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

The association of recurrent aphthous stomatitis with general health and oral health related quality of life among dental students

BACKGROUND

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosa diseases. This study aimed to investigate the association of RAS with general health and oral health-related quality of life among dental students of Shahrekord University of Medical Sciences in 2020.

METHODS

In this cross-sectional study, a researcher-made checklist about the type, size, location, number, and recurrence rate of ulcers, oral health-related quality of life questionnaire (OHIP-14), and a 28-item general health questionnaire (GHQ-28) were completed by 100 dental students.

RESULTS

The proportion of RAS was significantly higher among females than males (61.1 versus 38.9, P=0.03) and was associated with family involvement history (P<0.001) and a Tendency to eat spicy foods (P=0.02). Moreover, the oral health-related quality of life was significantly lower among students with a history of RAS (8.17 ± 8.33 versus 4.22 ± 4.10, P=0.003). The results showed that GHQ-positive status was significantly associated with ulcer size (P=0.01). The general health status was positively correlated with RAS prevalence (p=0.04). Also, an investigation of the OHIP questionnaire showed that there was a significant correlation between physical status (r=0.31, P<0.001), insomnia, and mental status (r=0.33, P<0.001) with OHIP total score.

CONCLUSION

The results of this study confirmed a significant association between aphthous stomatitis and general health and oral health-related quality of life. So possibly improving general health and oral health-related quality of life may be effective in preventing aphthous stomatitis.

Insight into the Role of Psychological Factors in Oral Mucosa Diseases

With the development of psychology and medicine, more and more diseases have found their psychological origins and associations, especially ulceration and other mucosal injuries, within the digestive system. However, the association of psychological factors with lesions of the oral mucosa, including oral squamous cell carcinoma (OSCC), burning mouth syndrome (BMS), and recurrent aphthous stomatitis (RAS), have not been fully characterized. In this review, after introducing the association between psychological and nervous factors and diseases, we provide detailed descriptions of the psychology and nerve fibers involved in the pathology of OSCC, BMS, and RAS, pointing out the underlying mechanisms and suggesting the clinical indications.

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.

Anxiety and Salivary Level of Alpha-Amylase in Patients with Geographic Tongue: A Case Control Study

Background:

Geographic tongue is a common benign condition involving the tongue with an unknown etiology.

Objective:

This study aimed to measure the salivary level of alpha-amylase as well as the level of anxiety of patients with geographic tongue.

Methods:

This case-control study was performed on 180 subjects including 89 patients with geographic tongue and 91 controls. The subjects were requested to fill out the Spielberger’s State-Trait Anxiety Inventory (STAI-S, STAI-T). Unstimulated saliva samples were collected by the spitting method to assess the salivary level of alpha-amylase. Data were analyzed using SPSS version 23, t-test and Pearson’s test (α=0.05).

Results:

The mean salivary level of alpha-amylase and the mean scores of state and trait anxiety in geographic tongue patients were higher than those of healthy controls. But these differences did not reach statistical significance (P>0.05).

Conclusion:

Anxiety may be an influential factor in the occurrence of geographic tongue. Salivary level of alpha-amylase cannot serve as a specific biomarker for assessment of geographic tongue.

The association between interleukin polymorphism and recurrent aphthous stomatitis: A meta-analysis

OBJECTIVE

To assess the association between interleukin gene polymorphism and recurrent aphthous stomatitis (RAS).

DESIGNS

Two electronic databases, PubMed and Embase, were utilized to assemble potentially relevant studies meeting the inclusion criteria. A meta-analysis was conducted using Revman 5.3 software (London, UK), and the pooled odds ratio (OR) and 95% confidence interval (CI) were then used to evaluate the strength of the relationship between the gene polymorphisms of IL-1beta(-511C/T), IL-1beta(+3954C/T), IL-6(-174G/C) and IL-10(-1082G/A) and the risk of RAS.

RESULTS

Ten studies were included in the final meta-analysis, with 884 cases and 1104 controls participating. The results demonstrated that the polymorphism of IL-1beta(-511C/T) significantly increased the probability of the development of RAS in Europeans. (T vs. C: OR = 1.35, 95%CI = 1.09-1.67; CC vs. CT + TT: OR = 1.77, 95%CI = 1.24-2.53; CC vs. TT: OR = 1.86, 95%CI = 1.18-2.95). Furthermore, the C allele in IL-1beta(+3954C/T) was determined to be related to the risk of RAS in Americans (C vs. T: OR = 1.52, 95%CI = 1.07-2.17) and the presence of the C gene was considered a risk variant (CC + CT vs. TT: OR = 1.46, 95%CI = 1.01-2.11), but no relationship was found between the polymorphism of IL-10(-1082G/A) and the risk of RAS.

CONCLUSIONS

The meta-analysis suggested that the mutation of IL-1beta(-511C/T) in Europe and IL-1beta(+3954C/T) in America tend to increase the risk of RAS, but the polymorphism of IL-10(-1082G/A) appears to have no association with RAS risk in America. Further study is required to confirm the above conclusions.