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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor</span>&#58;</p><p id="par0010" class="elsevierStylePara elsevierViewall">I read very carefully the publication of Ruiz Serrato et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> in <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span>&#44; where the authors report a case of halitosis secondary to Sj&#246;gren&#39;s syndrome &#40;SS&#41;&#46; I would like to express a few considerations&#44; which I hope will contribute to a better understanding of this association&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sj&#246;gren&#39;s syndrome is a systemic&#44; autoimmune disease&#44; with a prevalence that ranges between 0&#46;1&#37; and 0&#46;5&#37;&#44; with a predominance of women &#40;4th and 5th decades of life&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Histopathological studies show it to be characterized by lymphocytic infiltration at the level of the exocrine glands&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> This syndrome can be primary or secondary &#40;associated with systemic lupus erythematosus&#44; rheumatic arthritis and scleroderma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The destruction of the exocrine glands leads to &#8220;sicca syndrome&#8221; &#40;xerostomia and xerophthalmia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> However&#44; SS can show extraglandular manifestations&#44; including general&#44; cutaneous&#44; musculoskeletal&#44; respiratory&#44; urogenital&#44; thyroid&#44; gastrointestinal and hepatobiliary&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The association between halitosis and SS is multifactorial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">First&#58;</span> Parotid gland dysfunction results in xerostomia and a decrease in salivary flow that leads to periodontal diseases due to <span class="elsevierStyleItalic">Treponema denticola&#44; Porphyromonas gingivalis</span> and <span class="elsevierStyleItalic">Bacteroides forsythus</span>&#44; which produce mercaptan and sulfur that are associated with the level of halitosis &#40;oral cause of halitosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Saliva has antimicrobial properties&#59; thus&#44; the amount and quality of saliva are essential to prevent halitosis&#46; Therefore&#44; in patients with SS and xerostomia&#44; the production of saliva is reduced&#44; increasing the possibility of generating volatile sulfur compounds &#40;VSC&#41;&#44; the result of the degradation of proteins with sulfur-containing amino acids from the exfoliation of human epithelial cells&#44; leukocytes and the remains of food&#44; and with it&#44; oral malodor&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Volatile sulfur compounds are associated not only with halitosis&#44; but can enter into a vicious circle of pathogenesis of gingivitis and periodontitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Second&#58;</span> Extraglandular manifestations are factors that trigger halitosis in SS&#46; Patients with SS are more predisposed to develop chronic rhinosinusitis &#40;a perioral cause of halitosis&#41; and bronchiectasis &#40;an extraoral cause of halitosis&#41;&#46; Among the gastrointestinal manifestations&#44; they may present esophageal dysfunction&#44; chronic gastritis&#44; <span class="elsevierStyleItalic">Helicobacter pylori</span> infection and bacterial overgrowth&#44; which also cause halitosis &#40;extraoral cause&#41;&#46; Primary biliary cirrhosis&#44; as a hepatobiliary manifestation&#44; is an extraoral cause of halitosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Third&#58;</span> Diseases associated with secondary SS play their own role&#46; For example&#44; gastroesophageal reflux &#40;an extraoral cause&#41; in SS secondary to scleroderma produces dental erosion and dysphagia that provoke halitosis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Moreover&#44; patients with SS have an elevated risk of developing non-Hodgkin&#39;s B-cell lymphoma&#44; which can be an extraoral cause of halitosis&#46; On the other hand&#44; the symptomatology of halitosis in SS patients can&#44; subjectively&#44; be worse &#40;not genuine&#41;&#44; by psychosomatic halitosis&#44; halitophobia or because the xerogenic medicine they take &#40;antidepressant and nonsteroid anti-inflammation drugs&#41;&#46; With respect to the case reported by Ruiz Serrato et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> as the authors&#44; reasonably explain&#44; it is true halitosis due to oral causes &#40;xerostomia&#41;&#44; with a favorable response to pilocarpine&#46; However&#44; we recommend follow-up&#44; to screen for possible perioral and&#47;or extraoral causes related to SS&#44; in the case of therapeutic failure or recurrence&#46; I conclude that&#44; halitosis is a prevalent entity &#40;up to 50&#37; of the general population&#41;&#44; and has been studied little in SS&#46; Although&#44; it is considered more a problem related to poor dental hygiene or to diseases of the oral cavity &#40;87&#37;&#41;&#44; on occasions&#44; it may be a manifestation of the disease at other levels&#8212;perioral&#8212;or even of a psychiatric or systemic disease&#8212;extraoral&#8212;&#40;13&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Therefore&#44; an initial approximation should include a complete history &#40;diet&#44; drugs&#44; poor habits and dental hygiene&#41;&#44; a thorough examination&#44; a complete analysis&#44; as in screening&#46; The therapeutic management requires a multidisciplinary evaluation&#44; with hygienic&#44; dietetic&#44; pharmacological &#40;pilocarpine hydrochloride&#41; and&#47;or etiological&#8212;oral&#44; perioral&#44; extraoral or mixed&#44; as in the case of SS&#46;</p></span>"
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Letter to the Editor
Response to: Sjögren's Syndrome and Halitosis: A Case Report
Respuesta a: Síndrome de Sjögren y halitosis: descripción de un caso clínico
Rami Qanneta
