{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:17:56Z","timestamp":1782494276789,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>To determine salivary flow rate, oral and periodontal status, oral health-related quality of life (OHRQoL), objective and subjective indexes, and serum antibody reactivity in patients with primary Sj\u00f6gren\u2019s disease (pSD). Thirty-one patients with pSD and 31 control subjects participated in this cross-sectional, single-center study. The unstimulated whole salivary flow rate (UWSFR) and stimulated whole salivary flow rate (SWSFR), salivary pH, DMFT index (DMFT = D\u2014decayed, M\u2014missing, F\u2014filled tooth), periodontal pocket depth (PPD), clinical attachment level (CAL), interincisal distance, OHRQoL, objective European League Against Rheumatism (EULAR) SS Disease Activity Index (ESSDAI) and subjective (EULAR SS Patient Reported Index (ESSPRI), 6-items-VAS-SS (Visual Analog Scale), Profile of Fatigue) indexes were analyzed. The patients with pSD had a blood sample taken in the morning between 7 and 10 a.m. for comprehensive laboratory analysis. Patients with pSD had statistically significant lower UWSFR (0.20 vs. 0.90 mL\/min) and SWSFR (0.56 vs. 1.64 mL\/min) values compared with control subjects (p &lt; 0.001, Mann-Withney U test). Salivary pH value of pSD patients was significantly lower compared with control subjects (6.00 vs. 7.00; p &lt; 0.001, Mann-Whitney U test). The mean DMFT index of patients with pSD compared to control subjects was not statistically significant (23.74 \u00b1 7.28 vs. 20.77 \u00b1 5.73; p = 0.08, t-test). Interincisal distance was significantly decreased in the pSD group compared with control subjects (43.80 \u00b1 0.38 vs. 47.60 \u00b1 0.50; p = 0.003, t-test). The prevalence of periodontitis was similar in patients with pSD and control subjects (83.9% vs. 77.4%; p = 0.35, \u03bb2 test). The mean Oral Health Impact Profile (OHIP-49) total score was statistically significantly higher in pSD patients compared with control subjects (32.00 vs. 8.00; p &lt; 0.001, Mann\u2013Whitney U test). Patients with pSD have decreased salivary flow and salivary pH, poor oral health, decreased interincisal distance, high prevalence of periodontitis, and worse OHRQoL. These findings highlight the need for a multidisciplinary approach to the management of patients with pSD that includes physical and psychological aspects of the disease.<\/jats:p>","DOI":"10.3390\/jcm12144804","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T01:58:38Z","timestamp":1689904718000},"page":"4804","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Croatian Primary Sj\u00f6gren\u2019s Disease Oral Health Study: Oral Status and Oral Health-Related Quality of Life"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2137-9665","authenticated-orcid":false,"given":"Ana","family":"Glavina","sequence":"first","affiliation":[{"name":"Dental Clinic Split, 21000 Split, Croatia"},{"name":"Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivona","family":"Bo\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katica","family":"Parat","sequence":"additional","affiliation":[{"name":"Dental Clinic Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dijana","family":"Perkovi\u0107","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Bio\u010dina-Lukenda","sequence":"additional","affiliation":[{"name":"Dental Clinic Split, 21000 Split, Croatia"},{"name":"Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Du\u0161anka","family":"Martinovi\u0107 Kaliterna","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0350-6800","authenticated-orcid":false,"given":"Mislav","family":"Radi\u0107","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"ref_1","first-page":"387","article-title":"Oral Involvement in Patients with Primary Sj\u00f6gren\u2019s Syndrome","volume":"11","year":"2015","journal-title":"Multidisciplinary Care by Dentists and Rheumatologists. Reumatol. Cl\u00edn."},{"key":"ref_2","first-page":"354","article-title":"The Diagnosis and Treatment of Sj\u00f6gren\u2019s Syndrome","volume":"114","author":"Stefanski","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10238-021-00728-6","article-title":"Sj\u00f6gren\u2019s Syndrome: A Systemic Autoimmune Disease","volume":"22","author":"Negrini","year":"2022","journal-title":"Clin. Exp. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/j.jds.2020.11.015","article-title":"Periodontal Conditions in Patients with Sj\u00f6gren\u2019s Syndrome: A Meta-Analysis","volume":"16","author":"Wu","year":"2021","journal-title":"J. Dent. