, and overall well-being. However, obtaining and maintaining oral health is challenging for cases with memory complaints. Aim: To assess compliance of older people with memory complaints and oral health problems with given oral health care advice. Material and Methods: Consecutive patients visiting the memory clinic of the University Medical Center Groningen, the Netherlands, between May 2022 and October 2024 for the first time were asked whether they were willing to participate in a prospective study aimed at assessing the oral health and compliance with oral care advice. Exclusion criteria: not understanding Dutch, unable to follow instructions, or being incapacitated. After assessing the oral health and providing oral care advice, the compliance with the oral care advice was assessed after 6 weeks. If the given advice was not followed, another check was done 6 weeks later. Results: All 124 included patients needed oral health care advice. After 6 weeks, 114 of the patients (91.9%) had not followed the oral health care advice. At the recall 6 weeks later, 108/124 patients (87.1%) had still not followed the given advice. Conclusion: The compliance with oral care advice among older people with memory complaints and who need oral care is very low (12.9%).

Objectives The objectives are to evaluate variation in systemic disease activity (European Alliance of Associations For Rheumatology (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI)) over time at group and individual patient level and to assess associations of ESSDAI low disease activity (LDA) with other outcome measures in a standard-of-care cohort of patients with Sjögren’s disease (SjD).Methods Patients with SjD participating in a prospective longitudinal study (REgistry of Sjögren Syndrome LongiTudinal cohort) fulfilling the 2016 American College of Rheumatology/EULAR classification criteria with ≥2 years of follow-up were included. ESSDAI was assessed at least yearly, up to 5 years. Patient-reported, objective glandular and laboratory outcomes were compared between patients with ESSDAI LDA (score<5) for <75% vs ≥75% of time.Results Of 265 included patients with SjD, 236 (89%) were women, median disease duration was 6 years (IQR 2–10) and 114 (43%) received immunosuppressive treatment at some point during follow-up. At group level, median ESSDAI decreased slightly, from 4 (IQR 2–7) at baseline to 3 (IQR 2–5) at year 5, with a concomitant decrease in variation, indicating regression to the mean. At the individual patient level, ESSDAI varied in the majority of patients: 50/102 (49%) untreated patients with ESSDAI<5 at baseline changed to ESSDAI≥5 at least once during follow-up. Of the untreated patients with ESSDAI≥5 at baseline, 41/45 (91%) changed to ESSDAI<5. Patients with ESSDAI LDA for ≥75% of time showed better outcomes on saliva production.Conclusions In this cohort of patients with SjD, overall ESSDAI slightly decreased during 5 years of follow-up, whereas at individual patient level, large variation was seen over time for the majority of patients. Longer time in ESSDAI LDA was associated with better salivary gland outcomes.

This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies. Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article. A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions. This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.

To assess whether Steroid-Refractory chronic Graft-versus-Host Disease (SR-cGvHD) patients with oral involvement benefit from ruxolitinib regarding their clinical symptoms and oral lesions. A prospective real-life observational longitudinal patient study was conducted in patients with SR-cGVHD and oral involvement who were treated with ruxolitinib. The effects of ruxolitinib on oral lesions and symptoms were assessed 12 weeks after the start of treatment with ruxolitinib based on the complete response, partial response, and overall response rate. Additionally, oral mucosal clinical characteristics and symptoms were assessed using validated outcome scales 4 and 12 weeks after treatment. A total of 17 patients was included. Overall response rate after 12 weeks was 77

Objectives:Two different European Reference Networks cover CTDs with paediatric onset, the European Reference Network on Rare and Complex Connective Tissue Diseases (ERN ReCONNET) and the European Reference Network on Rare Immunological Disorders (ERN RITA). The transition of care is a significant focus, with ReCONNET centres actively addressing this through updated programs. Despite these efforts, challenges persist. We aimed to inventory transitional care programs for rare CTDs across Europe. Methods:In April 2023, the ERN ReCONNET Transition of Care Task Force, consisting of expert clinicians, patient advocates and coordination team members, created a survey to assess transitional care practices. The survey was distributed to ERN ReCONNET and ERN RITA centres and responses received by 15 March 2024 were analysed. Results:A total of 67 responses from 59 centres across 20 European countries were collected. Paediatric rheumatologists typically initiated the transition process (49% of centres). Twenty centres had joint clinics. Despite positive self-assessments of transitional programs, significant limitations were noted. Transition policies varied, with only 40% of centres having a formal standardized policy and less than half of the centres adhering to available transition of care guidelines. Transfer readiness was evaluated using validated questionnaires in 13% of centres, while 29% transitioned patients based solely on age without any readiness assessments. The main challenges included finding adult-oriented centres and the lack of guidelines or engagement from adult centres. Adult healthcare providers also noted a lack of training in adolescent medicine. Conclusion:The survey highlighted diverse transition practices and resources across centres, with challenges in readiness evaluation and the use of guidelines. Despite these obstacles, respondents rated ongoing transition processes positively. Enhancing patient perspectives in the transition process is crucial to meet their needs during this critical phase.

