Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis

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 1year, 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.