Epidemiologic study on recurrent aphthous ulcerations among 512 Danish dental students

Association of bedtime with recurrent aphthous stomatitis: A cross-sectional study among health.care professional students

Background:

Although recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease, the etiology remains poorly understood till date. In addition, RAS lacks definitive therapeutic options, and hence, it becomes even more important to know the etiological factor so as to relieve the symptoms and render treatment effectively. Recently, late bedtime has been shown to be associated with RAS. Due to prolonged duty hours along with lengthy learning and training periods, late bedtime is a frequent observation among health-care professional students. However, this is a less explored field in the previous studies on RAS.

Aims:

This study aimed to evaluate the role of bedtime in the causation of RAS among health-care professional students.

Methods:

This present cross-sectional survey was carried out among medical, dental and nursing students studying in our medical campus, using an anonymous, self-administered questionnaire consisting of 18 items. The collected data was statistically analyzed and interpreted. Descriptive analysis and Chi-square tests were employed to assess the association of RAS with various variables.

Results:

Among a total of 1111 students who participated in the study, 39.8% (n = 442) experienced RAS. Factors such as history of digestive tract disease, family history and stress showed a positive correlation with RAS. Interestingly, both during examination and nonexamination period, RAS was more prevalent among students with bedtime >11pm than in students with bedtime <11 pm.

Conclusion:

The study indicates that late bedtime is an independent risk factor for RAS and thus clinicians should focus on recommending a healthy lifestyle with adequate sleep to patients with RAS. This would benefit patients with RAS, especially health-care professional students, and could probably contribute to long-term remission in RAS.

Salivary cortisol and dehydroepiandrosterone as oral biomarkers to determine stress in patients with recurrent aphthous stomatitis

Background

Recurrent aphthous stomatitis (RAS) is one of the most common oral ulcerative diseases with a multifactorial etiology. Although psychological stress is an exacerbating factor, the role of salivary stress hormones, cortisol, and dehydroepiandrosterone (DHEA) in this oral disease has not been extensively reported. The study aimed to estimate and compare the salivary cortisol and DHEA levels in RAS patients and healthy control group with the aid of ELISA microplate reader.

Subjects and Methods

Sixty patients were enrolled in our study, which included 30 patients with clinically diagnosed RAS and 30 healthy controls. Two mL of unstimulated whole saliva was collected and salivary cortisol and DHEA levels were measured using ELISA kit, and the values were read by microplate ELISA reader and recorded in both groups.

Results and Conclusion

The mean salivary cortisol and DHEA levels were elevated in the RAS patients compared to the healthy controls and were statistically significant. Salivary cortisol and DHEA can serve as oral biomarkers to determine stress in patients with RAS. However, the present study necessitates further studies with larger sample size and an improved protocol to ascertain the actual role of these presumed oral biomarkers as well as anxiety and stress as triggers in the pathogenesis of RAS.

Short-Term Efficacy of Pudilan Keyanning Toothpaste in Treatment of Minor Recurrent Aphthous Ulcers

Aim. To examine the potential of Pudilan Keyanning toothpaste (PKT) to treat minor aphthous ulcers (MiAU). Method. A double-blind clinical trial was conducted in which 80 volunteers were randomly assigned to the PKT group (N = 40) or the control group (N = 40). The control group used a placebo toothpaste containing no Pudilan extract. At baseline, after 3 days, and after 6 days the following parameters were recorded for the target ulcers: healing rate, healing period, pain (visual analogue scale, VAS), areas of the target ulcerated lesions, degree of exudation, and hyperemia. Results. At the end of the study, the healing rate in the PKT group was 80%, compared to 50% in the control group (p < 0.05). At day 6, the VAS scores, ulcer area, degree of exudation, and hyperemia were significantly different between the two groups, with better performance observed in the PKT group (p < 0.05). Conclusion. PKT toothpaste appears to promote effective healing of MiAU.

One-Year Period Prevalence of Oral Aphthous Ulcers and Oral Health-Related Quality of Life in Patients with Behçet's Disease

The aim of this study was to investigate the 1-year period prevalence of oral aphthous ulcers (OAUs) and their association with oral health-related quality of life (OHQOL) in patients with Behçet's disease (BD) and in the general population. In this cross-sectional study, 675 patients with Behçet's disease (BD group) and 1,097 males and females in the Japanese general population (control group) completed both questionnaires on their OAU status during the prior year and the General Oral Health Assessment Index (GOHAI). In the BD group, 84% of patients reported experiencing an OAU during the previous year, and the mean number of OAUs/year was 13. In the control group, 31% of individuals experienced an OAU during the previous year, and the mean number of OAUs/year was one. Multivariate analysis indicated that both BD patients (OR, 6.2; 95% CI, 4.8–8.0) and controls (OR, 2.6; 95% CI, 2.0–3.5) who had OAUs at least twice per year were more likely to have GOHAI scores below the norm than were controls who had fewer than two OAUs per year. The association between HLA-B∗51 and OAUs remains unknown. The presence of OAUs has a negative effect on the OHQOL of patients with BD.

