Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis

Psychological problems and their impact on oral mucosal disease patients' quality of life: A cross-sectional study in the Chinese population

Objectives

We aimed to investigate the presence of common psychological factors (i.e., stress, depression, anxiety) and their impact on the Oral health-related quality of life (OHRQoL) in patients diagnosed with four oral mucosal diseases (OMDs): recurrent aphthous ulcers (RAU), oral lichen planus (OLP), oral leukoplakia (OLK), and oral submucous fibrosis (OSF).

Methods

A total of 229 patients with clinically diagnosed OMDs were enrolled in this study, consisting of 55 RAU, 68 OLK, 50 OLP, and 56 OSF patients. The patients were statistically analyzed for psychological problems and OHRQoL using the Visual Analog Scale (VAS)､ the 5-item Oral Health Impact Profile (OHIP-5) and the Depression Anxiety Stress Scale-21 (DASS-21) scales.

Results

There were 229 valid questionnaires collected, consisting of 83 females and 146 males with a mean age of 45.24 (SD = 11.88) years. Multiple regressions between DASS-21 scores and OHIP-5 scores revealed generally negative impacts of psychological problems on OHRQoL, with depression on OLP (β = 0.47), OLK (β = 0.65) and OSF (β = 0.38), stress on RAU (β = 0.29), OLP (β = 0.72), OLK (β = 0.38) and OSF (β = 0.60), and anxiety on OLP (β = 0.33), OLK (β = 0.49) and OSF (β = 0.51).

Conclusions

Psychological problems like depression, stress, and anxiety were found to be prevalent in OMDs patients and adversely affected their OHRQoL. The results support the biopsychosocial medical model in the treatment of OMDs patients.

Clinical significance

The present study reinforced the crucial roles of psychological factors in impacting OMDs patients' OHRQoL. Therefore, it is necessary to monitor patients' psychological status and OHRQoL using questionnaires like DASS-21 and OHIP-5. Followed by psychological interventions, the treatment is expected to be enhanced.

Sleep quality and perceived stress levels in Chinese patients with minor recurrent aphthous stomatitis: a cross-sectional questionnaire-based survey

OBJECTIVES

This cross-sectional study aimed to evaluate sleep quality and perceived stress levels in Chinese patients with active minor recurrent aphthous stomatitis (MiRAS) lesions, as well as to investigate the potential relationship between sleep quality and perceived stress levels and the risk of MiRAS episodes.

METHODS

The study population consisted of individuals recruited from a Chinese cohort who underwent medical and oral examinations from March 2022 to August 2023. All participants completed a set of uniform anonymous questionnaires, which included sociodemographic characteristics, clinical information, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI) and the Perceived Stress Scale (PSS-14). Statistical analysis was conducted using the independent sample t test, Mann-Whitney U test, Pearson's chi-square test and Pearson's correlation analysis. After adjusting for potential confounders (age, gender, marital status, and education level), multivariate logistic regression analyses were performed to assess the associations of sleep quality and perceived stress levels with the risk of MiRAS episodes. Additionally, restricted cubic spline curves were constructed to visualize these correlations.

RESULTS

A total of 329 eligible volunteers participated in the study, comprising 122 Chinese MiRAS patients and 207 healthy controls without MiRAS. Compared to healthy participants, MiRAS patients exhibited significantly higher PSQI and ISI scores (p = 0.000). However, no statistically significant difference was observed between the two groups regarding PSS-14 scores or its two subscales (p > 0.05). Multiple regression analysis indicated that lower sleep quality was significantly associated with an increased risk of MiRAS episodes (p = 0.000), whereas no statistically significant relationship was found between perceived stress levels and the risk of MiRAS episodes (p > 0.05).

CONCLUSION

Maintaining a regular bedtime and improving sleep quality may contribute to reducing the incidence and recurrence of MiRAS, while psychological intervention may be ineffective for MiRAS patients.

Classification-Predictive Model Based on Artificial Neural Network Validated by Histopathology and Direct Immunofluorescence for the Diagnosis of Oral Lichen Planus

The diagnosis of oral lichen planus (OLP) poses many challenges due to its nonspecific clinical symptoms and histopathological features. Therefore, the diagnostic process should include a thorough clinical history, immunological tests, and histopathology. Our study aimed to enhance the diagnostic accuracy of OLP by integrating direct immunofluorescence (DIF) results with clinical data to develop a multivariate predictive model based on the Artificial Neural Network. Eighty patients were assessed using DIF for various markers (immunoglobulins of classes G, A, and M; complement 3; fibrinogen type 1 and 2) and clinical characteristics such as age, gender, and lesion location. Statistical analysis was performed using machine learning techniques in Statistica 13. The following variables were assessed: gender, age on the day of lesion onset, results of direct immunofluorescence, location of white patches, locations of erosions, treatment history, medications and dietary supplement intake, dental status, smoking status, flossing, and using mouthwash. Four statistically significant variables were selected for machine learning after the initial assessment. The final predictive model, based on neural networks, achieved 85% in the testing sample and 71% accuracy in the validation sample. Significant predictors included stress at onset, white patches under the tongue, and erosions on the mandibular gingiva. In conclusion, while the model shows promise, larger datasets and more comprehensive variables are needed to improve diagnostic accuracy for OLP, highlighting the need for further research and collaborative data collection efforts.

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

The peripheral immune cell counts and mouth ulcers: A two-sample Mendelian randomization study

Objective

This study explored the causal association of peripheral immune cell counts with mouth ulcers (MUs) by two-sample Mendelian Randomization.

Design

The counts of 12 circulating immune cell types (leukocytes, lymphocytes, monocytes, eosinophils, neutrophils, basophils, CD4+ cells, CD8+ cells, unswitched memory B cells, NK cells, B cells and a derived ratio (CD4+/CD8+)) were determined as the exposure. MUs were the outcome. The analysis was conducted mostly using the inverse-variance weighted (IVW) approach. MR Egger, weighted median, weighted mode and simple mode were used to detect the horizontal pleiotropy.