A variety of methods are described in the literature for sampling oral microbiota, including their advantages and disadvantages. The aim of this study was to assess which method (swab, paper point, and oral fluid collection) for sampling oral microbiota is most favourable for use on a geriatric population. The oral microbiota of geriatric patients who visited the Geriatric Department of the University Medical Center Groningen (the Netherlands), because of memory complaints, were assessed between April 2022 and April 2023. The samples were collected using three methods: swab, paper point, and oral fluid collection. The participants had to have at least one natural tooth. The samples were checked for 11 oral bacteria commonly associated with oral and general diseases. Of the 30 potentially eligible participants, 28 could be enrolled. A 100% bacteria match was achieved by all 3 sampling techniques between 64% of the cases (18/28) and a 91% match between another 25% (7/28). The swab had the highest positivity rate in this population, as it was easy to perform and usable on edentulous individuals, even on those with (severe) disabilities. Overall, the sampling methods showed comparable microbiota in most cases but differed in the complexity of use. The swab seemed to be the most favourable method among the geriatric participants.

With ageing, chances of illness and physical problems increase; these are often accompanied by the need to use medication. With today s ageing of the population, oral healthcare providers will see increasing numbers of older people with multimorbidity and polypharmacy (using 5 or more different medicines) in their practice. Due to likely complications and possible interactions as a result of oral healthcare interventions, knowledge about health issues and medication used is of great importance. This article aims to inform the reader about issues concerning the use of medication by older people with frailty in the oral healthcare practice. Medicines most often used by older people, problems encountered by oral healthcare providers when acquiring proper insight into the medical situation of an older person with frailty (not merely physical but cognitive and social, too) and medical-dental interactions of medication used by older people are discussed.

Introduction: When replacing a single tooth in the aesthetic zone with an implant, alveolar ridge preservation is necessary in cases with extensive buccal bone defects. Prosthetically driven implant placement in the preserved ridge, followed by an immediate patient-specific temporary restoration, can be achieved with digital treatment planning. A digital workflow incorporates intraoral optical scanning and cone beam computed tomography, enabling a three-dimensional clinical and radiographic anatomy assessment. Furthermore, it facilitates fully guided implant placement by means of computer-assisted surgery and the prefabrication of temporary restorations with a CAD/CAM titanium abutment. Materials and Methods: Three patients with a failing tooth in the maxillary aesthetic zone and a buccal bone defect > 5 mm underwent alveolar ridge preservation. Four months later, a digital workflow was used to place the implant, which was restored with a prefabricated temporary restoration with a patient-specific titanium abutment. The definitive restoration was placed 3 months later. Clinical, aesthetic, radiographic, and patient-reported outcomes were assessed before treatment, 6 weeks after temporary restoration, and 1 month and 1 year following definitive restoration. Results: In all three cases, wound healing after alveolar ridge preservation was uneventful, and the implants could be placed and restored with a temporary restoration, as planned. At the final follow-up, healthy peri-implant tissues were observed with good aesthetics and high patient satisfaction. Conclusion: The three reported cases demonstrate the potential of a digital workflow for delayed implant placement with provisionalization using prefabricated restorations in preserved ridges within the maxillary aesthetic zone.

