A Tutorial on Saliva's Role in Swallowing With a Focus on Sjögren's Syndrome

• Published in: American journal of speech-language pathology Vol. 29; no. 3; pp. 1307 - 1319
• Main Authors: Letawsky, Veronica H, Schreiber, Ann-Marie, Skoretz, Stacey A
• Format: Journal Article
• Language: English
• Published: United States American Speech-Language-Hearing Association 01.08.2020
• Subjects: Anatomy; Bibliometrics; Body fluids; Deglutition; Deglutition disorders; Disease; Dysphagia; Enzymes; Etiology; Humans; Interdisciplinary Approach; Measures; Oral hygiene; Pathophysiology; Patients; Physiology; Proteins; Quality of Life; Rating Scales; Saliva; Sjogren's Syndrome - complications; Sjogren's Syndrome - diagnosis; Speech Language Pathology; Swallowing; Xerostomia - diagnosis; Xerostomia - etiology; Canada
• ISSN: 1058-0360; 1558-9110
• DOI: 10.1044/2020_AJSLP-19-00083

Purpose Saliva is integral to swallowing and necessary for oral health. Understanding saliva's origin and properties is important for swallowing assessment and management. Diseases such as Sjögren's syndrome (SS) can affect saliva negatively, often contributing to dysphagia. Our objectives are to (a) highlight saliva's fundamental role in swallowing, (b) provide a bibliometric overview of literature pertaining to SS pathophysiology and effects on saliva, (c) explore implications of salivary changes on swallowing and quality of life in SS and other populations, and (d) provide suggestions for systematic saliva assessment in practice. Method This tutorial reviews saliva production, composition, and involvement in swallowing within health and disease. Using rapid review methodology, we outline the effect of SS on saliva and describe SS etiology, diagnosis, and treatment. We discuss formal saliva assessments and a multidisciplinary approach. Results Saliva plays a vital role in swallowing, particularly lubrication, bolus formation, and oral health. SS affects the salivary glands altering salivary flow rate and composition. We identified 55 studies ( ) measuring salivary changes, grouping them according to four strata demarcated by SS classification criteria updates. For some, xerostomia, dysphagia, and reduced life quality result. Formal saliva assessments include the Clinical Oral Dryness Score, Xerostomia Inventory, and Secretion Rating Scale. Multidisciplinary care is optimal for patients with salivary changes. Conclusion Understanding salivary changes in disease may enhance understanding of swallowing and inform dysphagia practice. Expanding swallowing assessments with formal saliva evaluations, and patient perspectives thereof, may aid in developing bespoke treatments, ultimately improving outcomes and quality of life. Supplemental Material https://doi.org/10.23641/asha.12456449.