The efficacy of the bioadhesive patches containing licorice extract in the management of recurrent aphthous stomatitis

This study evaluated the efficacy of licorice bioadhesive hydrogel patches to control the pain and reduce the healing time of recurrent aphthous ulcer.This study was carried out in three episodes of ulcers: in the first episode of ulcer, all 15 patients were asked to record their baseline individual pain level by a visual analog scale. In the second and third episodes, comparative and consecutive subjective and objective evaluations of the bioadhesive were done. The effects of the following variables were investigated: (1) VAS pain score for 5 consecutive days, (2) profile of aphthous ulcers on days 3 and 5, (3) time to complete relief of pain and healing of the ulcers, (4) diameter of the lesions and necrotic zone.A significant reduction in VAS was recorded following application of the licorice patches on days 2, 3, 4 and 5 compared with the no-treatment group (p < 0.001). Licorice patches caused a significant reduction in the diameter of the inflammatory halo and necrotic center compared with the placebo group (p = 0.03).According to the results of this study, licorice bioadhesive can be effective in the reduction of pain and of the inflammatory halo and necrotic center of aphthous ulcers.

Oral mucosal disease: Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is common worldwide. Characterised by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors, it usually presents first in childhood or adolescence. Its aetiology and pathogenesis is not entirely clear, but there is genetic predisposition, with strong associations with interleukin genotypes, and sometimes a family history. Diagnosis is on clinical grounds alone, and must be differentiated from other causes of recurrent ulceration, particularly Behçet disease - a systemic disorder in which aphthous-like ulcers are associated with genital ulceration, and eye disease (particularly posterior uveitis). Management remains unsatisfactory, as topical corticosteroids and most other treatments only reduce the severity of the ulceration, but do not stop recurrence.

Mucosal disease series. Number VI. Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1beta; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.

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.

Efficacy of bioadhesive patches in the treatment of recurrent aphthous stomatitis

This study evaluated the efficacy of bioadhesive hydrogel patches, made of a pharmaceutical grade cellulose derivative, in the control of pain and as an aid to healing of aphthous ulceration. Patients kept a twice daily ulcer diary to record their pain level on a visual analogue scale. The sensitivity of the test ulcer was assessed by a challenge with pure orange juice as a stimulant before and after application of the patch by the patient. A significant reduction in stimulated pain was recorded following application of the patches to the ulcers (P < 0.01). The patches were found to adhere longer to large ulcers in the early stages of ulceration, when they achieved their maximum protective and pain-attenuating effects. The ulcer size was recorded daily by the patient and patients claimed a reduction in healing time following patch therapy.

Sucralfate suspension as a treatment of recurrent aphthous stomatitis

DESIGN

A prospective randomized, double-blind, placebo-controlled, cross-over clinical trial.

SETTING

A university hospital.

SUBJECTS

Twenty-one patients with symptomatic recurrent aphthous stomatitis (RAS), unresponsive to conventional treatment were enrolled. They were divided into three groups.

INTERVENTION

In a cross-over trial, the patients received an oral suspension of sucralfate, an antacid solution or a placebo for 2 years.

RESULTS

After 2 years of follow-up, sucralfate was found to be superior to both placebo and antacid (P < 0.001) with regard to duration of pain, reduction of the healing period, response time to first treatment and duration of remission.

CONCLUSION

Sucralfate suspension should be added to the armament of treatment modalities of RAS.

Toward assessing trends in oral mucosal lesions: lessons learned from oral cancer

Trend data on oral mucosal lesions are limited. The literature is comprised of a large number of studies documenting the prevalence of various lesions in different populations. Trend data on cancers of the oral cavity and pharynx are the exception. An overview of the international epidemiologic studies of these cancers is provided. General conclusions across studies and countries for trend data of these cancers cannot easily be drawn, since variations exist in data collection methods, risk factors, and other characteristics of the study populations. This paper also reviewed the available prevalence data for oral mucosal lesions in general as well as data on leukoplakia, recurrent herpes labialis, and recurrent aphthous ulcers. A few studies of the incidence of leukoplakia are described. In order to explore the potential for future trend data on oral mucosal lesions, this paper discusses issues related to the feasibility and structure of monitoring these lesions. Criteria that could be used to identify which conditions should be monitored in the future were discussed, such as, those that present a public health problem, those that are sentinel events for serious conditions, and infectious lesions. Once lesions are identified, it is clear that international consensus for diagnostic criteria of these lesions is needed in order to permit comparisons to be made among studies. Finally, strategies for monitoring these conditions and factors that may affect future trends are reviewed.

Epidemiologic studies of oral mucosal conditions--methodologic issues

The methods used in the international English-language literature of epidemiologic investigations of oral mucosal conditions were reviewed. Methods used to study leukoplakia, lichen planus, recurrent herpes labialis, recurrent aphthous ulcers, geographic tongue and candidiasis are highlighted. In addition, studies of the full range of pathologies documented in a population were reviewed. The methodologic issues raised by the epidemiologic literature as well as those to be considered for future studies of oral mucosal conditions are presented. Emphasis is placed on study population selection, diagnostic criteria development, type and training of examiners, risk factor assessment and issues related to data collection, analysis and reporting.

