A clinical threshold of unstimulated saliva flow below 0.1 mL per minute emerges as a key indicator for severe oral dysfunction in Sjögren's syndrome, complementing standard diagnostic criteria. This metric correlates with rapid multifocal decay affecting both root surfaces and cervical regions—a distinctive pattern that can help clinicians recognize the condition earlier. The review emphasizes preventive protocols combining dietary modifications, salivary stimulation techniques, and topical remineralization using casein phosphopeptide-amorphous calcium phosphate compounds alongside biomimetic hydroxyapatite dentifrices. This comprehensive approach addresses a critical gap in autoimmune care, where oral complications often go unrecognized until extensive damage occurs. For the estimated 4 million Americans with Sjögren's syndrome, early dental intervention could prevent the cascade of tooth loss that significantly impacts nutrition, social function, and treatment compliance. The systematic integration of simple salivary flow measurements into routine rheumatology visits represents a practical advance that could transform outcomes. However, the mixed evidence for fluoride varnish effectiveness in this population suggests that traditional caries prevention strategies may require modification for autoimmune-related xerostomia, highlighting the need for condition-specific oral care protocols.