Servicio de Reumatología, Hospital Universitari Joan XXIII, Tarragona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor</span>&#58;</p><p id="par0010" class="elsevierStylePara elsevierViewall">I read very carefully the publication of Ruiz Serrato et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> in <span class="elsevierStyleSmallCaps">Reumatolog&#237;a Cl&#237;nica</span>&#44; where the authors report a case of halitosis secondary to Sj&#246;gren&#39;s syndrome &#40;SS&#41;&#46; I would like to express a few considerations&#44; which I hope will contribute to a better understanding of this association&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sj&#246;gren&#39;s syndrome is a systemic&#44; autoimmune disease&#44; with a prevalence that ranges between 0&#46;1&#37; and 0&#46;5&#37;&#44; with a predominance of women &#40;4th and 5th decades of life&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Histopathological studies show it to be characterized by lymphocytic infiltration at the level of the exocrine glands&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> This syndrome can be primary or secondary &#40;associated with systemic lupus erythematosus&#44; rheumatic arthritis and scleroderma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The destruction of the exocrine glands leads to &#8220;sicca syndrome&#8221; &#40;xerostomia and xerophthalmia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> However&#44; SS can show extraglandular manifestations&#44; including general&#44; cutaneous&#44; musculoskeletal&#44; respiratory&#44; urogenital&#44; thyroid&#44; gastrointestinal and hepatobiliary&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The association between halitosis and SS is multifactorial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">First&#58;</span> Parotid gland dysfunction results in xerostomia and a decrease in salivary flow that leads to periodontal diseases due to <span class="elsevierStyleItalic">Treponema denticola&#44; Porphyromonas gingivalis</span> and <span class="elsevierStyleItalic">Bacteroides forsythus</span>&#44; which produce mercaptan and sulfur that are associated with the level of halitosis &#40;oral cause of halitosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Saliva has antimicrobial properties&#59; thus&#44; the amount and quality of saliva are essential to prevent halitosis&#46; Therefore&#44; in patients with SS and xerostomia&#44; the production of saliva is reduced&#44; increasing the possibility of generating volatile sulfur compounds &#40;VSC&#41;&#44; the result of the degradation of proteins with sulfur-containing amino acids from the exfoliation of human epithelial cells&#44; leukocytes and the remains of food&#44; and with it&#44; oral malodor&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Volatile sulfur compounds are associated not only with halitosis&#44; but can enter into a vicious circle of pathogenesis of gingivitis and periodontitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Second&#58;</span> Extraglandular manifestations are factors that trigger halitosis in SS&#46; Patients with SS are more predisposed to develop chronic rhinosinusitis &#40;a perioral cause of halitosis&#41; and bronchiectasis &#40;an extraoral cause of halitosis&#41;&#46; Among the gastrointestinal manifestations&#44; they may present esophageal dysfunction&#44; chronic gastritis&#44; <span class="elsevierStyleItalic">Helicobacter pylori</span> infection and bacterial overgrowth&#44; which also cause halitosis &#40;extraoral cause&#41;&#46; Primary biliary cirrhosis&#44; as a hepatobiliary manifestation&#44; is an extraoral cause of halitosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Third&#58;</span> Diseases associated with secondary SS play their own role&#46; For example&#44; gastroesophageal reflux &#40;an extraoral cause&#41; in SS secondary to scleroderma produces dental erosion and dysphagia that provoke halitosis&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Moreover&#44; patients with SS have an elevated risk of developing non-Hodgkin&#39;s B-cell lymphoma&#44; which can be an extraoral cause of halitosis&#46; On the other hand&#44; the symptomatology of halitosis in SS patients can&#44; subjectively&#44; be worse &#40;not genuine&#41;&#44; by psychosomatic halitosis&#44; halitophobia or because the xerogenic medicine they take &#40;antidepressant and nonsteroid anti-inflammation drugs&#41;&#46; With respect to the case reported by Ruiz Serrato et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> as the authors&#44; reasonably explain&#44; it is true halitosis due to oral causes &#40;xerostomia&#41;&#44; with a favorable response to pilocarpine&#46; However&#44; we recommend follow-up&#44; to screen for possible perioral and&#47;or extraoral causes related to SS&#44; in the case of therapeutic failure or recurrence&#46; I conclude that&#44; halitosis is a prevalent entity &#40;up to 50&#37; of the general population&#41;&#44; and has been studied little in SS&#46; Although&#44; it is considered more a problem related to poor dental hygiene or to diseases of the oral cavity &#40;87&#37;&#41;&#44; on occasions&#44; it may be a manifestation of the disease at other levels&#8212;perioral&#8212;or even of a psychiatric or systemic disease&#8212;extraoral&#8212;&#40;13&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Therefore&#44; an initial approximation should include a complete history &#40;diet&#44; drugs&#44; poor habits and dental hygiene&#41;&#44; a thorough examination&#44; a complete analysis&#44; as in screening&#46; The therapeutic management requires a multidisciplinary evaluation&#44; with hygienic&#44; dietetic&#44; pharmacological &#40;pilocarpine hydrochloride&#41; and&#47;or etiological&#8212;oral&#44; perioral&#44; extraoral or mixed&#44; as in the case of SS&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Qanneta R&#46; Respuesta a&#58; S&#237;ndrome de Sj&#246;gren y halitosis&#58; descripci&#243;n de un caso cl&#237;nico&#46; Reumatol Clin&#46; 2016&#59;12&#58;357&#8211;358&#46;</p>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
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