Association between Recurrent Aphthous Stomatitis and Stress

Recurrent aphthous stomatitis (RAS) is characterized by painful recurrent intraoral ulcers. The etiology of RAS is unknown. Patients often report stress as one of the precipitating factors. However, the association between stress and RAS has not been fully explored in research studies.

Objectives: Assess reported stress levels in RAS patients.

Methods: This is an ongoing unmatched case-control study conducted at the University of Florida. Data were collected through questionnaires and oral examinations (June 2006-July 2007). We analyzed stress ever (SV), in the past 12 months (SM) using a modified scale (modified PSS-4), and in the past seven days (SS; 0-10 scale) vs. RAS ever (RE), in the past 12 months (RM), and upon examination (RX), respectively. Data were analyzed using crude odd ratios (OR 95% CI), ANOVA, and the Wilcoxon two-sample test using two-sided alpha=0.05 and SAS v9.1.

Results: A total of 204 participants were screened, 11 were excluded, 18 withdrew, and 175 completed the study [117 cases (ever had RAS) and 58 controls (never had RAS)]. Participants were 18 and older, 58% females, 13% Hispanics, 67% Whites, 13% Blacks, 16% Asians, and 4% other race. Twenty-five percent of cases reported SV vs. 29% of controls (OR=1.26, 95% CI 0.62-2.54; p=0.52). Mean SM levels for cases with 0 (n=25), 1-3 (n=46), and 4+ (n=46) episodes of RM were 4.4, 4.5, and 4.2, respectively (ANOVA, p=0.74). Among cases, median SS levels for RX (n=18) and RAS in past 6-12 months (n=9), were 5 and 3, respectively (Wilcoxon, p=0.11).

Conclusion: Cases did not report higher overall stress levels than controls. However, there was a tendency for stress levels to be higher among cases in the week prior to developing aphthous ulcers. Further analyses and larger studies are needed to compare stress levels during the active (ulcerative) vs. inactive phase.

This research was supported by a UFCD Student Summer Research Fellowship, NIH grants R03DE016356, 5U24DE016509, and M01RR00082, and the contribution of the GCRC.