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1136\/annrheumdis-2012-202863","article-title":"UK primary Sj\u00f6gren\u2019s Syndrome Registry. Health-Related Utility Values of Patients with Primary Sj\u00f6gren\u2019s Syndrome and Its Predictors","volume":"73","author":"Lendrem","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.oooo.2012.03.010","article-title":"F2-Isoprostanes in soft oral tissues and degree of oral disability after mandibular third molar surgery","volume":"114","author":"Parrini","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.ijom.2013.07.003","article-title":"The role of preoperative oxidative stress and mandibular third molar postoperative outcome","volume":"42","author":"Chisci","year":"2013","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/2231-0762.115700","article-title":"Oral health related quality of life","volume":"3","author":"Bennadi","year":"2013","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.3325\/cmj.2008.4.536","article-title":"Psychometric Properties of Croatian and Slovenian Short Form of Oral Health Impact Profile Questionnaires","volume":"49","author":"Marion","year":"2008","journal-title":"Croat. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/j.1365-2842.2008.01919.x","article-title":"Quality of life in patients with Sj\u00f6gren\u2019s syndrome and sicca complex","volume":"35","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1136\/ard.2009.110619","article-title":"EULAR Sjogren\u2019s Syndrome Disease Activity Index: Development of a Consensus Systemic Disease Activity Index for Primary Sjogren\u2019s Syndrome","volume":"69","author":"Seror","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1136\/ard.2010.143743","article-title":"EULAR Sj\u00f6gren\u2019s Task Force. EULAR Sj\u00f6gren\u2019s Syndrome Patient Reported Index (ESSPRI): Development of a Consensus Patient Index for Primary Sj\u00f6gren\u2019s Syndrome","volume":"70","author":"Seror","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/art.39859","article-title":"ACR-EULAR Classification Criteria for Primary Sj\u00f6gren\u2019s Syndrome: A Consensus and Data-Driven Methodology Involoving Three International Patient Cohorts","volume":"69","author":"Shiboski","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1749-6632.1993.tb18343.x","article-title":"Methods for collecting saliva","volume":"694","author":"Navazesh","year":"1993","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0266-4356(97)90007-3","article-title":"Establishing a Normal Range for Mouth Opening: Its Use in Screening for Oral Submucous Fibrosis","volume":"35","author":"Cox","year":"1997","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_16","unstructured":"(2022, March 13). Oral Health Database. Available online: www.mah.se\/CAPP\/Methods-and-Indices\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1046\/j..2003.com122.x","article-title":"The World Oral Health Report 2003: Continuous Improvement of Oral Health in the 21st Century-the Approach of the WHO Global Oral Health Programme","volume":"31","author":"Petersen","year":"2003","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_18","unstructured":"World Health Organization (1997). Oral Health Surveys-Basic Methods, World Health Organization. [4th ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1902\/jop.2007.060264","article-title":"Case Definitions for Use in Population-Based Surveillance of Periodontitis","volume":"78","author":"Page","year":"2007","journal-title":"J. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/j.1600-051X.2009.01408.x","article-title":"A Systematic Review of Definitions of Periodontitis and Methods That Have Been Used to Identify This Disease","volume":"36","author":"Savage","year":"2009","journal-title":"J. Clin. Periodontol."},{"key":"ref_21","first-page":"841","article-title":"The Croatian Version of the Oral Helath Impact Profile Questionnaire","volume":"33","year":"2009","journal-title":"Coll. Antropol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1067\/moe.2001.111551","article-title":"Development of a Visual Analogue Scale Questionnaire for Subjective Assessment of Salivary Dysfunction","volume":"91","author":"Pai","year":"2001","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Xin, W., Leung, C.M., Lo, E., Mok, M.Y., and Leung, M.H. (2020). Sicca Symptoms, Oral Health Conditions, Salivary Flow and Oral Candidia in Sj\u00f6gren\u2019s Syndrome Patients. