This study aimed to examine the effects of modified multiple divided dosing of pilocarpine hydrochloride （3.75mg, 4 times daily） as compared with the conventional dosing regimen on patient satisfaction with treatment. The subjects were patients with Sjögren’s syndrome who had reduced salivary secretion （≤10ml by 10-minute gum test） after treatment with a conventional pilocarpine hydrochloride-dosing regimen for at least 1 year. The patients were switched from conventional dosing to modified multiple divided dosing （without a washout period）, and the study treatment was continued for 8 weeks. They underwent a 10-minute gum test, assessment of subjective symptoms of dry mouth, and so on, before and after the study treatment. Twenty-six patients were eligible for the study. The mean salivary secretion on the 10-minute gum test decreased significantly from 6.57±0.90ml （at conventional dosing） to 5.75±0.91ml （after 8 weeks of modified multiple divided dosing）. In addition, for further analysis, the patients were divided into severe and mild groups based on the subjective symptom of dry mouth at night. The mean subjective symptom score of dry mouth at night in the severe group significantly decreased from 3.57±0.79 （at conventional dosing） to 1.86±1.07 （after 8 weeks of modified multiple divided dosing）. These results suggest that treatment with modified multiple divided dosing of pilocarpine hydrochloride is effective for improving dry mouth in patients with severe subjective symptoms of nighttime dry mouth.

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von Willebrand disease （vWD） is a disorder which is characterized by prolonged bleeding time. We report a case with severe vWD who underwent the extraction of three wisdom teeth at one time. The patient was a 36-year-old female, and her chief complaint was pain in the region of the right lower wisdom tooth. We administered FactorⅧ Concentrate before surgery. Three wisdom teeth were extracted at one time. The operation was completed without bleeding episode, and the wounds healed well. To manage the bleeding of vWD patients, dentists need to carefully decide the treatment strategy.

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Laugier-Hunziker-Baran syndrome （LHB） is characterized by acquired hyperpigmentation of the oral mucosa, digital skin and nails without gastrointestinal diseases. We experienced a patient who was found to demonstrate disease progression. The patient was a 71-year-old woman with multiple instances of dark-brown hyperpigmentation on her lower lip and buccal mucosa. After four years of observation, dark-brown macules on the digital skin and nails were newly observed. We ultimately diagnosed her with LHB based on the results of systemic examinations. Diagnosis of hyperpigmentation of the oral mucosa requires careful monitoring of the systemic status and strict observations.

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Chronic GVHD and/or secondary cancer are often seen after the transplant of hematopoietic stem cells for blood-forming organ malignant tumors. A 57-year-old Japanese woman was treated with peripheral blood stem cell transplant for acute myeloid leukemia after chemotherapy, and she developed chronic GVHD after the treatment when she was 41 years old. She developed squamous cell carcinoma in the tongue 16 years after the treatment. It is suggested that after treatment of blood-forming organ malignant tumors, long-term intraoral follow-up is necessary in consideration of the development of secondary tumors.

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