Dry mouth etiologies, which often present as a combination of hyposalivation and xerostomia, are difficult to differentiate. Employing a combination of a location-based approach in the oral cavity and salivary ion measurement may resolve this differential diagnostic gap. In this light, the aim of this cross-sectional study was to determine the concentrations of salivary sodium, potassium, chloride, phosphate, calcium, ammonium, nitrate, nitrite, fluoride, sulphate and magnesium at 7 intra-oral locations in healthy subjects (N = 30). First, sterile foam tipped applicators were selected as the most suitable tool to take saliva samples from these areas. Ion levels were analyzed using a capillary electrophoresis system. Almost every ion included showed a unique intra-oral distribution pattern across the selected regions. For example, the palate demonstrated the highest sodium concentration and in contrast, the floor of the mouth showed the lowest. The observed distribution patterns were consistent between individuals. Local variations in salivary ion concentrations may be influenced by the positioning of the salivary glands and their associated ducts but could also relate to their function in the oral cavity. The results from our healthy controls can form a reference for future studies and potentially for diagnostic purposes in clinical contexts.

BACKGROUND:Soft tissue grafting at dental implant sites has been proposed to enhance esthetic outcomes. A xenogeneic collagen matrix (XCM) was introduced as an alternative grafting material to connective tissue. Only short-term results are yet available. METHODS:Sixty patients were treated in a randomized controlled trial with a connective tissue graft (n = 20, CTG group), an XCM (n = 20, XCM group), or received no graft (n = 20, NG group). The grafts were placed at the time of implant placement in a preserved alveolar ridge. The primary outcome was a change in mid-buccal mucosal level (MBML) after 5 years (T60). Secondary outcomes were marginal bone level, clinical peri-implant parameters, esthetics, and patient satisfaction. RESULTS:At T60, mean changes in MBML were -0.41 ± 1.20 mm, -0.30 ± 1.22 mm, and -0.61 ± 1.72 mm in the CTG, XCM, and NG groups (p = 0.78), respectively. Also, regarding the secondary outcome variables, no significant between-group differences were observed. CONCLUSIONS:Soft tissue grafting at single implant placement after alveolar ridge preservation, either with a CTG or  XCM, does not result in a better esthetic outcome and should not be considered as a standard procedure. PLAIN LANGUAGE SUMMARY:Implant placement in case of a failing tooth is a favorable treatment option. However, since the extraction socket is often associated with a large bone defect, alveolar ridge preservation with bone grafts prior to implant placement is often needed. To compensate for possible soft tissue defects, the application of a CTG or an XCM has been proposed. The question has arisen whether the use of an XCM will give a better outcome than a CTG. Furthermore, are both soft tissue augmentation therapies accompanied by a better esthetic result than performing no soft tissue therapy at all? Therefore, a 5-year study was carried out in which 60 patients with a failing tooth in the frontal region of the upper jaw were treated with removal of the tooth and restoring the gap with bone graft and sealing the socket with mucosagraft from the tuberosity region. At the time of implant placement 5 months thereafter, 20 patients received a CTG, 20 patients received an XCM, and 20 patients no soft tissue therapy. After 5 years, it appeared that there was no difference between the 3 soft tissue treatment procedures. Thus, implant placement combined with soft tissue grafting in preserved alveolar ridges does not result in a better esthetic outcome.

BACKGROUND:Cancer patients are at risk of developing a wide range of treatment-related toxicities that may affect the head and neck region. Iatrogenic necrosis of bone and soft tissue in this area represents a distinct clinical entity characterized by significant complexities and challenges, arising as a consequence of radiotherapy (osteoradionecrosis) or the administration of bone-modifying and/or antiangiogenic therapies (medication-related osteonecrosis of the jaw). OBJECTIVE:This review provides a comprehensive understanding of this potentially highly impactful complication of cancer therapy and antiresorptive therapy by examining its pathophysiology, risk factors, clinical presentation, and management strategies. RESULTS:Risk factors associated with these conditions include radiotherapy-related variables, medication-related factors, and local predisposing conditions. CONCLUSION:This review highlights the importance of preventive strategies, including comprehensive dental evaluations and the development of personalized treatment plans before, during, and after cancer therapy, as well as when patients are undergoing or are expected to undergo treatment with bone-modifying medications. By addressing these critical aspects, clinicians can better manage and mitigate the impact of this challenging complication on the quality of life and morbidity outcomes.

