However, the increment rate of WSS after cevimeline treatment in the Grades 0–2 group was significantly higher than that in the Grades 3 and 4 group (p = 0.002). Similar findings [21] were reported for the use of pilocarpine, a cholinergic parasympathomimetic agent, which has shown efficacy in treating dry mouth symptoms in Sjögren’s syndrome

patients [22] and [23]. Since both sialography and biopsy showed Selleckchem SCH727965 an increase in the increment rates of WSS, and thereafter the relative influence of the various clinical and immunological factors, which are the examinations for diagnosis of Sjögren’s syndrome, on the increase of WSS were next analyzed. A multiple regression analysis was employed to examine the relative contributions of the sialography stage, grade of lip biopsy, and titer of anti-La/SS-B antibodies to the post-treatment WSS (Table 1). It was thus demonstrated that the post- treatment WSS could be predicted by the model (R2 = 0.880): Post-treatment WSS = 5.784 + (0.847 × pre-treatment WSS) − (0.869 × grade Bcl 2 inhibitor of lip biopsy) − (0.867 × stage of sialography) − (0.001 × anti-La/SS-B antibody), and that the stage classification of sialography (p = 0.004) and the histological grade of the labial minor salivary gland biopsy (p = 0.003) were significantly associated with the post-treatment WSS. Our

preliminary results demonstrated the relationship between the effect of cevimeline on saliva secretion and the degree of salivary gland destruction as evaluated by sialography and histopathological findings in the labial minor salivary glands. These diagnostic approaches could provide useful prognostic information about the efficacy of cevimeline in Sjögren’s syndrome patients. To verify the results in the present study, a placebo-controlled, double blind randomized trial will need to be performed. When saliva production cannot be stimulated by secretagogues, symptomatic management should be attempted. Various artificial saliva and saliva substitutes (lubricants) have been used. There are three main types

of saliva substitutes; gels, mouth rinses, and sprays [24] and [25]. Gel type lubricants can be effectively used in combination with a bite guard. Sleep-related xerostomia is a sensation of dry mouth associated with a report of Niclosamide either mouth and/or throat discomfort that induces awakening for water intake [26] and [27]. We applied a simple bite guard for patients with sleep-related xerostomia [12]. The device, fabricated with a soft material, is often used as a sports mouth guard or as a night guard for the treatment of nighttime bruxism. The 1.5-mm-thick ethylene vinyl acetate sheet (Sof-Tray Sheets, Ultradent Products, Inc., South Jordan, UT) was heated and aspirated to secure the model using a vacuum forming system (Dental Sta-Vac Model; Buffalo Dental Manufacturing, Syosset, NY). The bite guard covered the dental arch and the hard palate, and did not possess a reservoir for retaining the saliva substitute (Fig. 2A).