title: Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis.
abstract: BACKGROUND
  Recurrent aphthous stomatitis (RAS) is a common and painful oral mucosal disease. Possible etiologies include genetics, vitamin deficiencies, trauma, immune dysfunction, and stress. The goal 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.
  
  
  METHODS
  One hundred and sixty subjects with a history of RAS completed a weekly phone survey for up to 1 year, providing data on the occurrence of RAS episodes and details of any stressful events they experienced during the previous week. During RAS episodes, subjects also completed daily paper diaries that recorded incidence and duration of the RAS episode. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors.
  
  
  RESULTS
  Stressful life events were significantly associated with the onset of RAS episodes (P < 0.001), however, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Huling
authors.forename: Lorena
authors.initials: L
authors.lastname: Baccaglini
authors.forename: Linda
authors.initials: L
authors.lastname: Choquette
authors.forename: Richard S
authors.initials: RS
authors.lastname: Feinn
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010919:Placebos; D012008:Recurrence; D012737:Sex Factors; D013281:Stomatitis, Aphthous / Q000188:drug therapy / Q000523:psychology*; D013312:Stress, Physiological / Q000502:physiology; D013315:Stress, Psychological / Q000145:classification / Q000523:psychology*; D013997:Time Factors; D014815:Vitamins / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D010919:Placebos; D014815:Vitamins
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