Sjogren’s Syndrome – effect on the teeth

My doctor thinks I have sjogren’s syndrome. It has taken its toll on my teeth. I have always taken great care of my teeth and was lucky that I had nice teeth. Anyhow, my front teeth are very close together. A piece of my front tooth has chipped (it chipped between the 2 teeth) It’s getting worse. My question is-should I get this bonded or a veneer? Also some of the teeth in the back of my mouth are chipping. Can I get them filled with white bonding? Or what should I do?
– Andrea from Pennsylvania

Dear Andrea,
With Sjogren’s syndrome, since you do not have the proper amount of saliva in your mouth, you have to be especially careful to keep your teeth clean and to restrict your frequency of eating. Many people don’t realize that your saliva has powerful defenses against decay. Not only does it have antibodies that fight decay bacteria, but it has minerals that repair early decay spots. Since your rate of repair has now decreased dramatically, you have to drastically limit the number of acid attacks on your teeth by confining your eating only to meals and avoiding snacking at all costs.

About the chipping of your front tooth – I would recommend having this repaired with dental bonding. The more aggressive you are with any dental treatment, the more you are going to create places on your teeth where they are vulnerable to breakdown, and especially with Sjogren’s Syndrome, you need to be especially careful. Doing a porcelain veneer covers the entire front surface of the tooth and creates a long margin of vulnerability which is the margin of where the veneer meets the tooth. Keeping the repair as small as it needs to be and no larger reduces that vulnerability. Dental bonding replaces the missing tooth structure only.

But then I see that you are from a small town in central Pennsylvania where I’m sure there aren’t many dentists. Doing good dental bonding is a skill that is possessed by very few dentists, and those extra-skilled dentists tend to go to the larger cities. And you really need this done well. I hesitate to suggest this, because you probably have an excellent family dentist you have gone to for years, but I would suggest that for the bonding work you find someone with direct bonding skills, and then go back to your family dentist for more routine care.

Check with the American Academy of Cosmetic Dentistry and look for an accredited cosmetic dentist. Or, if there is no one like that, check the website They examine the work and check the credentials of cosmetic dentists and then recommend excellent cosmetic dentists all over the country.

About the chipping on your back teeth. Again, this could be fixed with bonding. If your family dentist typically does a lot of white fillings on back teeth, he or she could do this. If he or she tends to prefer the amalgam fillings, then I would suggest the dentist you find to do that, also.

This blog brought to you by Chicago cosmetic dentist Dr. William Cohen.