Results

The IVW results for leukocytes and lymphocyte counts were OR = 0.93, 95 % CI = 0.88-0.98, p = 0.0115 and OR = 0.91, 95 % CI: 0.84-0.98, p = 0.0150, respectively. The Wald ratio result for CD4+ cell and CD8+ cell counts were OR = 0.70, 95 % CI: 0.65-0.75, p = 1.05 × 10-20 and OR = 1.25, 95 % CI: 1.19-1.31, p = 9.99 × 10-21, respectively.

Conclusions

This study supports a causal effect of peripheral immune cell counts on MUs. Higher leukocyte, lymphocyte and CD4+ cell counts can protect against MUs, but higher CD8+ cell counts enhance the risk of MUs. This finding confirms host immune factors play a crucial role in the aetiology of MUs.

Diagnostic Significance of Neutrophil to Lymphocyte Ratio in Recurrent Aphthous Stomatitis: A Systematic Review and Meta-Analysis

INTRODUCTION

Recurrent aphthous stomatitis (RAS) is a prevalent ulcerative condition affecting oral mucosa.

OBJECTIVES

A systematic review and meta-analysis was performed to compare the level of neutrophil to lymphocyte ratio (NLR) between individuals with RAS and those who are healthy.

METHODS

A systematic search for relevant publications before June 21, 2022, was conducted using Web of Science, PubMed, and Scopus. The results were presented as the standardized mean difference (SMD) with a 95% confidence interval (CI), and a random-effects model was used to calculate pooled effects due to the presence of significant heterogeneity. Quality assessment was performed using the Newcastle-Ottawa scale.

RESULTS

Overall, 13 article with were included in the analysis. NLR was higher among patients with RAS compared to healthy controls (SMD = 0.50, 95% CI = -0.20 to 0.79, P = 0.001, I2 = 91.5%). In the subgroup analysis based on the study design, it was found that retrospective studies showed higher levels of NLR in patients with RAS compared to healthy controls (SMD = 0.62, 95% CI= 0.16 to 1.08, P < 0.01), but these results were not applied to prospective studies (SMD = 0.35, 95% CI = -0.03 to 0.74, P < 0.07).

CONCLUSION

Elevated neutrophil to lymphocyte ratio revealed crosstalk between systematic inflammation and RAS.

Hematological parameters, obesity, stress and oxidant - antioxidant indicators in patients with or without recurrent aphthous stomatitis: A case control study

INTRODUCTION

Recurrent Aphthous Stomatitis (RAS) is a frequent chronic disease of the oral cavity that affects 5-25 % of the population with a plethora of predisposing factors. Despite its equivocal etiology, immune alterations, hematologic deficiencies and oxidative stress has been reported to be significant etiologic factors. Stress and obesity are other environmental factors that have been studied to understand associations with RAS.

OBJECTIVES

This study investigated the association of stress, hematologic parameters, oxidative indices and other selected salivary factors in a case control study on RAS Methods: Twenty-two participants each in both case and control groups were recruited with saliva and serum samples collected from them after a self-administered Recent Life Changing Questionnaire (RLCQ). OHI-S and salivary flow rate (SFR) were calculated with selected hematologic parameters and oxidative indices such as Total oxidant (TOS) and anti-oxidant (TAS) levels and their ratio - Oxidative Stress Index (OSI). Anti-oxidative indices of Ferric-Reducing Antioxidant Power (FRAP) and Glutathione Peroxidase Activity (GsPHx) were also estimated.

RESULTS

The RAS group had a significantly higher RLCQ scores at a median of 145 more than the control (57.5). There was no significant in their obesity indices, however there was a significant higher mean in the ESR (p< 0.0001) and Vit B12 (p = 0.0001); OHI-S was also significantly higher in the RAS group with a median of 1.65. Both the salivary and serum TOS were significantly higher in the RAS (10.0 ± 3.8, 15.4 ± 8.9) compared to the control group (7.92 ± 1.49, 9.56 ± 3.5). GsPHx activity was significantly higher in both the saliva and serum in the control group (0.08 ± 0.08, 0.19 ± 0.11) while nil significant difference was found in the FRAP activity. Regression showed most important variables to be the salivary GsPHx activity, followed by serum OSI and GsPHx activity.

CONCLUSION

The oxidative indices of TOS, TAS and GsPHx can serve as significant biomarkers in detecting RAS. This further corroborates the role of immune dysregulation in the etiology and predisposition to RAS.

Correlating Salivary Levels of Immunoglobin E and Human Eosinophil Cationic Protein in the Aseer Cohort with Recurrent Apthous Stomatitis

Background

Repeated Aphthous Stomatitis (RAS) is the most prevalent inflammatory disorder of the oral mucosa, characterized by recurrent emergence of single or numerous painful ulcers. RAS usually affects healthy people without systemic illnesses. There is evidence linking atopy to the progression of this illness. Immunoglobulin E (IgE) and human eosinophil cationic protein (HECP) levels in the saliva of individuals with aphthous stomatitis were assessed as allergy-related indicators.

Materials and Methods

Sixty people were assessed for this study. 30 patients with RAS were included in the patient group, while 30 healthy individuals made up for the control group. Sixty participants' non-stimulated saliva was taken and IgE and HECP were evaluated using enzyme-linked immunosorbent assay (ELISA). Data were analyzed in SPSS 20 through the Mann-Whitney test and p<0.05 was considered significant.

Results

The salivary level of HECP was significantly (p 0.05) higher among cases (0.83 0.70) compared to controls (0.170 0.15), whereas the salivary level of IgE was not significantly (p = 0.41) higher among cases (35.60 11.19) compared to controls (67.42 18.34).

Conclusion

Even though this study found a positive correlation between elevated HECP levels and RAS, additional research with larger sample sizes is required to identify the biological mechanisms responsible for the observed associations and to include salivary HECP levels in the RAS patient's evaluation.

