If you’ve been suffering from a cotton dry mouth, could this possibly be Sjogren’s syndrome, even as your only symptom?

One of the hallmark symptoms of Sjogren’s syndrome is the very dry mouth.

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

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

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

But you’re healthy, right? So is it possible to have Sjogren’s syndrome with only that one symptom of dry mouth?

For this article I interviewed 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 in many patients.

“Dry mouth and dry eyes are important components of Sjögren’s syndrome,” begins Dr. Askari, “and indicate the presence of inflammation in the salivary glands, and in a whole variety of other exocrine glands (these glands are the ones putting the secretions out into the body and not into the circulation).”

It’s possible for a cottony dry mouth to be the first sign of Sjogren’s syndrome, and the only symptom actually for many years before other symptoms (such as dry eyes, joint pain, a burning throat) begin to show.

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

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

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

The lips contain salivary glands, and when Sjogren’s syndrome reduces saliva production, dry mouth results.

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

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

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

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

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

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

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

The latter is fairly common and can present with just a dry cottony mouth, but may also present with difficulty in swallowing, opening the mouth, and pain in the mouth or face. Sometimes, though, there are zero symptoms.

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.