Recurrent oral ulcerations associated with recurrent herpes labialis--two distinct entities?

Recurrent aphthous stomatitis in 18-year-old adolescents - Prevalence and associated factors: a population-based study

BACKGROUND

Recurrent aphthous stomatitis is a painful disorder of unknown etiology. It is among the most common oral mucosal lesions with high prevalence among young adults.

OBJECTIVES

To conduct a population-based study with 18-year-old army recruiters to assess its prevalence and associated factors in male adolescents.

METHODS

Interview during clinical examination in the army.

RESULTS

In this group (2,427 interviewed adolescents) there was a RAS prevalence of 24.9%. Smoking, herpes labialis and socioeconomic status correlated with the outcome.

STUDY LIMITATIONS

only male adolescents were interviewed.

CONCLUSIONS

Our results showed high prevalence of RAS; association with higher economic level and herpes simplex was found. Protective effect of smoking was confirmed.

Recurrent aphthous stomatitis: do we know what patients are using to treat the ulcers?

OBJECTIVES

The objectives of this study were to determine prevalence and types of treatments used by patients with recurrent aphthous stomatitis (RAS), and to study the sources of information about treatments used.

METHODS

The study was a cross-sectional survey. The participants were 530 students who had a history of RAS and were studying at the University of Jordan, Amman.

RESULTS

Of the 530 patients, 267 (50.4%) have attempted treatment of RAS. Of those who treated RAS, 86 (32.2%) have used alternative treatments (ATs). Topical anaesthetics/analgesics, antiseptic mouthwashes, and topical steroids represented 84.5% of the conventional medicines used. Of those who used ATs, 34 (39.5%) used tahini, 21 (24.4%) used salt/salt and warm water mouthrinse, and 7 (8.1%) used lemon/lemon salt. The tendency to treat RAS or not was not significantly affected by sociodemographic variables, but ATs were more significantly used by students living in rural areas. Relatives were the most frequently cited source of information about treatment (44.6%), followed by medical practitioners (22.9%), and only 9.4% sought treatment advice from dentists. Interestingly, 7% of the ATs were recommended by health care providers and 38.7% of the conventional treatments were recommended by non-health-care providers including 15 cases of topical steroids.

CONCLUSIONS

This survey revealed a high prevalence of ATs use among Jordanian patients with RAS. There is a need to educate patients with RAS on the treatment options available to reduce their distress and to improve their quality of life. Health care providers such as medical practitioners and pharmacists are frequently consulted by patients with oral lesions, so they should provide patients with better education in the diagnosis and treatment of oral diseases. Randomized clinical trials are needed to examine the potential usefulness of the commonly used ATs in this study such as tahini/sesame oil in the treatment of RAS.

Diagnostic test evaluation by patient-outcome study in homeopathy: balancing of feasibility and validity

BACKGROUND

Signs and symptoms can be considered as diagnostic tests, updating prior odds by applying Bayes' theorem. In homeopathy, signs and symptoms guide the doctor when prescribing appropriate medicines but the powers of these indicators are largely based on common experience.

OBJECTIVE

We want to know whether it is possible to calculate the power of arguments of signs and symptoms indicating homeopathic medicines, expressed in likelihood ratios.

METHODS

An observational patient-outcome study as advocated for diagnostic test evaluation. There was no independent observation of symptoms and results. Instead, observers were extensively trained in assessing each other's cases and the process was regularly monitored.

RESULTS

A total of 4072 prescriptions for 4094 patients were recorded. The relation between six clinical symptoms and outcome was calculated. Variance between observers in assessing symptoms and results were considerable. Some indications of confirmation bias were detected by follow-up, and 48 statistically significant likelihood ratios regarding six symptoms were calculated.

CONCLUSION

A diagnostic patient-outcome study within homeopathy collecting a large amount of data is demonstrated. Results partly confirm clinical practice at a 95% confidence level. This kind of research could validate knowledge from practical experience.