Integrating GWAS and proteome data to identify novel drug targets for MU

Mouth ulcers have been associated with numerous loci in genome wide association studies (GWAS). Nonetheless, it remains unclear what mechanisms are involved in the pathogenesis of mouth ulcers at these loci, as well as what the most effective ulcer drugs are. Thus, we aimed to screen hub genes responsible for mouth ulcer pathogenesis. We conducted an imputed/in-silico proteome-wide association study to discover candidate genes that impact the development of mouth ulcers and affect the expression and concentration of associated proteins in the bloodstream. The integrative analysis revealed that 35 genes play a significant role in the development of mouth ulcers, both in terms of their protein and transcriptional levels. Following this analysis, the researchers identified 6 key genes, namely BTN3A3, IL12B, BPI, FAM213A, PLXNB2, and IL22RA2, which were related to the onset of mouth ulcers. By combining with multidimensional data, six genes were found to correlate with mouth ulcer pathogenesis, which can be useful for further biological and therapeutic research.

Prevalence and risk factors of recurrent aphthous stomatitis among college students at Mangalore, India

Background

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases affecting an approximate 25% of the world's population. Some common etiological factors are genetics, nutritional deficiencies, stress and immune dysfunction. There is currently no specific medication to treat the condition but RAS tends to heal by itself within a week or two. We aimed to explore about the prevalence and related risk factors of recurrent aphthous ulcers among college students aged 18-30 years who had been affected within the preceding six months prior to the study duration.

Methods

A questionnaire survey was conducted among 681 students from four colleges in Mangalore, Karnataka, India after obtaining the approval for the same from the respective colleges. Consenting participants returned a survey containing various questions. The collected data was then analyzed using descriptive statistics. The study was approved by the Institutional Ethics Committee.

Results

Of the 681 participants, 322 (47.2%) were affected with RAS in the past six months which included 131 (40.6%) males and 191 (59.3%) females. Single mouth ulcers were the most common presentation seen among the study participants (74.2%). Factors showing statistically significant association were: family history of RAS (P < 0.001), known diabetics (P < 0.001), history of smoking (P < 0.001), oral trauma (P < 0.001), history of wearing braces/dentures (P < 0.001) as well as those using toothpastes containing sodium lauryl sulphate (P < 0.001), stress and lack of sleep (P < 0.001). The most common form of medication used were topical agents (43.1%) (P < 0.001).

Conclusions

There was a statistically significant association between the occurrence of RAS and family history of RAS, diabetes, smoking, history of braces/dentures, oral trauma, sodium lauryl sulphate toothpastes, lack of sleep, stress, menstruation, consumption of particular foods and beverages. Further research is needed in this field to truly understand the prevalence and risk factors of RAS and to help in discovering a treatment modality for this condition.

Detection and Analysis of the Oral Flora in Patients with Recurrent Aphthous Stomatitis

The present study detected differences in the oral mucosal flora in healthy people and patients diagnosed with recurrent aphthous stomatitis (RAS) using the 16S ribosomal RNA high-throughput sequencing (rRNA-seq). All samples were collected from the lower lip mucosa of 100 healthy individuals and 100 patients with RAS. After the extraction, DNA was subjected to PCR amplification for the bacterial 16S rRNA gene, before subjecting to high-throughput sequencing, and matched to a database. Most bacterial species and most unique bacteria were from the healthy control group, and the amount of operational taxonomic units (OTUs) calculated was similar in the ulcer and nonulcer sites. Firmicutes, Proteobacteria, and Bacteroidetes were most abundant in the healthy group and in ulcer, nonulcer, and healed ulcer sites at the phylum level. Meanwhile, the number of Prevotella was significantly elevated in ulcer sites (P < 0.05). Healthy people had more species of bacteria inhabiting their oral mucosa than did RAS patients, and patients with ulcers had the lowest abundance of bacterial species. We suggest that the number of Prevotella is associated with RAS.

Fatty acid-binding protein 4 circulating levels in non-segmental vitiligo

Background

Vitiligo is an acquired and progressive mucocutaneous disease resulting from the loss of active epidermal melanocytes. Metabolic syndrome (MetS) affects about 25% of the world’s population and is linked to inflammatory skin diseases including vitiligo. Fatty Acid-Binding Protein 4 (FABP4) is an intracellular lipid chaperone. FABP4 is closely associated with MetS.

Objectives

To evaluate the serum level of FABP4 in vitiligo patients and its relation to MetS in the investigated cases.

Methods

This case control study was conducted on 45 patients having non segmental vitiligo and 45 matched controls. Their lipid profile, blood glucose and serum FABP4 levels were measured.

Results

There were significant elevations in FABP4 (p < 0.001), cholesterol (p < 0.001), triglycerides (p = 0.005), and glucose (fasting [p = 0.001] and 2 hours post prandial [p < 0.001]) levels in patients in comparison with controls. MetS was significantly more prevalent among vitiligo patients (p < 0.001) and associated with high FABP4 serum levels (p = 0.037). In vitiligo patients, there were significant positive correlations between FABP4 serum levels and triglycerides (p = 0.047), cholesterol (p = 0.001) and LDL (p = 0.001) levels and negative correlation regarding HDL level (p = 0.009). FABP4 level was a significantly good diagnostic test for early detection of vitiligo (p < 0.001).

Study limitations

The small number of studied subjects.

Conclusions

FABP4 may play an active role in the disease process of vitiligo that could be mediated through associated dyslipidemia and hyperglycemia. FABP4 may be a marker of vitiligo helping in its early diagnosis, but it does not appear to be useful for determining vitiligo severity, activity or associated MetS.

Assessment of Prevalence of Recurrent Aphthous Stomatitis in the North Indian Population: A Cross-Sectional Study

Aim and Objective

The present study was undertaken for assessing the prevalence of recurrent aphthous stomatitis (RAS) in the North Indian population.

