💧 Sjögren's Syndrome Oral Dryness Simulator

Lymphocytes Begin Infiltrating the Salivary Glands

Autoreactive T and B cells target the salivary gland as the first oral event.

• Acinar cells: Primary target (saliva-producing units)
• CD4+ T cells: Infiltrate type (periductal foci)
• Near normal: Saliva flow (compensated stage)
• Often silent: Symptom onset (years before diagnosis)

Focal lymphocytic sialadenitis

Lymphocyte clusters form around small salivary ducts.

Autoantibody involvement

Anti-Ro/SSA and anti-La/SSB antibodies mark gland attack.

Reserve capacity masks damage

Remaining acini compensate, so saliva output stays adequate.

Acinar Tissue Is Progressively Replaced by Infiltrate

Ongoing autoimmune attack destroys secretory acini faster than they regenerate.

• ~40-60%: Acinar loss (by this stage)
• Rising: Focus score (lymphocyte foci per 4mm²)
• Declining: Saliva flow (unstimulated rate falls)
• Symptoms emerge: Patient awareness (dry mouth noticed)

Fibrous replacement

Destroyed acini are replaced by fibrous, non-secretory tissue.

Duct epithelium changes

Ductal cells upregulate immune-signaling molecules, worsening the attack.

Xerostomia begins

Reduced flow starts drying speech, chewing, and swallowing.

Severe Hyposalivation Leaves the Mouth Chronically Dry

Glandular destruction now overwhelms compensation, and saliva output collapses.

• <0.1 mL/min: Unstimulated flow (diagnostic threshold)
• ~25-30%: Acinar tissue left (of original volume)
• Drops: Oral pH (buffering capacity lost)
• Impaired: Speech/swallowing (lubrication insufficient)

Loss of salivary buffering

Bicarbonate buffering fails, letting oral pH fall sharply.

Antimicrobial proteins depleted

Lysozyme and lactoferrin drop, weakening the mouth's defenses.

Daily function suffers

Eating dry food, talking, and sleeping all become harder.

Oral Mucosa Turns Atrophic, Fissured, and Fragile

Without lubrication, the mucosal surface thins, cracks, and injures easily.

• Compromised: Mucosal integrity (atrophic epithelium)
• Fissured, lobulated: Tongue changes (papillae loss)
• Common: Angular cheilitis (cracked mouth corners)
• Poor: Denture tolerance (friction ulcers form)

Epithelial thinning

Chronic dryness thins the mucosal lining over time.

Fissuring and trauma

Cracked mucosa tears easily from food or dentures.

Loss of protective mucin

Reduced mucin coating removes the mouth's lubricating shield.

Candidiasis and Rampant Caries Take Hold

Lost salivary protection lets fungal overgrowth and dental decay accelerate rapidly.

• ~70-80%: Oral candidiasis (of severe Sjögren's cases)
• Cervical, rampant: Caries pattern (atypical decay sites)
• Sharply elevated: Tooth loss risk (vs healthy controls)
• Frequent: Denture stomatitis (candida-driven inflammation)

Fungal overgrowth

Candida albicans thrives once antimicrobial saliva disappears.

Rampant dental caries

Lost remineralization drives decay at the gumline and roots.

Compounding cycle

Infection and decay further damage an already fragile mucosa.