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103625"},{"key":"ref_24","first-page":"225","article-title":"Sj\u00f6gren\u2019s Syndrome Is Not a Risk Factor for Periodontal Disease: A Systematic Review","volume":"37","author":"Maarse","year":"2019","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1080\/000163501750266684","article-title":"Dental Caries and Dental Health Behavior of Patients with Primary Sj\u00f6gren Syndrome","volume":"59","author":"Christensen","year":"2001","journal-title":"Acta Odontol. Scand."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/j.1601-0825.2005.01224.x","article-title":"Evaluation of Palatal Saliva Flow Rate and Oral Manifestations in Patients with Sj\u00f6gren\u2019s Syndrome","volume":"12","author":"Boros","year":"2006","journal-title":"Oral Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lin, C.-Y., Tseng, C.-F., Liu, J.-M., Chuang, H.-C., Lei, W.-T., Liu, L.Y.-M., Yu, Y.-C., and Hsu, R.-J. (2019). Association between Periodontal Disease and Subsequent Sj\u00f6gren\u2019s Syndrome: A Nationwide Population-Based Cohort Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16050771"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.oooo.2017.11.018","article-title":"Relationship between Sj\u00f6gren Syndrome and Periodontal Status: A Systematic Review","volume":"125","author":"Rocha","year":"2018","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/jcpe.12485","article-title":"Periodontitis Prevalence and Serum Antibody Reactivity to Periodontal Bacteria in Primary Sj\u00f6gren\u2019s Syndrome: A Pilot Study","volume":"43","author":"Lugonja","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1046\/j.1365-2842.2003.01088.x","article-title":"Periodontitis, Caries and Salivary Factors in Sj\u00f6gren\u2019s Syndrome Patients Compared to Sex- and Age-Matched Controls: SECONDARY SJ\u00d6GREN\u2019S SYNDROME","volume":"30","author":"Jorkjend","year":"2003","journal-title":"J. Oral. Rehabil."},{"key":"ref_31","first-page":"e8","article-title":"Effects of Periodontal Treatment on Primary Sj\u022bgren\u2019s Syndrome Symptoms","volume":"31","author":"Rovai","year":"2017","journal-title":"Braz. Oral Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1080\/14397595.2020.1795391","article-title":"Evaluation of Changes in Oral Health-Related Quality of Life over Time in Patients with Sj\u00f6gren\u2019s Syndrome","volume":"31","author":"Azuma","year":"2021","journal-title":"Mod. Rheumatol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gobelji\u0107, M.\u0160., Mili\u0107, V., Pejnovic, N., and Damjanov, N. (2020). Chemosensory Dysfunction, Oral Disorders and Oral Health-Related Quality of Life in Patients with Primary Sj\u00f6gren\u2019s Syndrome: Comparative Cross-Sectional Study, Research Square.","DOI":"10.21203\/rs.2.21168\/v3"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Schmalz, G., Patschan, S., Patschan, D., and Ziebolz, D. (2020). Oral-Health-Related Quality of Life in Adult Patients with Rheumatic Diseases\u2014A Systematic Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041172"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/eos.12358","article-title":"Oral Disorders, Saliva Secretion, and Oral Health-Related Quality of Life in Patients with Primary Sj\u00f6gren\u2019s Syndrome","volume":"125","author":"Rusthen","year":"2017","journal-title":"Eur. J. Oral Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"762","DOI":"10.4067\/S0034-98872019000600762","article-title":"Association between chronic periodontitis and rheumatoid arthritis. A systematic review","volume":"147","author":"Wen","year":"2019","journal-title":"Rev. Med. Chil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/prd.12385","article-title":"Periodontitis and Rheumatoid Arthritis: What Have We Learned about Their Connection and Their Treatment?","volume":"87","author":"Sanz","year":"2021","journal-title":"Periodontol. 2000"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"539","DOI":"10.2147\/PPA.S159621","article-title":"Complex Interrelations between Self-Reported Oral Health Attitudes and Behaviors, the Oral Health Status, and Oral Health-Related Quality of Life","volume":"12","author":"Vigu","year":"2018","journal-title":"Patient Prefer. Adherence"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4804\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:16:08Z","timestamp":1760127368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,21]]},"references-count":38,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12144804"],"URL":"https:\/\/doi.org\/10.3390\/jcm12144804","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,21]]}}}