The subjective symptoms were assessed using a questionnaire before and after the 2-week treatment. The questionnaire was composed of 2 parts: a general impression (Fig. 3) and a visual analogue scale (VAS) (Table 2). Following the completion of the 2-week treatment, a substantial improvement was reported by the treatment group (Fig. 3). The post-treatment VAS value was significantly decreased compared with that of the pre-treatment period in sensation of oral dryness, thirstiness, and burning sensation of the tongue in the treatment group (Table 2). A hypothesis was proposed that unconscious LY294002 episodes of rhythmic masticatory muscle activity play an important role in lubricating the oral

cavity [26] and [27] and that the night guard could help to regulate appropriate rhythmic muscle activity. A second possible mechanism for nocturnal xerostomia improvement with the night guard is maintenance

of saliva volume in the oral cavity. It was suggested that patients recognized the sensation of dryness when there was not enough saliva to cover the various oral surfaces, especially the palate [28]. A third possible factor could be that the night guard decreases the vaporization of saliva from the oral cavity, which is dependent upon how long the mouth is open. The night guard possibly prevents mouth opening, which occurs due to malocclusion, nasal congestion, and enlarged adenoids. We concluded that the application of a bite guard this website is therefore a useful and simple method for the management of nocturnal xerostomia. Furthermore, the device can be used not only during the

night, but also during the daytime. Dry mouth patients can use this device to maintain the presence of artificial gel type lubricants in the mouth (Fig. 2B). As a result, 3-oxoacyl-(acyl-carrier-protein) reductase such a bite guard could also be useful for Sjögren’s syndrome patients. Immunological management is one of the options for patients who do not respond to secretagogues or moisturizing saliva substitutes with or without the bite guard. However, no trials concerning the immunological treatment of primary Sjögren’s syndrome, such as interferon-alpha [29] and [30] and anti CD antibodies [31], [32] and [33] have been conducted so far in Japan, although interferon-alpha and anti CD20 antibody were recognized to be an effective and safe treatment strategy for patients with primary Sjögren’s syndrome in double-blind placebo-controlled clinical trials [30], [33] and [34]. Furthermore, no clinicians in Japan have accepted even systemic administration of corticosteroids for the primary Sjögren’s syndrome patients, and thus, the corticosteroid irrigation of the parotid gland is the only currently available immunological treatment option [35]. Acute stress, such as anger and anxiety induce dry mouth even for healthy people. Chronic psychological and psychiatric factors including anxiety and depression are related to the occurrence of dry mouth sensation [36], [37] and [38].