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Yesterday was World Oral Health Day and in honor of this day, we would like to share the Foundation’s advocacy initiatives for oral health in Sjögren’s. 

World Oral Health Day

World Oral Health Day is an initiative sponsored by the FDI World Dental Federation, which represents more than one million dentists worldwide raising awareness about the importance of good oral health and its role in securing overall health and well-being. 

The goal of World Oral Health Day is to reduce the burden of oral health conditions in hopes to achieve optimal health for everyone. The current theme for World Oral Health Day is “Happy Mouth, Happy Body.”

Sjögren’s and Oral Health                                                     

Sjögren’s patients know a lot about an unhappy mouth. According to the Foundation’s Living with Sjögren’s patient survey,1 dry mouth is one of the top-most experienced symptoms. Dry mouth in Sjögren’s interferes with daily activities such as eating, swallowing, and talking, but is also accompanied by more serious tissue and glandular complications. This can lead to oral pain, Candida (yeast) infections, sores, tooth decay and loss, gum disease (periodontitis) and other serious oral health conditions. In fact, over 30% of Sjögren’s patients reported experiencing tooth decay, mouth sores, and dental caries/cavities, and approximately 85% of Sjögren’s patients have at least one diagnosed oral health condition in addition to dry mouth.1 

Oral health, as mentioned in the World Oral Health Day theme, can also affect the body. Systemic complications can arise from poor oral health, including risk of cardiovascular disease, pulmonary complications, and sepsis, among others.2,3 

Importance of Oral Health Coverage for Sjögren’s Patients 

Dental appointments are critical not only for dental caries, but also for examination of the major (parotid) salivary glands and minor salivary glands to monitor inflammation and other serious complications for Sjögren’s patients. In Sjögren’s and other autoimmune diseases, the salivary glands are a key site for the development of Mucosa-Associated Lymphoid Tissue (MALT) non-Hodgkin B-cell lymphoma. Approximately 10% of Sjögren’s patients develop a non-Hodgkin B-cell lymphoma.4,5,6 Patients that develop dental caries and periodontal diseases are at risk for bacterial infections that can cause complications such as sepsis and cellulitis in immunocompromised individuals. 

Oral healthcare places a significant financial burden on Sjögren’s patients who reported that dental care ($1580), on average, was the most significant, single cost of their disease management.1 Not only is dental care expensive for patients, but many symptomatic treatments for dry mouth and other oral manifestations are prescription drugs or costly over the counter (OTC) preventive treatments. 

Sjögren’s Foundation Oral Health Initiatives

The Foundation is proud to continue advocacy efforts to improve oral health for our patients.

Request for Information for Prescription to OTC switch

To address the accessibility and cost of prescription drugs and OTC preventive treatments, the Foundation wrote a response to the information request from the Administration that would demonstrate the need for a prescription-to-OTC switch for several products as well as coverage of OTC preventive products. One of our key points was that accessibility to treatment may be improved, but the cost of OTC products for our patients is also a significant financial burden.

Center for Medicare and Medicaid Services (CMS) Proposal for Medicare Coverage of Dental Services for Autoimmune Disease Patients

Last February, the Foundation submitted our first nomination to the CMS for coverage of medically necessary dental services for systemic autoimmune diseases. Despite CMS agreeing with the overwhelming evidence to support the benefit of dental services for individuals with autoimmune diseases, CMS did not move forward with the nomination due to lack of precedent for previously Medicare-covered services. However, CMS recommended that we resubmit and consider circumstances where dental services are linked to a specific Medicare-covered service, instead of a diagnosis. For more information on the first CMS ruling, you can learn more here.

This year, CMS announced that it would cover dental or oral examinations as part of a comprehensive workup prior to some Medicare-covered immunosuppressive or immunomodulatory cancer treatments. CMS established the link between dental services and these cancer treatments stating that proceeding with therapy without a dental or oral exam could lead to systemic infection or sepsis, which could lead to worse outcomes for the patient. 

Currently, the Foundation has resubmitted a nomination with other autoimmune disease organizations to align with this new parameter for Medicare-covered dental services. Our new nomination reflects the need for dental coverage for individuals with autoimmune disease who are undergoing immunosuppressive or immunomodulatory therapy, aligning care strategy with CMS’s decision to cover dental services for immunosuppressed cancer patients. There is considerable evidence to support the nomination as patients undergoing immunosuppressive therapy are highly susceptible to serious infections, which can result from poor dentition. 

We are currently arranging a meeting with CMS to have our oral medicine and Sjögren’s experts present the necessity for this dental coverage. Congressman Morelle, who presented our Resolution to the House, is also circulating a letter of support for our CMS nomination. CMS will make their ruling and publish in late June or July...and we hope they rule in our favor.

What can you do to support the Foundation’s initiative? 

TAKE ACTION! Please call your Congressperson and ask them to sign the Congressman Morelle letter to CMS regarding dental coverage for individuals with autoimmune diseases. If you do not know who your member of Congress is, please click here:


  1. Living with Sjögren's: Summary of Patient Survey. The Sjögren's Foundation; 2022
  2.  Kotronia, Eftychia et al. “Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA.” Scientific Reports, vol. 11,1 16452. 12 Aug. 2021, doi:10.1038/s41598-021-95865-z
  3. Sanz, Mariano et al. “Periodontitis and cardiovascular diseases: Consensus report.” Journal of Clinical Periodontology, vol. 47,3 (2020): 268-288. doi:10.1111/jcpe.13189
  4. Ekström Smedby, Karin et al. “Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the InterLymph Consortium.” Blood, vol. 111,8 (2008): 4029-38. doi:10.1182/blood-2007-10-119974
  5. Goulabchand, Radjiv et al. “Cancer incidence in primary Sjögren's syndrome: Data from the French hospitalization database.” Autoimmunity Reviews, vol. 20,12 (2021): 102987. doi:10.1016/j.autrev.2021.102987
  6. Hernández-Molina, Gabriela et al. “Characterization and outcomes of 414 patients with primary SS who developed hematological malignancies.” Rheumatology (Oxford, England), keac205. 6 Apr. 2022, doi:10.1093/rheumatology/keac205