title: A study to evaluate the impact of examination stress on recurrent aphthous ulceration in professional college students in Jaipur district.
abstract: OBJECTIVE
  Recurrent aphthous ulcers (RAU) are one of the most common and poorly understood mucosal disorders. Most of the literature suggests that stress has a causal role in RAU and it is estimated that at least 1 in 5 individuals is afflicted with RAU. Review of literature reveals that nutritional and stress factors may be of paramount importance in the occurrence and severity of RAU. To test this hypothesis we have derived a study to explore definitive relationship between nutrition, stress and RAU in professional undergraduate students.
  
  
  METHODS
  A total of 80 undergraduate students were selected randomly for the study from professional colleges. On evaluation 50 subjects were identified to be RAU positive and the rest 30 never had ulcers. All the subjects were evaluated during their university examinations and the 50 RAU positive subjects were later evaluated for the stress levels after the examinations. The major variables that were compared were simplified oral hygiene index, body mass index, hemoglobin percentage, mid upper arm circumference and malnutrition universal screening tool, Hamilton anxiety rating scale and general health questionnaire.
  
  
  RESULTS
  The stress level was measured using Hamilton anxiety scale (HAS) and a highly significant difference was determined between during exams and post exam period in the students who tested positive for RAU. The General Health Questionnaire (GHQ) also appeared to be a sensitive instrument to determine the stress levels and statistically significant differences were recorded in the RAU positive students during exams and post exam period. General health is also poor during exams as compared after exams. The hematological factor as denoted by HB measurement showed significant statistical difference between patients who had RAU (present and history) and those who did not. Nutritional indicator (Malnutrition Universal Screening Tool) MUST also showed that it was a sensitive measure for detecting nutritional compromise and the statistically significant difference was shown between RAU positive and negative. The BMI, OHI-S and MUAC had no statistical differences shown in our analysis.
  
  
  CONCLUSIONS
  A number of conditions and diseases have been shown to lead to the onset of RAU. However, RAU can occur in the absence of any diagnosable disease or physical condition. According to our evaluation, stress emerged as having a causal role on RAU, along with hematinic deficiencies and poor nutritional status in professional undergraduate college students.
authors.affiliation: Department of Oral Medicine and Radiology, M. M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Handa
authors.forename: D N
authors.initials: DN
authors.lastname: Bailoor
authors.forename: V D
authors.initials: VD
authors.lastname: Desai
authors.forename: S
authors.initials: S
authors.lastname: Sheikh
authors.forename: G
authors.initials: G
authors.lastname: Goyal
mesh_terms: D004521:Educational Measurement; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D013281:Stomatitis, Aphthous / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications*; D013334:Students; D014495:Universities; D055815:Young Adult