Having a dry mouth can be a problem in and of itself. It can make it difficult to swallow food and talk. But it’s also a common symptom of Sjögren’s disease, and it can lead to other oral (mouth) health issues like mouth sores, pain, infections, tooth decay, and gum disease. In fact, the majority of people living with Sjögren’s — about 85 percent of them — have at least one oral health condition in addition to dry mouth.

Your oral hygiene plays a significant role in your overall health. Poor oral health can lead to complications throughout the body, such as infections that may affect the heart, lungs, or other parts of the body. Sjögren’s disease and other chronic conditions, meanwhile, also can take a toll on your mouth’s health.

The good news is that regular dental checkups and good oral hygiene practices can help to keep your mouth healthy. Here, we discuss Sjögren’s disease and mouth sores, including how the condition can cause these oral issues and what you can do to manage them.

How Sjögren’s Disease Can Cause Mouth Sores

Sjögren’s disease is an autoimmune disease that affects the eyes and mouth. It can occur either in the absence of other autoimmune disorders — called primary Sjögren’s disease — or with other autoimmune conditions like lupus or rheumatoid arthritis — called secondary Sjögren’s disease. It was previously known as Sjögren’s syndrome.

In people with Sjögren’s disease, the immune system mistakenly attacks the glands in the eyes and mouth that produce tears and saliva. This produces inflammation that damages the moisture-producing glands and causes them to stop working properly, resulting in uncomfortably dry eyes and dry mouth.

Saliva has several functions within the mouth, including:

• Forming a barrier to protect the mouth from bacteria (germs)
• Washing away food particles that contribute to tooth decay
• Balancing acids from food and drinks that wear away tooth enamel
• Repairing damaged enamel

Without enough saliva, the mouth’s natural, protective balance is disrupted. This imbalance makes you more prone to oral issues like mouth sores, tooth decay, gum disease, and different types of infections.

Types of Mouth Sores in Sjögren’s Disease

Mouth sores are more common among people living with Sjögren’s disease. Results from a survey conducted by the Sjögren’s Foundation showed that around one-third of people with the autoimmune disorder had mouth sores, tooth decay, or cavities.

Here are some types of mouth sores and issues commonly found in people living with Sjögren’s disease.

Mouth Ulcers

Mouth ulcers are sores that look red, white, or yellow. They can form anywhere in the mouth, including soft tissues, the tongue, and the roof of the mouth. Although mouth ulcers can cause discomfort and pain, they usually resolve on their own within a couple of weeks. According to the Sjögren’s Foundation survey, around 38 percent of people with the autoimmune disease report having mouth ulcers or sores.

The term mouth ulcer is used to describe many types of mouth sores including oral lichen planus (white, lacy sores) and sores related to chewing tobacco. A sore that doesn’t heal can also be a sign of oral cancer. Canker sores and oral thrush also fall into the mouth ulcer category.

One study that looked at people with primary Sjögren’s disease found that 7 percent developed lichen planus and almost 4 percent had recurring canker sores.

Canker Sores

Canker sores are tiny, round lesions that form over areas of soft tissue in the mouth. These sores commonly have a yellow or white center surrounded by a border of red. They can affect the inside of cheeks and lips, the bottom of gums, the top or bottom of the tongue, and the soft palate (back, flexible section of the mouth).

They’re not contagious and they often go away on their own. That said, they can cause discomfort and pain that makes it hard to do things like eat. Some people may feel a strange burning or tingling in the canker sore spot before it forms. Canker sores that don’t heal within two weeks or are especially big or painful should be evaluated by a doctor or dentist.

Thrush

Oral candidiasis — better known as oral thrush — is another common oral complication of Sjögren’s disease. Thrush is a fungal infection caused by yeast overgrowth (yeast infection). People with oral thrush may notice raised, white spots on their tongue or cheeks that resemble cottage cheese. When these spots become inflamed, they can become painful and red.

Researchers have linked low saliva levels and oral thrush, which may explain why the fungal infection is more common among people with Sjögren’s disease.

