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      Psychological Stress and Recurrent Aphthous Stomatitis

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          Abstract

          INTRODUCTION AND OBJECTIVES:

          Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS.

          METHOD:

          Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist.

          RESULTS:

          There was a higher level of psychological stress among RAS group patients when compared to the control group ( P < 0.05).

          CONCLUSION:

          Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.

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          Most cited references34

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          The diagnosis and management of recurrent aphthous stomatitis: a consensus approach.

          Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting. The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published. RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available. There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention. In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.
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            Association between psychological disorders and the presence of Oral lichen planus, Burning mouth syndrome and Recurrent aphthous stomatitis.

            The aim of this study was to determine the existing relation between the Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), Burning Mouth Syndrome (BMS) and psychological alterations of the patient, such as stress, anxiety and depression. 18 patients with RAS, 9 patients with OLP and 7 patients with BMS, that presented the condition at the moment of the examination, were studied, as well as a control group of 20 healthy patients. Both groups were extracted of hospitals and university centers, where the clinical diagnosis was made by a team of oral pathologists. Two measuring instruments were applied to them about their psychological condition: the Test of Recent Experience, to measure the stress level and scale H.A.D., to determine the level of anxiety and depression; the score given by them were statistically analyzed through T-test and the ANOVA Tukey test. Our results suggested a statistically significant association between these psychological disorders and the diseases of the oral mucosa in study. It was observed that the stress level is greater in patients with RAS and OLP, depression is particularly high in patients with BMS, and levels of anxiety are raised in the three groups, in comparison with the group control. A positive relationship can be established between psychological alterations and RAS, OLP and BMS. The RAS and the OLP stress and anxiety levels were considered as high, whereas the BMS was more related to important levels of anxiety and depression. According to these findings it is possible to assume that psychological factors should be taking into account when oral health wants to be maintain as normal.
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              Salivary cortisol and anxiety in recurrent aphthous stomatitis.

              Anxiety and salivary cortisol were measured in two groups of patients with recurrent aphthous ulceration. One group of patients had persistent aphthae (Group 1) and the others had been relieved of their aphthae following correction of detected haematinic deficiency states (Group 2). Anxiety was measured using the Hospital Anxiety and Depression scale and radioimmunoassay of salivary cortisol. There was a statistically significant increased proportion of borderline or clinically anxious patients in Group 1 compared to Group 2 (P < 0.05). Median salivary cortisol levels also showed a statistically significant elevation in Group 1 (P < 0.01). It is concluded that stress may play a role in the aetiology of recurrent aphthous stomatitis, particularly in patients who have an underlying anxiety trait.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo, Brazil)
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                July 2009
                : 64
                : 7
                : 645-648
                Affiliations
                [I ] Disciplina de Estomatologia Clínica, Departamento de Estomatologia, Faculdade de Odontologia da Universidade de São Paulo - São Paulo/SP, Brazil
                [II ] Disciplina de Semiologia, Faculdade de Odontologia da Universidade Ibirapuera - São Paulo/SP, Brazil, Email: camilagallo@ 123456gmail.com , Tel / Fax: 55 11 3091.7883
                Article
                cln64_7p645
                10.1590/S1807-59322009000700007
                2710437
                19606240
                cb3b738c-e362-4d2a-b75c-9a0f859a3397
                Copyright © 2009 Hospital das Clínicas da FMUSP
                History
                : 02 February 2009
                : 15 April 2009
                Categories
                Clinical Sciences

                Medicine
                ulcerative disease,aphthous stomatitis,psychological stress,canker sores
                Medicine
                ulcerative disease, aphthous stomatitis, psychological stress, canker sores

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