Prevalence of oral soft tissue lesions in out-patients at two Malaysian and Thai dental schools

At the Faculties of Dentistry in Chiang Mai, Thailand (CM), and Kuala Lumpur, Malaysia (KL), 234 and 233 consecutive out-patients of mean ages 33.8 and 31.0 yr, respectively, were examined for the presence of oral mucosal lesions. Tobacco in some form was regularly used by 31.7% and 27.5% of the study populations in CM and KL, respectively. Cigarette smoking was the predominant habit. In CM three persons chewed betel quids and nine smoked banana leaf cigars daily. In addition, there were 24 habitual chewers of tea leaves (miang). In KL six persons chewed betel quids daily. In CM and KL three cases each (1.3%) of tobacco-associated leukoplakias were found. In KL an additional idiopathic leukoplakia was registered. One and three cases of betel related lesions were found in CM and KL, respectively. One case of a squamous cell carcinoma was found in a 45-yr-old Indian woman in KL who had been chewing betel with tobacco daily for many years. High prevalence figures were found for lichen planus, 3.8% in CM and 2.1% in KL, and an extremely high one, 48.3%, in CM for episodes of aphthous ulcers experienced during the last 2 yr. Comparatively low prevalence figures were found for herpes labialis. As could be expected melanin pigmentation was prevalent while only low figures were encountered for denture-related lesions and amalgam tattoos.

Performance of a hydroxypropyl cellulose film former in normal and ulcerated oral mucosa

Although oral ulcers are commonly encountered in clinical dental and medical practice, current therapeutic options with respect to pain relief are limited. This study evaluated the mucosal binding characteristics and the pain relief and protection properties of Zilactin, a hydroxypropyl cellulose film former. In 12 healthy volunteers, the mean duration of mucosal adherence of Zilactin was 3.92 hours, which was significantly longer than that of a widely available topical preparation (1.38 hours, p = 0.0001). When evaluated in 20 subjects with recurrent aphthous ulcerations, Zilactin demonstrated the ability to significantly decrease ulcer pain over a 4-hour period when compared with the subjects' individual standardized level of initial discomfort, which was used as an internal control for all subsequent steps. Challenge with an irritating citrus beverage was made before and after application of the medication. A significant difference in premedication and postmedication sensitivity was shown (p = 0.0001), indicating that the film provides protection, as well as pain relief. As a result of its unique and tenacious film-forming characteristics, this agent is exceptionally effective in the treatment of oral mucosal ulcerations. Greater awareness on the part of physicians and dentists may lead to the development of additional applications.

The occurrence of recurrent aphthous ulcers in an adult Swedish population

Aphthous ulcers were found in 2% of a total of 20,333 individuals aged 15 years or more examined in urban, suburban, and rural regions of Sweden. When a history of 2 years was considered, the prevalence was 17.7%. A slight predominance was found for females. The younger age groups showed the highest prevalences of the condition, which then decreased steadily with age. Interviews were conducted with a fraction of the population comprising 2771 people with regard to their experiences of aphthous ulcers. Thus, for example, the average number of episodes per year was two to four and the most prevalent time for healing, 5-8 days. Among the factors thought by patients to trigger the condition, catching a cold was reported as the main one, followed by stomach problems and menstruation.

Stereologic analysis of leukocyte infiltration in oral ulcers of developing Mikulicz aphthae

Biopsy specimens of 1- to 7-day-old oral ulcers from patients with minor (Mikulicz), herpetiform, and Behcet's aphthae and of nonulcerated oral mucosa of aphthous patients were subjected to a quantitative, stereologic, electron microscopic analysis of the connective tissue infiltrate residing both at the center of and lateral to the ulcers. The data representing volume fractions and the numerical density of cellular and other infiltrate components demonstrated that (1) the infiltrate under the epithelium lateral to the ulcer is different from that at the ulcer's center, (2) at both sites, composition of the gross infiltrate does not change with age of the ulcer, (3) a large population of leukocytes (about 18% in the lateral and 23% in the central region) belong to the monocyte/macrophage series, (4) blast-forming T-lymphocytes are consistently present, blast-forming B-lymphocytes and plasma cells are very rare, and (5) mast cells are several times more numerous than in normal mucosa. In a comparison of the infiltrates of Mikulicz aphthae with those of herpetiform and Behcet's ulcers, it appears that the pathogenesis of the various oral ulcerations may well be diverse.

Aphthous ulcers--a review of the literature on etiology, pathogenesis, diagnosis, and treatment

Recurrent aphthous ulcerations are seen in everyday dental practice. These lesions may easily be misdiagnosed and mistreated. A comprehensive but nondefinitive review of the literature is presented in hope that the practitioner can better diagnose, evaluate, research, and treat RAS. Although many modalities of treatment have been advocated, a truly effective therapeutic regimen to prevent RAS does not yet seem available. Additional research on the ideology, pathogenesis, and treatment of RAS is, therefore, needed.