Angular Cheilitis

Angular cheilitis is a condition that affects the sides of the mouth and is triggered by dryness. It causes the skin at the corners of your mouth to appear cracked and irritated. Although it’s sometimes mistaken as a contagious cold sore, you can’t pass on angular cheilitis to someone else.

In addition to Sjögren’s disease, angular cheilitis can be triggered by other causes of dryness like eczema, drooling during sleep, and oral thrush. The cracked skin can sometimes become infected, requiring treatment. One review noted that angular cheilitis was the most common oral complication of Sjögren’s disease.

Burning Sensations

Having a dry mouth can lead to another complication of Sjögren’s disease called burning mouth syndrome. As the name suggests, this condition causes a burning feeling in the mouth. The burning sensation can range from moderate to severe and last for months or years. Pain may come and go depending on the time of day or remain constant. Burning mouth syndrome may also cause feelings of numbness or tingling, a metallic or bitter taste, and a sore mouth.

Common Triggers of Mouth Sores

Even though Sjögren’s disease increases your risk of these oral issues, it’s important to keep in mind that there are other reasons you might have a mouth sore. Common causes of irritation that can lead to mouth sores include:

• Consumption of food or drink that’s too hot, spicy, or acidic
• Dehydration
• Trauma, such as from biting parts of your mouth, broken teeth, or dentures that don’t fit well
• Stress or illness that weakens the immune system
• Hormonal changes
• Use of chewing tobacco
• Vitamin deficiency, such as too little vitamin B12 or folate

Managing Oral Symptoms in Sjögren’s Disease

To manage mouth sores and other oral Sjögren’s issues, you’ll need to address their root cause. Several treatment options can help you deal with dry mouth caused by dysfunctional salivary glands.

Self-Care Treatments

Staying hydrated is important when living with Sjögren’s. Sipping water or another nonalcoholic beverage throughout the day can help keep your mouth moist. It’s also important to limit acidic drinks to protect your tooth enamel. Avoid caffeine, alcohol, and alcohol-containing products like mouthwash, as they can make dry mouth worse. Avoid smoking can also help.

Practicing good dental hygiene, such as brushing and flossing your teeth after each meal, can also help reduce the risk of oral symptoms.

Sugar-free lozenges, gum, or candy can help to promote saliva production and flow. Make sure to avoid sugary versions to avoid tooth decay.

Similar to artificial tear eye drops, you can also try over-the-counter artificial saliva products to lubricate your mouth.

Saline (salt water) sprays for the nose can help to clear out any congestion in your nose that may be causing you to breathe through your mouth.

Medications

Depending on what type of mouth sore you’re dealing with, you may need medication to help resolve it. If over-the-counter and home remedies for dry mouth aren’t helpful or you have symptoms of an infection like oral thrush, talk to your doctor about other treatment options.

Your healthcare provider may prescribe medications that increase the amount of saliva your body produces. If you’re dealing with oral thrush, your doctor will likely prescribe antifungal medications to treat the infection. Your provider may also recommend other medications to deal with the underlying inflammation from Sjögren’s.

Regular Dental Checkups

Keeping up with regular dental appointments is essential for people living with Sjögren’s who have a higher risk of tooth decay. Make a point to see your dentist at least twice a year. At your checkup, your dentist will assess your teeth, gums, and salivary glands for signs of inflammation and other Sjögren’s complications, such as lymphoma. Your dentist will communicate with your rheumatology and primary care providers to best manage your condition.

The American Dental Association (ADA) recommends that people with Sjögren’s disease who have dry mouth use topical fluoride. Talk with your dentist about whether prescription fluoride toothpaste or mouthwash would be right for you. Nonfluoride remineralizing agents may also be suggested for people with a high volume of cavities. Antimicrobial treatments like chlorhexidine may be an option for people with cavities located within the roots of their teeth.

Join the Conversation

On MySjögrensTeam, people share their experiences with Sjögren’s disease, get advice, and find support from others who understand.

How do you manage mouth sores? Let others know in the comments below.