Oral poliovirus vaccine in management of recurrent aphthous stomatitis

Oral poliovirus vaccine (OPV) is reported to be effective in treatment of recurrent herpes simplex (RHS). According to our observation during recent years, OPV was not only effective in management of RHS but also in some patients with concomitant recurrent aphthous stomatitis (RAS) reducing its severity and frequency. The purpose of this study was to evaluate the efficacy of OPV in the management of RAS. In a longitudinal, case--control study 48 patients with RAS were recruited. Twenty patients received OPV and 28 patients received placebo. OPV was administered in a dose of 4 drops at monthly intervals for 3 months to the study group while the control group received placebo. The results were registered in 3 months after the last dose. Eight cases (40%) in the OPV group showed significant reduction in the duration of the ulcers, while no change was seen in the control group (P = 0.048). The frequency of recurrence of RAS was reduced in 13 cases (65%) in the OPV group, and in 6 cases (21.4%) of the placebo group (P = 0.006). The severity of attacks was reduced in 12 cases (60%) in the OPV group and in 4 cases (14.3%) in the placebo group (P = 0.008). In conclusion OPV appeared to be effective in the management of RAS.

A Bayesian perspective on the reliability of homeopathic repertories

An interim assessment of likelihood ratio of homeopathic symptoms shows that there are serious flaws in Kent's repertory. The system of expressing relationship between symptoms and expected results from medicines by type-face is unclear and unreliable. Bayesian methods can improve this and expand the possibilities of the repertory including the possibility of interpreting the absence of expected symptoms.

Dermatology position paper on the revision of the 1982 ACR criteria for systemic lupus erythematosus

The 1982 ACR classification criteria have become de facto diagnostic criteria for systemic lupus erythematosus (SLE), but a review of the criteria is necessary to include recent diagnostic tests. The criteria were not developed with the help of dermatologists, and assign too much weight to the skin as one expression of a multiorgan disease. Consequently, patients with skin diseases are classified as SLE based mostly on skin symptoms. We discuss specific problems with each dermatologic criterion, but changes must await a new study. We suggest the following guidelines for such a study, aimed at revision of the criteria. 1) The SLE patient group should be recruited in part by dermatologists. 2) The study should evaluate an appropriate international ethnic/racial mix, including late onset SLE as well as pediatric patients. 3) All patients should have current laboratory and clinical evaluations, as suggested in the paper, to assure the criteria can be up-to-date. This includes anti-SS-A and anti-SS-B antibodies and skin biopsies for suspected cutaneous lupus erythematosus except for nonscarring alopecia and oral ulcers. 4) The study should be based on a series of transparent power calculations. 5) The control groups should represent relevant differential diagnoses in numbers large enough to assess diagnostic problems that might be specific to these differential diagnoses. In order to demonstrate specificity of the criteria with a 95% confidence interval between 90 and 100%, each control group of the above should have at least 73 patients.

The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population

OBJECTIVE

To determine point and annual prevalence of recurrent aphthous stomatitis (RAS).

SETTING

Reported prevalence of RAS in textbooks and much of the literature varies according to study location, patient selection and whether point prevalence (presence of lesions at examination) or period prevalence (history of lesions during a specified period) is reported. Many studies are based on non-probability samples and this may contribute to significant variation in reported prevalence and factors presumed to be associated with RAS.

METHODS

We analyzed data from the Third National Health and Nutrition Examination Survey, 1988-1994, a large United States probability sample, for RAS and covariates suggested in the literature using bivariate and multivariate logistic regression.

RESULTS

Oral mucosal examinations were performed on 17 235 adults 17 years and older. Of these, 146 (0.89%) had at least one clinically apparent aphthous lesion. For annual (reported) prevalence, Whites (20.87%) and Mexican-Americans (12.88%) had several fold higher prevalence of RAS than Blacks (4.96%). Adults younger than 40 years of age had almost twice the prevalence (22.54%) of those older than 40 years (13.42%).

CONCLUSION

Annual prevalence was significantly higher in whites and Mexican-Americans (compared with blacks), individuals 17-39 years of age, cigarette non-smokers, and those with recurrent herpes labialis history; while it was lower in males. Point prevalence was significantly higher in whites, Mexican-American, individuals 17-39 years of age, cigarette non-smokers, and males.