Materials and Methods

Assessment of a total of 4255 patients was done over a period of 2 years, who came for a routine dental checkup. Recording of the complete demographic and clinical details of all the patients was done. The prevalence of RAS was assessed. Profile of patients with RAS was assessed separately. A pro forma was made and the type of treatment protocol followed by patients with RAS was also recorded. All the results were recorded in a Microsoft Excel sheet and were analyzed using SPSS software.

Results

Analysis of a total of 4255 patients was done. RAS was found to be present in 800 patients. The overall prevalence of RAS was found to be 18.93%. Significant results were obtained when analyzing age, gender, and occupation as risk factors for RAS. Labial/buccal mucosa involvement occurred in 51.875% of the cases. In 44% of the cases, the size of the RAS was between 1 cm and 3 cm. Home remedy was followed in 17.875% of the cases.

Conclusion

A significant proportion of patients in the North Indian population is affected by RAS. In comparison to males, females are more commonly affected.

Recent advances in the aetiology of recurrent aphthous stomatitis (RAS)

Recurrent aphthous stomatitis (RAS) is the most common disease of oral mucosa, which almost attacks each individual once in their lifespan. Although plenty of factors have been suggested to play a role in the pathogenesis of RAS, the aetiology of RAS is still controversial, which might lead to limited clinical therapies in accordance with each RAS patient. This review mainly illustrates recent advances in potential causes associated with RAS in detail. Deeper comprehension of the aetiology of RAS will support doctors and researchers to make a better management of RAS patients and to discover new treatments. The aetiology of RAS is complicated, hence we should take a comprehensive view into its aetiology, with multiple potential factors being considered. Sample collection of RAS patients have greatly limited the progress in the aetiology of RAS. A research model of multiagency cooperation can help achieve perfect sample collection of year-round and multiposition.

Combined signatures of serum proteome and transcriptome in patients with recurrent aphthous ulcer

OBJECTIVES

Recurrent aphthous ulcer (RAU) is a common oral disease with unclear mechanism. This study aimed to explore the serum signatures of RAU patients via proteomic and transcriptomic analysis.

METHODS

This study was based on clinical observation. Part of serum was used for clinical tests, while the rest was processed for isobaric tags for relative and absolute quantitation (ITRAQ) labeling coupled with two-dimensional liquid chromatography-tandem mass spectrometry (2D LC-MS/MS) combined with microRNA (miRNA) microarrays. Bioinformatic analysis was then used to obtain significant signatures, which was verified by ELISA, qRT-PCR, and dual-luciferase reporter gene assays.

RESULTS

Clinical data showed that triglyceride level, white blood cell count, and neutrophils percentage were increased in RAU group, while lymphocytes percentage was decreased. ITRAQ-2D LC-MS/MS identified 22 upregulated and 33 downregulated proteins in RAU group. Simultaneously, miRNA microarrays identified 64 upregulated and 31 downregulated miRNAs. After integrative bioinformatic analysis and verification, three miRNA-protein pairs, mainly involved in oxidative stress and inflammation responses, were obtained. Additionally, the interaction network indicated the crucial role of complement and coagulation cascade pathway in RAU.

CONCLUSIONS

Our study revealed that complement and coagulation cascade pathway, oxidative stress, and inflammation responses may act as vital factors in pathogenesis of RAU.

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.

Exploring the Relationship Between Psychiatric Traits and the Risk of Mouth Ulcers Using Bi-Directional Mendelian Randomization

Background

Although the association between mouth ulcers and psychiatric traits has been reported by observational studies, their causal relationship remains unclear. Mendelian randomization (MR), powered by large-scale genome-wide association studies (GWAS), provides an opportunity to clarify the causality between mouth ulcers and psychiatric traits.

Methods

We collected summary statistics of mouth ulcers (sample size n = 461,106) and 10 psychiatric traits from the largest publicly available GWAS on Europeans, including anxiety disorder (n = 83,566), attention deficit/hyperactivity disorder (n = 53,293), autism spectrum disorder (n = 46,350), bipolar disorder (n = 51,710), insomnia (n = 1,331,010), major depressive disorder (n = 480,359), mood instability (n = 363,705), neuroticism (n = 168,105), schizophrenia (n = 105,318), and subjective wellbeing (n = 388,538). We applied three two-sample bi-directional MR analysis methods, namely the Inverse Variance Weighted (IVW) method, the MR pleiotropy residual sum and outlier (MR-PRESSO) method, and the weighted median method, to assess the causal relationship between each psychiatric trait and mouth ulcers.

Results

We found significant effects of autism spectrum disorder, insomnia, major depressive disorder, and subjective wellbeing on mouth ulcers, with the corresponding odds ratio (OR) from the IVW method being 1.160 [95% confidence interval (CI): 1.066–1.261, P = 5.39 × 10^–4], 1.092 (1.062–1.122, P = 3.37 × 10^–10), 1.234 (1.134–1.342, P = 1.03 × 10^–6), and 0.703 (0.571–0.865, P = 8.97 × 10^–4), respectively. We also observed suggestive evidence for mood instability to cause mouth ulcers [IVW, OR = 1.662 (1.059–2.609), P = 0.027]. These results were robust to weak instrument bias and heterogeneity. We found no evidence on causal effects between other psychiatric traits and mouth ulcers, in either direction.

Conclusion

Our findings suggest a protective effect of subjective wellbeing and risk effects of autism spectrum disorder, insomnia, major depressive disorder, and mood instability on mouth ulcers. These results clarify the causal relationship between psychiatric traits and the development of mouth ulcers.

Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis is a chronic inflammatory disease of the oral mucosa. It is characterized by painful mouth ulcers that cannot be explained by an underlying disease. Recurrent oral mucosal ulcers require a proper differential diagnosis to rule out other possible causes before recurrent aphthous stomatitis is diagnosed. The condition is common, with prevalence rates ranging from 5 to 60% in different series. Its pathogenesis is unknown, but multiple factors are considered to play a part. There are no standardized treatments for this condition and none of the treatments are curative. The goal of any treatment should be to alleviate pain, reduce the duration of ulcers, and prevent recurrence.