Background: Sjögren's disease (SjD) is a complex systemic autoimmune disease with substantial morbidity and 21 known genetic associations. The International Sjögren's Genetics Network (SGENE) is a growing international collaboration focused on understanding how genetic variants influence SjD pathology. As sample sizes increase, we are focusing our efforts on the analyses of clinical subsets, which few studies have done. Objectives: Our genome-wide association study (GWAS) aimed to identify additional risk loci of genome-wide significance (GWS, p<5E-08; suggestive, p<5x10E-5) in European-derived subsets of SjD. Methods: This study was conducted with IRB/EC approvals. All SjD patients met the 2002 AECG criteria for SjD. A total of 5058 cases and 25943 controls were genotyped on GWAS arrays. After QC, 4855 cases and 25408 controls were included in the analyses. Logistic regression was calculated, adjusting for ancestry using the first 4 principal components to identify SjD-associated SNPs. Cases were split into Ro/SSA+ (n=2898) and Ro/SSA- (n=1313), and analyzed vs. each other, controls, and all-SjD. Results: We observed many differences in the genomic architecture of Ro/SSA- compared to Ro/SSA+ and all SjD (Figure 1a,b), most notably, a complete loss of the significance of the association with MHC on chromosome 6 in the Ro/SSA- cases(Figure 1b). The Ro/SSA+ subjects had a much stronger HLA association with OR ≈ 4 (Figure 1a), while the overall SjD showed OR ≈ 3. While none of the associations observed in the Ro/SSA- population reached GWS, 8 regions (near PLXNA2, PCDH7, IRF5-TNPO3, DLD, LOC100134229, JAK3, LOC643529, and TMTC1) show suggestive associations (Figure. 1a). Of these, only two, IRF5-TNPO3 and LOC643529, are also suggestive in the Ro/SSA+ subset. However, while the Ro/SSA+ have both the IRF5 promoter effect and the extended haplotype through TNPO3, the Ro/SSA- lack the IRF5 promoter effect. Interestingly, previous studies have shown that lupus and systemic sclerosis have both haplotypes while primary biliary cholangitis only has the haplotype extending into TNPO3, similar to Ro/SSA- SjD [1]. When comparing Ro/SSA- to the all-SjD dataset, PLXNA2 and LOC100134229 showed no association; PCDH7, DLD, and TMTC1 showed some association but did not reach suggestive levels; and LOC643529, IRF5-TNPO3, and JAK3 surpassed the suggestive threshold, the latter two nearing or surpassing GWS. Two of the novel suggestive associations in Ro/SSA- are particularly intriguing. PLXNA2 is a member of a semaphorin co-receptor family that mediates repulsive effects on axon pathfinding during nervous system development; interestingly, Ro/SSA- SjD has a higher frequency of neurological involvement. JAK3 is a member of the Janus kinase (JAK) family of tyrosine kinases involved in cytokine receptor-mediated intracellular signal transduction; it is predominantly expressed in immune cells. Mutations in this gene are associated with autosomal severe combined immunodeficiency disease. Novel drugs target the JAK-STAT pathways, making this finding markedly relevant. Conclusion: Our findings highlight the relevance of expanding genetic studies to specific subphenotypes of the disease. While we continue to increase our GWAS sample size and explore other subphenotypes, more work is needed to increase the power of these studies to determine if the suggestive regions will surpass the GWS threshold. REFERENCES: [1] Kottyan LC, et al. Hum Mol Genet. 2015 Jan 15;24(2):582-96. Acknowledgements: NIH/NIAMS R01 AR073855, P50 AR060804; NIH/NIDCR U01DE028891; Sjögren's Foundation; Jerome L. Greene Foundation. Disclosure of Interests: Astrid Rasmussen: None declared, Marcin Radziszewski: None declared, Bhuwan Khatri: None declared, Kandice L Tessneer: None declared, Elena Pontarini: None declared, Michele Bombardieri: None declared, Maureen Rischmueller: None declared, Marie Wahren-Herlenius: None declared, Marika Kvarnström: None declared, Torsten Witte: None declared, Hendrika Bootsma: None declared, Gwenny M. Verstappen: None declared, Frans G.M. Kroese: None declared, Arjan Vissink: None declared, Sarah Pringle: None declared, Athanasios Tzioufas: None declared, Clio Mavragani: None declared, Alan Baer Received consulting fees from Bristol Myers Squibb (BMS) and iCell Gene Therapeutics., Marta Alarcon-Riquelme: None declared, Javier Martin: None declared, Xavier Mariette: None declared, Gaetane Nocturne: None declared, Jacques-Olivier Pers: None declared, Jacques-Eric Gottenberg: None declared, Wan-Fai Ng I have consulted for Novartis, BMS, Janssen, Sanofi, Abbvie, IQVIA, Argenx, Resolve Therapeutics., Caroline Shiboski: None declared, Kimberly E Taylor: None declared, Lindsey Criswell: None declared, Blake M Warner: None declared, A Darise Farris Grant/research support from Johnson and Johnson Innovative Medicine (formerly Janssen; ended 12/31/2023)., Judith A. James: None declared, R Hal Scofield Received consulting fees from Johnson and Johnson Innovative Medicine (formerly Janssen) and Merk Pharmaceuticals., Joel M Guthridge: None declared, Daniel J Wallace: None declared, Swamy Venuturupali: None declared, Michael T Brennan: None declared, Juliana Imgenberg-Kreuz: None declared, Lars Ronnblom: None declared, Eva Baecklund: None declared, Maija-leena Eloranta: None declared, Lara A Aqrawi: None declared, Øyvind Palm: None declared, Johan G Brun: None declared, Daniel Hammenfors: None declared, Malin V Jonsson: None declared, Silke Appel: None declared, Sara Magnusson Bucher: None declared, Helena Forsblad-d'Elia: None declared, Thomas Mandl Employee of UCB., Per Eriksson: None declared, Gunnel Nordmark: None declared, Christopher J Lessard Grant/research support from Johnson and Johnson Innovative Medicine (formerly Janssen; ended 12/31/2023).

