TRIP

Stress associated with onset of recurrent mouth ulcers

The Dental Elf, 2012

It is characterised by recurring mucosal ulceration in an otherwise healthy individual.  Its prevalence is commonly estimated to be between 5% and 25%  with a peak age of onset between 10 and 19 years although they may continue throughout the patient’s life span.  An exact cause of RAS  is unknown and genetics, vitamin deficiencies, trauma, immune dysfunction, and stress have all been implicated.
The aim of this study was to examine the relationship between the occurrence, type, and magnitude of stressful events and the onset and duration of RAS episodes.
The authors followed a cohort of  160 patients with a history of RAS for up to a year getting them to complete a weekly phone survey.
This provided data on the occurrence of RAS episodes and details of any stressful events they experienced during the previous week.
During RAS episodes, patients also completed daily paper diaries that recorded incidence and duration of the RAS episode.
The validated Recent Life Changes Questionnaire (RLCQ) was used to quantify stressful events which were classified as mental or physical stressors.
Stressful life events were significantly associated with the onset of RAS episodes ( P  < 0.001), but not with the duration of the RAS episodes.
Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04–3.62).
When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54–4.72) than physical stressors (OR = 1.44; 95% CI = 1.04–1.99) on the occurrence of RAS episodes.
 In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes.
Currently a Cochrane Review is underway  with the aim of determining the clinical effectiveness and safety of any intervention for pain relief and/or prevention of recurring aphthous stomatitis.  The protocol is available on the Cochrane Library.