Comparison of microbiomes in ulcerative and normal mucosa of recurrent aphthous stomatitis (RAS)-affected patients

BACKGROUND

Recurrent aphthous stomatitis (RAS) is the most common form of oral ulcerative disease, whose cause is still unknown. Researchers have found the association of many factors with the occurrence of RAS, and proposed oral bacterial infection could be a cause for this disease.

METHODS

To investigate whether the occurrence of RAS is associated with oral bacterial infection, we performed high throughput sequencing analysis of bacterial samples collected from the normal oral mucosa and aphthous ulcers of 24 patients.

RESULTS

Firmicutes, Proteobacteria and Bacteriodetes were the most abundant phyla in the microbiomes analysed. The alpha diversities of the oral mucosa and aphthous ulcer microbiomes were similar, suggesting a similar richness and diversity. The NMDS analysis showed the oral mucosa and aphthous ulcer microbiomes are significantly different. This suggestion is further supported by Anosim, MRPP, and Adonis analyses. More detailed comparison of the two groups of microbiomes suggested that the occurrence of RAS is significantly associated with the increase of Escherichia coli and Alloprevotella, as well as the decrease of Streptococcus.

CONCLUSIONS

Considering E. coli is a very common intestinal bacterium, we propose that E. coli colonization could be a cause for RAS, and controlling E. coli colonization could help curing RAS.

Salivary levels of IgE and ECP in patients with recurrent aphthous stomatitis

Background

Recurrent aphthous stomatitis is a common oral mucosa disease, with no specific etiology. Atopy has been implicated in the development of this disease. In this study, the salivary levels of immunoglobulin E (IgE) and eosinophil cationic protein (ECP) were measured as allergy-related biomarkers in patients with aphthous stomatitis.

Material and Methods

In this case-control study, non-stimulated saliva was collected from 85 participants and IgE and ECP were measured. Data were analyzed in SPSS 20 through the Mann-Whitney test, and p<0.05 was considered significant.

Results

The salivary levels of IgE and ECP were 1.11±0.65 Iu/ml and 26.93±6.95 ng/ml in the case group and 0.73±0/39 Iu/ml and 21.97±6.72 ng/ml in the control group. There was a significant difference between the two groups in terms of salivary levels of IgE and ECP (p=0.001).

Conclusions

The results showed that patients with oral aphthous had higher levels of salivary IgE and ECP than controls. Therefore, measurement of these biomarkers may be useful in the initial evaluation of patients with aphthous stomatitis. Key words:Recurrent aphthous stomatitis, saliva, immunoglobulin E, eosinophil cationic protein.

Validation of the HADS and PSS-10 and a cross-sectional study of psychological status in patients with recurrent aphthous stomatitis

OBJECTIVES

To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross-sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS.

METHODS

The validity and reliability of the HADS and PSS-10 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate-to-high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS-10 and bivariate analyses, respectively.

RESULTS

A bi-factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS-10 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate-to-high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms.

CONCLUSION

The HADS and PSS-10 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group.

Salivary levels of IgE and ECP in patients with recurrent aphthous stomatitis

Background

Recurrent aphthous stomatitis is a common oral mucosa disease, with no specific etiology. Atopy has been implicated in the development of this disease. In this study, the salivary levels of immunoglobulin E (IgE) and eosinophil cationic protein (ECP) were measured as allergy-related biomarkers in patients with aphthous stomatitis.

Material and Methods

In this case-control study, non-stimulated saliva was collected from 85 participants and IgE and ECP were measured. Data were analyzed in SPSS 20 through the Mann-Whitney test, and p<0.05 was considered significant.

Results

The salivary levels of IgE and ECP were 1.11±0.65 Iu/ml and 26.93±6.95 ng/ml in the case group and 0.73±0/39 Iu/ml and 21.97±6.72 ng/ml in the control group. There was a significant difference between the two groups in terms of salivary levels of IgE and ECP (p=0.001).

Conclusions

The results showed that patients with oral aphthous had higher levels of salivary IgE and ECP than controls. Therefore, measurement of these biomarkers may be useful in the initial evaluation of patients with aphthous stomatitis.

Key words:Recurrent aphthous stomatitis, saliva, immunoglobulin E, eosinophil cationic protein.

Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm

Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including, but not limited to, infections, medications, autoimmune disease, and other systemic disease. This review discusses the pathogenesis, clinical presentation, diagnosis, and management of the common causes of recurrent oral ulceration. The following types/etiologies of recurrent oral ulceration are covered: traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease. A diagnostic algorithm for recurrent oral ulceration is also presented.

Psychological factors in oral mucosal and orofacial pain conditions

The psychological aspects of chronic pain conditions represent a key component of the pain experience, and orofacial pain conditions are not an exception. In this review, we highlight how psychological factors affect some common oral mucosal and orofacial pain conditions (namely, oral lichen planus, recurrent aphthous stomatitis, burning mouth syndrome, and temporomandibular disorders) with emphasis on the significance of supplementing classical biomedical treatment modalities with appropriate psychological counseling to improve treatment outcomes in targeted patients. A literature search restricted to reports with highest relevance to the selected mucosal and orofacial pain conditions was carried out to retrieve data.

My preferred pronoun is she: Understanding transgender identity and oral health care needs

Objective

This literature review summarizes current research and evidence regarding transgender persons and oral health.

Methods

A search of the literature was conducted in the following databases: PubMed, Google Scholar, EBSCO Host, Science Direct, and Wiley Online Library using the keywords "transgender identity, gender non-conforming, discrimination, transition, binary systems, transgender oral cavity, transgender, transgender oral health, transgender dental health." Articles published from 2000 to 2017 in both peer-reviewed and non-peer reviewed journals, which reported information regarding the oral health status of transgender populations, were selected for review.

