Can Sjogren’s syndrome present with just dry mouth only?

If you’ve been suffering from dry mouth, could this be Sjogren’s syndrome, even though you don’t have any other symptoms or ailments?

After all, one of the hallmark symptoms of Sjogren’s (pronounced show-grens) syndrome is a very dry mouth.

This situation can have a variety of causes, and one of the most notable causes, if not the absolute most notable, is that of medication side effects.

Hundreds of prescription drugs can cause dry mouth. But what if you haven’t been on any medication at all?

What if you don’t have diabetes (another cause)? AIDS and Parkinson’s disease can also be culprits.

But you’re healthy; thus, might you have Sjogren’s syndrome with only that one symptom of dry mouth?

“Dry mouth and dry eyes are important components of Sjögren’s syndrome and indicate the presence of inflammation in the salivary glands, and in a whole variety of other exocrine glands (exocrine glands are the glands putting the secretions out into the body and not into the circulation),” explains Ali D. Askari, MD, Professor of Medicine – Case Western Reserve University; Chief, Division of Rheumatology – University Hospitals Case Medical Center; Director, Rheumatology – University Hospitals Case Medical Center. Sjogren’s syndrome causes joint pain or stiffness in many patients.

It’s possible for dry mouth to be the first sign of Sjogren’s syndrome, and the only symptom for many years before other symptoms (e.g., dry eyes, joint pain, a burning throat) begin setting in.

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But usually, the Sjogren’s dry mouth is also accompanied with dry eyes (which may include itchiness, burning or a gritty feeling in the eyes). In 80 percent of patients, joint aches or pain are present.

Antibodies that are associated with Sjogren’s syndrome are present in 60-70 percent of patients.

Dr. Askari explains, “In the absence of clinical manifestations and in the absence of antibodies, one can proceed with doing a lip biopsy, which is a small incision biopsy of the (inside of) lips, that indicates the presence of inflammatory changes, that supports the diagnosis of Sjögren’s syndrome.”

This is because the lips contain salivary glands, and when Sjogren’s syndrome diminishes saliva production, dry mouth results.

“In the absence of all these findings, one can presume that the dryness of the mouth and eyes are due to causes other than Sjögren’s syndrome.

“These include iron overload in the body referred to as hemochromatosis, hyperlipidemia (excess fat in the blood), sarcoidosis (formation of inflammatory cellular clumps that can exist throughout the body), and other immunologic disease, which leads to the inflammatory changes of salivary and lacrimal (tear duct) glands.”

When a person has just dry mouth along with dry eyes, this is called sicca syndrome.

“Occasionally dryness of the mouth and eyes precede other manifestations of Sjögren’s syndrome for years.

“This is particularly important in the close relatives of those who have already been diagnosed with primary Sjögren’s syndrome based on the criteria established for this diagnosis.”

For a diagnosis of Sjogren’s syndrome, the dry mouth (or eyes) must be present for three months; there must be objective findings such as chronic enlargement of salivary glands; and a lip biopsy must be positive for antibodies.

There are two other causes of dry mouth, but not chronic: salivary gland infection, and salivary gland “stones,” which are mineral deposits that become large enough to block the portals of the salivary glands through which saliva is secreted.

The latter is fairly common and can present with just dry mouth, but may also present with trouble swallowing, opening the mouth, and pain in the mouth or face. Sometimes there are no symptoms, however.

Dr. Askari’s special interests include diseases of the muscles, fibromyalgia, general rheumatology, lupus and Sjögren’s syndrome.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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