Recurrent herpes labialis in US children and youth

OBJECTIVE

This study reports data from the Third National Health and Nutrition Examination Study, 1988-1994 (NHANES III).

METHODS

NHANES III was a complex, multistage sample of 33 994 civilian, non-institutional individuals from 19 528 households. Dentist examiners were trained to recognize, classify oral mucosal lesions to include recurrent herpes labialis (RHL). Subjects >or=8 years of age were asked if they had cold sores in the past year and serologic tests for herpes virus type 1 (HSV-1) and type 2 (HSV-2) were performed on blood of youth >12 years of age.

RESULTS

Examinations were performed on 10 032 individuals 2-17 years of age. Overall point prevalence was 1.42% (0.69-2.15); annual prevalence in individuals 8-17 years of age was 14.77% (12.74-16.80); and serologic prevalence of HSV-1 in youth 12-17 years of age was 43.18% (38.88-47.48). When the data were subset to youth 12-17, annual prevalence for seropositives was 24.13% (20.44-27.82) compared with 16.87 (14.16-19.57) for all subjects. Approximately 25% of the seropositive youth had at least one recurrence in the past year.

CONCLUSION

As RHL is a recurrent infection, prevalence in a population will be related to the proportion of the population that has been infected with herpes simplex virus. When lesion-specific prevalences are cited in the literature, they should be stratified by covariates known to be associated with them. Future studies should examine RHL prevalence in infected individuals.

Prevalence and handedness correlates of recurrent aphthous stomatitis in the Turkish population

OBJECTIVES

The present study was designed to determine the relationship between recurrent aphthous stomatitis (RAS) and handedness, and to assess the prevalence of RAS in the Turkish population.

METHODS

The present study was conducted among 11,360 persons (5,705 males and 5,655 females) with a mean age of 30.4 years. A questionnaire focusing on handedness was administered to these patients. Handedness was assessed according to the Edinburgh Handedness Inventory. The diagnosis of RAS was made on the basis of clinical appearance, location, and the patient's health history. RAS information of patients was collected by means of a data form specifically designed for this study. Subjects were informed about RAS. We took anamneses and filled out the investigation forms. Apart from patients with registration of current aphthae (average point prevalence, APP), patients who had a past two-year history (self-reported two-year prevalence, SRTP) of the lesion were also included in this study. Data were analyzed using the chi-square and logistic regression tests.

RESULTS

The prevalence of RAS (APP) was 2.7 percent and that of a history of RAS (SRTP) 22.8 percent. Thus, the total prevalence (APP+SRTP), including present lesions and a two-year history (SRTP), was 25.5 percent. Adjusted results showed that females, left-handers, 10-30-year-olds, and nonsmokers were 1.53, 1.69, 2.05, and 1.61 times more likely to have RAS (APP+SRTP) than males, right-handers, 31-50-year-olds, and smokers, respectively (P<.0001).

CONCLUSION

The present study suggests that left-handedness appears to be a predictor factor for RAS.

An exploration of point, annual, and lifetime prevalence in characterizing recurrent aphthous stomatitis in USA children and youths

BACKGROUND

This report presents and contrasts the prevalence of recurrent aphthous stomatitis (RAS) in 51 471 children and adolescents from two major studies: the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) and the National Survey of Oral Health in USA Schoolchildren, 1986-1987 (OHSC), large USA studies based on multistage probability sampling.

METHODS

Prevalence proportions, 95% confidence limits and multivariate logistic regression models were constructed for point, 12-month, and lifetime RAS prevalence using SAS-callable SUDAAN 8.0.2.

RESULTS

Examinations were performed on 51 471 children and adolescents. Point prevalence was 1.51% (NHANES III) and 1.21% (OHSC); annual prevalence was 19.84% (NHANES III); and lifetime prevalence was 40.18% (OHSC). Multivariate logistic models showed that being white, having a history of herpes labialis, (NHANES III), and being white and an adolescent (OHSC) were predictors of RAS.

CONCLUSIONS

Caution should be used in interpreting 12-month and lifetime RAS prevalence based a subject's recall.