Results

The search revealed 18 articles, only 7 of which pertained to the oral health status of transgender client populations. Five other articles were eliminated due to either poor quality or irrelevance.

Discussion

The 13 articles included in the review revealed a need for oral health care professionals to be aware that gender is not binary, nor is it a mental health disorder. Transgender people face heightened risk of discrimination, violence, anxiety, depression, suicidality, substance abuse, and sexually transmitted diseases, as well as significant barriers to health care of which oral health professionals should be made aware.

Conclusions

Transgender people have the same rights as everyone else to oral health care. Oral health care providers are responsible for ensuring that transgender clients receive care that aligns with their needs and for providing that care in a culturally competent manner. This requires an understanding of the basics of gender nonconformance and its impact on oral-systemic health. Additional research is needed to increase the scientific knowledge base to facilitate improved health outcomes for this client population.

Oxidative Stress and Oral Mucosal Diseases: An Overview

BACKGROUND

Reactive oxygen species (ROS) and free radicals are physiologically produced during cellular metabolism. When their balance is disrupted in favor of ROS, a condition called oxidative stress occurs. Oxidative stress represents a widespread phenomenon involved in several pathological conditions. The aim of the present review was to report current knowledge on oxidative stress related to oral mucosal diseases.

MATERIALS AND METHODS

Articles from 2000 to 2018 were selected for relevance, validity and quality, from results obtained in PubMed, MEDLINE and Google Scholar using the following search terms: oxidative stress and oral lichen, oral pemphigus, aphthous stomatitis, oral leukoplakia, oral cancer, oral squamous cell carcinoma and oral carcinoma. All articles were independently screened for eligibility by the authors.

RESULTS

This narrative review integrates extensive information from all relevant published studies focusing on oxidative stress in oral mucosal diseases. We outline the pathogenetic function of oxidative stress in the most frequent inflammatory, potentially malignant and malignant diseases of the oral mucosa and provide detailed findings from human research.

CONCLUSION

Although variability in findings between individual studies exists, it justifies the conclusion that oxidative stress is a significant process in the oral mucosal diseases pathogenesis.

PATTERN OF PRESENTATION OF ORAL ULCERATIONS IN PATIENTS ATTENDING AN ORAL MEDICINE CLINIC IN NIGERIA

AIM

This study aimed at describing the epidemiology and pattern of presentation of oral ulcerations among patients seen in Oral Medicine clinic of Obafemi Awolowo University Complex, Ile-Ife.

METHODOLOGY

This study was a retrospective cohort study of all cases that presented with oral ulcers in the oral medicine clinic between May 2015 and May 2017. The clinical diagnosis of oral ulcers was based on the WHO guidelines for oral mucosa diagnosis. All the case notes in the unit were retrieved and reviewed. Information extracted from the case notes included age, sex, medical history, clinical findings and treatment received. The data was analyzed using STATA 13 statistical software.

RESULTS

Out of 250 patients seen in the Oral Medicine Clinic during the study period, oral ulcerations were seen in 50 patients comprising 34(68%) males and 16(32%) females, giving a prevalence of 20%. The mean age was 35.4 ±14.7 years and patients were most frequently seen in the third decade of life 16 (32%). The commonest site was lower lip (20; 40%) and ulcers were rare on the gingiva (1, 2%). More than half of the ulcers were solitary (26; 52%) and painful at presentation. Recurrent aphthous ulceration accounted for 47 cases (94%), others were traumatic ulcer (2; 4%) and Chemical burns (1; 2%). Physical stress was the most frequent implicated predisposing factor observed in 38 (76%) patients.

CONCLUSION

Recurrent apthous ulcer was the most frequent form of oral ulceration and was commoner in males. Physical stress was the most frequently implicated predisposing factor.

Healthy lifestyle habits benefit remission of recurrent aphthous stomatitis and RAS type ulceration

In a clinical setting, it is not practical to separate recurrent aphthous stomatitis (RAS) from RAS-type ulceration in every case, so both conditions have been considered together for the purpose of this article. Due to the lack of consistently effective therapeutic options for RAS, other approaches to treat the disease are considered here, beginning with an analysis of possible aetiological factors. The aetiology of RAS, the most common mucosal disease, remains undefined thus far. A few researchers have proposed psychological disorders as a major factor impacting RAS. Some systemic diseases and lifestyle habits are also reported to be associated with RAS; these also impact mental health. I believe that all habits contributing to mental health might also benefit patients with RAS. I suggest that practitioners of oral medicine should recommend a healthy lifestyle to patients with RAS, before prescribing medicines.

Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease

OBJECTIVE

The nature and impact of food and other external triggers in recurrences of Behçet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and nondietary triggers of BD-related OU recurrences.

METHODS

Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (percentage) of positive responses.

RESULTS

Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behçet's Disease classification criteria, and 53% qualified their OU recurrences during the previous 12 months as very discomforting or discomforting. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a "sure" trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37-47% of patients) and food (32-35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies.

CONCLUSION

Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism.

Evaluation of Salivary Cortisol Changes and Psychological Profiles in Patients with Recurrent Aphthous Stomatitis

BACKGROUND AND OBJECTIVE

Some studies suggest that psychological condition and stress can play role in the development of recurrent aphthous stomatitis (RAS). The purpose of this study was to evaluate salivary cortisol changes and psychological conditions in patients with RAS.

MATERIALS AND METHODS

Twenty-seven patients (13 males and 14 females, mean age of 32.8 (±10.2) years) with minor RAS and 27 age- and sex-matched controls without RAS participated in this study. The concentration of cortisol (nanomole/L) was measured in samples of unstimulated saliva from patients and controls two times; once during the presence of active lesions and once again when the lesions had healed by immunologic assay. The Hospital Anxiety and Depression Scale was employed to determine psychological condition. Visual analog scale for pain severity was recorded for patients with active lesions episode. Data were analyzed by the SPSS software (version 18.0) using paired and unpaired t-tests and Pearson correlation coefficient.

