Stress associated with onset of recurrent mouth ulcers

shutterstock_73929085 dental pain bearded man

Recurrent aphthous stomatitis (RAS) is a common and painful oral disease. 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.

They found

  • 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.
  • RAS episodes did not occur more frequently or last longer with increasing stress severity.

The authors concluded that

 In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors.

Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med. 2011 Nov 12. doi: 10.1111/j.1600-0714.2011.01102.x. [Epub ahead of print] PubMed PMID: 22077475.


Related  Review

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.

Prolo P, Domingo DL, Fedorowicz Z, Outhouse TL. Interventions for recurrent aphthous stomatitis (mouth ulcers) (Protocol). Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005411. DOI: 10.1002/14651858.CD005411.



Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Derek Richards

Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

More posts - Website

Follow me here –