Letter to the Editor,“Sjögren’s Disease Is Not a Clinical Risk Factor for Periodontitis”

Reckelkamm et al. (2024) performed a genome-wide association study regarding the association of Sjögren’s disease (SjD) with caries and periodontitis. Their conclusion that SjD promotes periodontitis is in contrast to a systemic review that concluded that SjD is not a risk factor for periodontitis (Maarse et al. 2019). This difference could be caused by differences in patient populations, inclusion/classification criteria, type of analysis, and statistical methods used that differ from any prior study.

Gingivitis, not periodontitis, is indeed a common problem in SjD, but it consists mainly of point bleeding after probing related to an increased accumulation of plaque (Korfage et al. 2016). This was indicated in the systematic review by Yang et al. (2023), who showed that bleeding on probing, plaque index, and gingival index, but not pocket probing depth, were slightly higher in patients with SjD. They also concluded that there is a positive correlation between periodontitis and SjD, but in clinical reality, periodontitis is an exception when adjusted for covariates (e.g., age, sex, diabetes mellitus; Aga et al. 2023). In case of severe hyposalivation, cervical caries progresses so fast that teeth are lost before periodontitis has developed (Jansma et al. 1988; Maarse et al. 2018). We hardly observed any periodontitis in SjD patients (Bootsma et al. 2020).

As gingivitis indeed can be present, it could be expected that a genome-wide association analysis finds markers of periodontitis. However, it can be questioned whether this result has any clinical relevance, as SjD is not a risk factor for periodontitis in clinical reality.