title: Psychological stress and recurrent aphthous stomatitis.
abstract: OBJECTIVE
  Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS.
  
  
  METHODS
  Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist.
  
  
  RESULTS
  There was a higher level of psychological stress among RAS group patients when compared to the control group (P < 0.05).
  
  
  CONCLUSIONS
  Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.
authors.affiliation: Disciplina de Estomatologia Clínica, Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo/SP, Brazil. camilagallo@gmail.com
authors.forename: Camila de Barros
authors.initials: Cde B
authors.lastname: Gallo
authors.forename: Maria Angela Martins
authors.initials: MA
authors.lastname: Mimura
authors.forename: Norberto Nobuo
authors.initials: NN
authors.lastname: Sugaya
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013281:Stomatitis, Aphthous / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D055815:Young Adult