In reply

Thank you for your interest in the paper. It is known that Sjögren syndrome patients are susceptible to Candida species, a component of oral flora, owing to hyposalivation, and they often develop candidiasis. In the present study, the patients did not show any clinical sign of candidiasis at the time of tongue papilla examination. But antifungal drugs had been used for these patients when clinical signs of candidiasis were observed. Symptoms of candidiasis, such as painful erythema of dorsal surface of the tongue and angular cheilitis, were reduced or eliminated by antifungal treatment. Tongue papilla also regenerated to some extent after treatment and looked normal in some cases. However, we found that atrophy of tongue papilla was still evident when examined by digital microscope, even though clinical signs of candidiasis visually disappeared. There is no doubt that Candida species are related to atrophy of tongue papilla in Sjögren syndrome patients. However, we consider that other factors are also involved in atrophic change of tongue papilla in these patients.