The Role of Stress in Recurrent Aphthous Stomatitis

Abstract

Objectives This study aimed to determine the role of stress in recurrent aphthous stomatitis. Stress was examined with the Perceived Stress Scale and cortisol levels; meanwhile, recurrent aphthous stomatitis was assessed with the duration of the lesion. Materials and Methods This was a cross-sectional analytical study conducted at Oral Medicine Installation, Universitas Sumatera Utara Dental Hospital, and Prodia Laboratory, Medan. The subjects were 50 patients with minor recurrent aphthous stomatitis, without systemic disease, who did not take systemic drugs or use orthodontic appliances. The diagnosis of recurrent aphthous stomatitis was established with anamnesis and clinical examination. Stress was examined by filling out the Perceived Stress Scale questionnaire and blood tests for serum cortisol levels. Statistical analysis The data were analyzed using the Fisher test and Mann–Whitney U test. Results This study showed no significant relationship between the Perceived Stress Scale category and recurrent aphthous stomatitis, with a p-value of 0.392. This study also showed no significant relationship between blood cortisol level and recurrent aphthous stomatitis with a p-value of 1.000. Conclusion Stress may play an important role in recurrent aphthous stomatitis. However, this study did not show any difference in stress examined through the Perceived Stress Scale and cortisol levels based on the duration of recurrent aphthous stomatitis.

Depression, Anxiety, Stress, and Pain Severity in Patients With Recurrent Aphthous Stomatitis: A Cross-Sectional Study

“…According to some studies, the majority of people with RAS had the ailment before the age of 30, with the condition peaking in their 20s. As one ages, the frequency of active lesions has shown a decline [4]. Females had a higher prevalence of the lesion in our sample than males.…”

“…Previous studies also found that females were more likely than males to suffer from RAS, in both children and adults. Some studies attribute this greater prevalence of RAS in females to hormonal differences between the two sexes [4].…”

“…Another observational study showed RAS patients with elevated salivary and blood cortisol levels, as well as increased anxiety [16]. Stress and anxiety can boost salivary cortisol levels by activating the HPA (hypothalamic-pituitary-adrenal axis) and impact immune function, leading to inflammation through increased leukocyte activity, which may lead to episodes of recurrent aphthous ulcers in the oral cavity [4]. Ziaudeen et al found that psychological stress in RAS patients disturbed the oxidant-antioxidant balance, leading to oxidative stress and the onset and persistence of aphthous ulcers [17].…”

“…Various factors, such as positive family history, local trauma, hypersensitivities, dietary inadequacy, immunological disruption, and smoking, have been linked to the pathophysiology of RAS. Psychological factors, such as anxiety, stress, and depression, have gained traction in this regard as they hold significance in both the onset and continuation of RAS ulcers [4][5][6][7].…”

Prevalence and distribution of recurrent aphthous stomatitis in 10-13 years old: observational study in elementary school

“…The results in this study align with the study conducted by Nurdiana et al, that showed 75.8% of subjects had moderate stress levels as predisposing factor for RAS. [30][31][32] Stress can create habits that can damage the oral mucosa, such as biting the lips and cheeks, which eventually causes RAS. 31 when a person experiences stress, the body will produce more cortisol.…”