Psychometric analysis of stress, anxiety and depression in patients with recurrent aphthous Stomatitis-A cross-sectional survey based study

Recurrent Oral Ulcers and Its Association With Stress Among Dental Students in the Northeast Indian Population: A Cross-Sectional Questionnaire-Based Survey

Aim The term "aphthous" is derived from the Greek word "aphtha," which means ulceration. The cause of aphthous ulcers is multifactorial, but emotional stress is one of the most important risk factors for its occurrence in young individuals. The aim of this study was to evaluate the association of recurrent oral ulcers (ROUs) with stress among dental students in the Northeast Indian Population. Materials and methods A total of 1,134 students were recruited for the study. Two sets of questionnaires were designed. The first set consisted of 11 questions related to demographic data and information about recurrent oral ulcers. The second set of questionnaire had 14 questions related to stress symptoms. Google Forms (Google, Inc., Mountain View, CA, USA) was used for recording the responses of the study participants. Questionnaires were sent to the participants through e-mail, and responses were recorded. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21 (IBM SPSS Statistics, Armonk, NY, USA) and Microsoft Office Excel (Microsoft Corp., Redmond, WA, USA). The chi-square test was used to compare categorical variables. Results Among the 1,134 participants, 32.7% (371 students) reported a previous history of recurrent oral ulcers. Out of 371 participants who had given a history of oral ulcers, only 27.2% exhibited direct stress to ulcer association. On further assessment using the Perceived Stress Scale (PSS), it was found that a far greater percentage of students (i.e., more than 27.2%) were under some form of stress or the other. Conclusions The results of this study will help improve the quality of life among the study population, either by tackling their stress levels or by identifying adequate interventions.

Regulatory T cell therapy suppresses inflammation of oral mucosa

Oral inflammatory diseases, including oral lichen planus (OLP) and recurrent aphthous ulcer (RAU), seriously affect the patient’s quality of life. Due to the lack of ideal disease models, it is difficult to determine whether novel immunotherapy strategies are effective in treating oral inflammatory diseases. Here, we show that the deficiency of Foxp3 or IL-2 caused oral mucosa inflammation in mice, proving that Treg cells are important in maintaining the immune homeostasis in the oral mucosa. Then we determined that adoptive transfer of CD4⁺CD25^-CD45Rb^high T cells could induce oral inflammation in Rag1^-/- mice, and co-transfer of Treg cells together with CD4⁺CD25^-CD45Rb^high T cells could suppress the development of oral inflammation in this mouse model. Our study showed that adoptive transfer of CD4⁺CD25^-CD45Rb^high T cells into Rag1^-/- mice could be a novel disease model of oral inflammation. Our data provides direct evidence that Treg cell therapy is effective in suppressing oral mucosa inflammation in mice. Therefore, Treg cell therapy may be a promising novel strategy to treat oral inflammatory diseases.

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.

Oral health-related quality of life in children with celiac disease

PURPOSE

There is limited knowledge about oral health-related quality of life (OHRQoL) in children with celiac disease (CD). This study aimed to assess OHRQoL in children with CD compared to healthy controls.

METHODS

This case-control study included children with CD and healthy controls. Three scales were used to assess OHRQoL in different age groups: 6-7 years, 8-10 years, and 11-14 years. The OHRQoL scores were compared between cases and controls to examine the possible associations between OHRQoL and demographics, socioeconomic status, and oral health.

RESULTS

Overall, 104 children with CD and 104 healthy children (controls) were included. The mean age was 10.67 ± 2.39 years in CD patients and 10.69 ± 2.36 in controls (P = 0.971). Male and female children constituted 50% of each group. Children with CD had significantly higher OHRQoL scores than controls (P = 0.003). Low education levels of parents of children with CD and a higher number of siblings in controls were associated with high OHRQoL scores (P = 0.002, P < 0.020, and P = 0.010, respectively). Recurrent aphthous stomatitis (RAS) increased the OHRQoL scores by 7.5 on average (P = 0.016).

CONCLUSION

Children with CD had poor OHRQoL compared with healthy controls. Poor OHRQoL in children with CD was associated with RAS and with lower parental income and education. RAS was an independent predictor of poor OHRQoL in children with CD.

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.

Evaluation the relationship between psychological profile and salivary cortisol in patients with recurrent aphthous stomatitis

BACKGROUND

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases which are diagnosed with recurrent and painful ulcers. The possible association between psychological factors and salivary stress related factors in patients with aphthous ulcers has been discussed in various studies. The aim of this study was to evaluate salivary cortisol level, anxiety, and depression in patients with RAS.

MATERIALS AND METHODS

In this case control study, 30 patients with RAS and 30 healthy individuals were enrolled by matching their age and sex. Anxiety and depression were assessed by beck anxiety inventory and beck depression inventory. Unstimulated saliva of both groups were collected and then tested by DiaMetra kit and the ELISA method. Data were analyzed by SPSS using an Independent t-test and Mann-Whitney test. A statistical significance level of <0.05 was considered.

RESULTS

The mean salivary cortisol in the case group was 5.35 ng/ml and in the control group was 4.73 ng/ml which was not statistically significant (P > 0.05). There was no significant difference in anxiety and depression level between the two groups (P > 0.05). According to Spearman correlation coefficient, there was an average, negative, and significant correlation between salivary cortisol and anxiety and depression scores in the case group (P < 0.05).

CONCLUSION

This study shows that, although the mean salivary cortisol was slightly higher in patients with aphthous lesions, anxiety, and depression were not possible factors for RAS. There was a moderate, negative correlation between salivary cortisol level and stress and anxiety in patients with RAS.

Safety and Effectiveness of Copaiba Oleoresin (C. reticulata Ducke) on Inflammation and Tissue Repair of Oral Wounds in Rats

In traditional communities of the Brazilian Amazon, the copaiba oleoresin (C. reticulata Ducke) is widely known for its therapeutic activity, especially its wound healing and anti-inflammatory actions. Our study aimed to evaluate these effects in oral lesions and the safety of the dosage proposed. A punch biopsy wound was induced on the ventral surface of the tongue of forty-five male Wistar rats under anesthesia. Animals were randomly allocated to one of three groups based on the treatment: control, corticoid and copaiba. A daily dose of each treatment and vehicle was administrated by oral gavage for three consecutive days. Sample collections took place on the third, seventh and 15th days post-wounding for clinical and histopathological analyses. Blood was collected on the third and seventh days for kidneys and liver function tests. Semi-quantitative analyses were performed based on scores of inflammation and reepithelization. Tissue collagen deposition was detected by PicroSirius red staining. Copaiba-treated wounds revealed a smaller wound area, decreased of acute inflammatory reaction and enhanced reepithelization. The levels of kidney and liver function tests did not reveal presence of damage post-treatments. Our findings suggest that copaiba oleoresin is a safe and effective alternative therapy for inflammation and tissue repair of oral wounds in this animal model.

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.

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.