INTRODUCTION:The complex nature of Sjögren's Disease (SjD) necessitates a comprehensive and patient-centered approach in both diagnosis and management. This narrative review emphasizes the need for a holistic understanding of the connection between salivary gland inflammation and oral symptoms in SjD. AREAS COVERED:The intricate relationship between salivary gland inflammation and dry mouth is explored, highlighting the variability in associations reported in studies. The association of the severity of xerostomia and degree of inflammation is also discussed. The frequent presence of recurrent sialadenitis in SjD further accentuates the connection of compromised salivary gland function and inflammation. The review additionally discusses local inflammatory factors assessed through salivary gland biopsies, which could potentially serve as predictors for lymphoma development in SjD. Insights into compromised quality of life and hypercoagulable state and their association with salivary gland inflammations are provided. Advancements in noninvasive imaging techniques, particularly salivary gland ultrasonography and color Doppler ultrasound, offer promising avenues for noninvasive assessment of inflammation. EXPERT OPINION:There is a need for longitudinal studies to unravel the connections between salivary gland inflammation and oral symptoms. This will enhance management strategies and optimize treatment outcomes for SjD patients.

Objective To analyse intraobserver and interobserver reliability of colour Doppler (CD) ultrasonography of the major salivary glands (SGUS) in patients clinically suspected of Sj & ouml;gren's disease (SjD). Methods One hundred consecutive outpatients visiting the University Medical Center Groningen for a diagnostic trajectory because of a suspicion of SjD were evaluated using CD ultrasonography of the submandibular and parotid salivary glands. All images were independently assessed by four observers (two experienced observers, one lesser experienced resident, one inexperienced trainee) in two sessions using the Outcome Measures in Rheumatology (OMERACT) CD scoring system (scale 0-3). A total score was calculated as the sum of the scores of the 4 glands (scale 0-12). Intra- and interobserver reliability, and reliability of live versus static scores were determined. Factors influencing variability in scores were analysed. Results Intraobserver weighted Cohen's kappa's of individual glands ranged from 0.23 (inexperienced observer) to 0.81 (experienced observer). Intraclass Correlation Coefficients (ICCs) for intraobserver reliability of the total CD score ranged from 0.53 (inexperienced observer) to 0.90 (experienced observer). The ICC for intraobserver reliability of live scoring compared to static images was 0.72. ICCs for interobserver reliability of the total CD score were 0.81 for session 1 and 0.71 for session 2. Patient variance was 74.1%, whereas residual variance contributed 15.5% to the total variance. Conclusion CD SGUS is a reliable imaging technique to visualise intraparenchymal vasculature in patients suspected of SjD, and therefore could be an asset in daily clinical practice. It requires, however, experience and prior training.