Systemic sclerosis with secondary sjögren's syndrome

It can be extremely challenging to diagnose systemic disorders through their oral manifestations. Sometimes, these oral findings can be the only manifestation for years, logically improving the prognosis if identified at an early stage. This case report is about a female patient who had been under medical treatment for a wide range of oral and systemic symptoms including recurrent parotid abscess, which were being treated individually without ascertaining the probable underlying cause. Based on a positive history and clinical evaluation for ocular and oral dryness, sialography, and minor salivary gland biopsy was performed which revealed sialectasis. A diagnosis of Sjögren's syndrome was arrived at and the patient underwent further workup to determine any potential associated disorders. Skin biopsy and serology indicated systemic sclerosis with lung involvement. The patient received intravenous pulse methylprednisolone therapy and symptomatic treatment for oroocular dryness. Apart from systemic antibiotics for management of recurrent parotid abscess, a novel approach consisting of retrograde irrigation of salivary glands with intravenous metronidazole and amoxicillin was performed at regular intervals. This case report also revisits and reintroduces sialography for glandular pathologies. Although over the years, many new imaging techniques have superseded this procedure, it still remains the one procedure that can be easily performed within the confines of the most basic dental setup.