RESULTS

Salivary cortisol level was lower in patients during active lesions (12.4 ± 5.1) and healing (10.5 ± 3.9) episodes compared to the controls (13.1 ± 3.6) (P = 0.583, P = 0.015; respectively). There was no significant difference in salivary cortisol between active lesions and healing episodes (P = 0.943). Anxiety and depression represented no significant differences between active lesions and healing episodes (P > 0.05). Anxiety and depression levels in patients were significantly higher than in controls (P < 0.05). Pain severity in active lesions was not significantly correlated to salivary cortisol level, and anxiety or depression scores (P > 0.05).

CONCLUSION

The findings showed that occurrence of RAS was associated with anxiety and depression but not with alterations of salivary cortisol level.

Salivary Alpha-Amylase Enzyme, Psychological Disorders, and Life Quality in Patients with Recurrent Aphthous Stomatitis

Objective. The aim of this study was to evaluate stress, anxiety, and salivary alpha-amylase (SAA) activity in patients with recurrent aphthous stomatitis (RAS). The impact of this disease on the life quality was also evaluated. Design. Twenty-two patients with RAS and controls, matched by sex and age, were selected. Stress and anxiety were assessed using Lipp's Inventory of Stress Symptoms and Beck Anxiety Inventory. Life quality was assessed through the World Health Organization Quality of Life-bref (WHOQOL-BREF) and the Oral Health Impact Profile-14 (OHIP-14). Saliva samples were collected in the morning and afternoon and the SAA activity was analyzed by enzymatic kinetic method. Results. No significant difference was observed between the groups regarding the SAA activity (p = 0.306). Patients with RAS had higher scores of anxiety (p = 0.016). The scores of WHOQOL-BREF were significantly lower in patients with RAS. The values obtained through OHIP-14 were significantly higher in these patients (p = 0.002). Conclusion. RAS negatively affects the life quality. Patients with the disease have higher levels of anxiety, suggesting its association with the etiopathogenesis of RAS.

Assessment of Oxidant-Antioxidant Status and Stress Factor in Recurrent Aphthous Stomatitis Patients: Case Control Study

INTRODUCTION

Despite its vast occurrence, the aetiology of Recurrent Aphthous Stomatitis (RAS) still remains unknown and its aetiology is multifactorial. The factors believed to be associated with the aetiology of RAS, may disturb the equilibrium of oxidant-antioxidant status of the organism and may accelerate the formation of free radicals, resulting in Oxidative Stress (OS). Psychological stress is believed to act as a triggering factor or modifying factor for RAS.

AIM

To find whether oxidant-antioxidant status and psychosocial stress play a role in the pathogenesis of RAS.

MATERIALS AND METHODS

The study was conducted on 60 subjects over a period of one year (August 2014-August 2015) equally divided into two groups-patients with RAS and healthy controls. Psychosocial stress was analyzed by using Recent Life Changes Questionnaire (RLCQ). Saliva was analyzed to evaluate Superoxide Dismutase (SOD) and Glutathione Peroxidase (GSHPx) activities, Malondialdehyde (MDA) and Uric Acid (UA) levels in both the study and the control groups, using UV spectrophotometry.

RESULTS

The mean value of salivary SOD and MDA was increased while the activity of GSHPx and UA decreased in the study group when compared to the controls; the difference being statistically significant (p<0.005). The mean RLCQ stress score was also found to be increased in the RAS group, which showed elevated levels of mental stresses when compared to physical stresses. No significant association was observed between SOD, MDA, GSHPx and UA with high levels of stress score (p>0.05). In the study group, no correlation was observed between the study variables and gender, the number of ulcer episodes in one year, the number of ulcers per episode or the duration of ulcers.

CONCLUSION

This study shows that salivary antioxidant levels show a significant difference in response to OS in RAS patients. An increase in levels of psychosocial stress is seen associated with patients with RAS indicating its role as a modifying or triggering factor in the initiation of RAS.

The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse

OBJECTIVE

The aim of the study was to assess the efficacy of 2 different concentrations of minocycline mouthwashes on the symptoms of recurrent aphthous stomatitis (RAS).

STUDY DESIGN

The 2-year study was designed as a randomized, double-blind, crossover study. Healthy patients with frequent RAS episodes received 2 sealed and computer-randomized marked kits containing minocycline mouthwashes (0.2% and 0.5% solution). The patients were asked to use 1 of the kits on the first episode of RAS, starting with the first onset of prodromal symptoms, until the symptoms resolved or up to a maximum of 10 days (whichever came first). The patients were asked to use their second kit during a subsequent episode.

RESULTS

A total of 14 patients (8 males, 6 females) completed the 2 arms of the study. The mean intensity of pain was significantly lower when the 0.5% solution was used compared with the 0.2% solution (P = .027). The difference reached the level of statistical significance as soon as the end of the second day of use (P = .032). Only minor and temporary adverse reactions were documented.

CONCLUSIONS

We found that 0.5% minocycline mouth rinse was more effective than the 0.2% concentration, which had been suggested by our group in previous studies for the management of RAS.

Investigation of Behçet's Disease and Recurrent Aphthous Stomatitis Frequency: The Highest Prevalence in Turkey

BACKGROUND

The Recurrent Aphthous Stomatitis (RAS) is the most frequently observed painful pathology of the oral mucosa in the society. It appears mostly in idiopathic form; however, it may also be related with systemic diseases like Behçet's Disease (BD).

AIMS

Determining the prevalence of RAS and BD in the Northern Anatolian Region, which is one of the important routes on the Antique Silk Road.

STUDY DESIGN

Cross-sectional study.

METHODS

Overall, 85 separate exemplification groups were formed to reflect the population density, and the demographic data of the region they represent. In the first stage, the individuals, who were selected in random order, were invited to a Family Physician Unit at a certain date and time. The dermatological examinations of the volunteering individuals were performed by only 3 dermatology specialists. In the second stage, those individuals who had symptoms of BD were invited to our hospital, and the Pathergy Test and eye examinations were performed.

RESULTS

The annual prevalence of RAS was determined as 10.84%. The annual prevalence was determined to be higher in women than in men (p=0.000). It was observed that the prevalence was at the peak level in the 3(rd) decade, and then decreased proportionally in the following decades (p=0.000). It was also observed that the aphtha recurrence decreased in the following decades (p=0.048). The Behçet's prevalence was found to be 0.60%. The prevalence in women was found to be higher than in men (0.86% female, 0.14% male; p=0.022).

CONCLUSION

While the RAS prevalence ratio was at an average value when compared with the other societies; the BD prevalence was found as the highest ratio in the world according to the literature.

[Aphthous ulcers and oral ulcerations]

Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates...), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia.

Quality of life in patients with recurrent aphthous stomatitis treated with a mucoadhesive patch containing citrus essential oil

PURPOSE

To assess 1) patient satisfaction of a mucoadhesive biopatch with citrus essential oil and 2) the change in pain severity and the oral health-related quality of life in patients with recurrent aphthous stomatitis.

PATIENTS AND METHODS

Thirty-seven patients with recurrent aphthous stomatitis participated in the study. Baseline records of personal data, ulcer assessment, visual analog scale, and Oral Health Impact Profile-14 were documented. A mucoadhesive patch was applied over the ulcer. Patients were recommended more applications if pain continued. On the fifth day, a post-therapy assessment was made.

RESULTS

The mean visual analog scale scores at baseline and posttreatment were significantly different (7.3±2.11 and 4.9±2.6, respectively; P=0.001). The mean duration of pain reduced after patch application. The mean total Oral Health Impact Profile-14 scores before and after treatment showed a statistically significant difference (P=0.001). In total, 78.4% of patients reported a considerable improvement in oral functions after treatment (P=0.008).

CONCLUSION

The mucoadhesive biopatch containing citrus essential oil resulted in satisfying pain alleviation and restoration of oral functions with a significant improvement in the oral health-related quality of life.

Total antioxidant status and oxidative stress in recurrent aphthous stomatitis

BACKGROUND

Recurrent aphthous stomatitis is an idiopathic, chronic, recurrent inflammatory disease of the oral mucosa. It is thought that oxidative stress caused by systemic inflammation plays a basic role in the etiopathogenesis of recurrent aphthous stomatitis. The aim of this study is to review oxidative status and DNA damage in recurrent aphthous stomatitis.

METHOD

The study included 42 patients with an active recurrent aphthous stomatitis lesion and 39 healthy volunteers with similar demographic characteristics. DNA damage was analyzed using alkaline single cell gel electrophoresis (comet assay). Plasma levels of total antioxidant status and total oxidative status were determined by using an automated measurement method. Oxidative stress index was calculated as total oxidative status/total antioxidant status and × 100.

RESULTS

The total oxidative status and oxidative stress index values were significantly higher in the recurrent aphthous stomatitis group compared to the control group, while total antioxidant status values were significantly lower. In the recurrent aphthous stomatitis group, DNA damage was observed to be significantly higher than the control group. In correlation analysis, significant correlation was found between DNA damage and the oxidative stress index and total oxidative status values in the recurrent aphthous stomatitis group.

CONCLUSION

This is the first report in the literature that demonstrates association of recurrent aphthous stomatitis with increased oxidative status.

Risk factors of recurrent aphthous ulceration among university students

Recurrent aphthous ulceration (RAU) is a common oral mucosal disease. The etiological involves in genetics, vitamin deficiencies, trauma, immune dysfunction and stress. This study was to explore the related risk factors of recurrent aphthous ulceration (RAU) among college students, and provide basis for further research. We conducted a questionnaire survey among students from three colleges in Wuhu by stratified cluster sampling. The information collected includes general demographic characteristics, dietary habits and so on. The overall prevalence of RAU is 23.30% among college students (23.23% in male and 23.39% in female). There are statistical significance in prevalence of RAU between subjects with RAU and without RAU (P<0.05) the prevalence of RAU in different grade, age, adequate brushing time, good brushing habits, wear dentures or braces, other oral disease, eat barbecue, adequate exercise time is statistic difference. According to the result of multinomial logistic regression analysis, the risk of recurrent aphthous ulceration factors including grade, inadequate brushing time. Tempering was a protective factor of RAU. Some measure should be taken to control dental ulcer, which consist of promoting a correct way of living habits, paying attention to the health conscious diet, strengthen physical exercise, self-decompression and keeping good mentality.

Prevalence of recurrent aphthous ulceration in the Indian Population

Objective: Patients with an oral ulcer may present initially to a general physician or a dental practitioner. Majority of the ulcers are benign and resolve spontaneously but small proportions are malignant. The aim of the present study was to determine the prevalence of recurrent aphthous ulcerations in the Indian population. Material and Methods: 3244 patients attending the Department of Oral Medicine and Radiology during the period from November, 2010 to December, 2012 with various complaints were examined. Of the patients examined 1669 were females and 1575 were males. Results: 705 patients presented with recurrent aphthous ulceration (21.7%). Females (56.3%) were more commonly affected than males (43.7%). Patients in the third and fourth decade were most commonly affected. Stress was the most common factor associated with recurrent aphthous stomatitis (386 patients). 54.5% patients did not take any medications and 72.9% patients opined that the condition needed no dental consultation. Conclusion: The results of the present study indicate that recurrent aphthous ulceration is a common mucosal disorder in the Indian population. The early and proper diagnosis of the ulcers will help the dental practitioner in providing information to the patient regarding awareness and management of the condition.

Key words:Recurrent aphthous ulcers, prevalence, Indian population.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.