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Journal of Islamic Dental Association of IRAN (JIDAI) Autumn 2014 ;26, (4) Pakfetrat et. al

predisposing factors, immunity disorders, and neutrophil phagocytosis decrease in patients with
family history also play a role in some patients [6]. RAS [7, 15].
On the other hand, it has been demonstrated that To assess the level of stress and anxiety and their
cigarette smoking by increasing mucosal correlation with a group of oral conditions that are
keratinization decreases the prevalence of RAS; believed to be correlated with stress and anxiety
also, RAS-free periods are observed during (such as lichen planus, mouth burning syndrome,
pregnancy [7]. and RAS), several studies with different
Different theories have been suggested regarding questionnaires and assessment tools have
the etiopathogenesis of RAS. But, in general, been performed. These tools include the Recent
impaired immunity (mentioned in most studies as Life Changes Questionnaire, Hamilton Anxiety
the primary or secondary cause), decreased Scale, Cattle 16 PF, HAD scale, Beck Depression
mucosal thickness and increased antigen Inventory, General Health Questionnaire and
expression are among the proposed mechanisms Spielberger State-Trait Anxiety Inventory [16].
[8, 9]. The role of T-cell mediated immunity in the Recent investigations have shown that stressful
pathogenesis of RAS has been confirmed and conditions have greater correlation with the
decreased ratio of CD4/CD8 cells, increased T cell occurrence of RAS compared to personal
receptors, and increased level of TNFD in the characteristics of patients [17]. Several studies
peripheral blood of patients with RAS have been with different tools have also been performed
reported [7]. recently in Iran.
Stressful life events are significantly associated Molashahi et al, in 2011 evaluated 90 RAS patients
with development of RAS [10]. Thus, stress may in three groups of patients, positive control
be an etiology of RAS especially in patients with (suffering from AFP, BMS, MPD) and negative
anxious personality [11]. Lack of a direct control group using the Beck Anxiety Inventory
association between the level of stress and severity (BAI) questionnaire. They reported that patients
of RAS indicates that stress is an initiator of with RAS and the positive control group had
recurrent aphthous attacks rather than being the anxiety and depression levels higher than those in
cause of it [12]. It should be noted that recurrent the negative control group. Although the
ulcers can be stressful for patients. On the other association between the level of anxiety and RAS
hand, was not significant, the correlation between the
parafunctional habits due to psychological stress level of depression and RAS was statistically
can initiate RAS by causing mild trauma [4]. significant [18].
Also, the reason for increased incidence of RAS In a study by Sanatkhani, patients with RAS were
during the menstruation may be hormonal and mentally evaluated using SCL-90 questionnaire
physiological alterations leading to physical and and psychological interview and it was revealed
emotional changes such as irritability, fatigue and that 74.3% of patients had some kind of psycho-
pain [7, 13]. logical disorder [19].
Evidence shows that 5-HTTLPR gene Chamani psychologically evaluated 550 medical,
polymorphism is significantly higher in patients dental and pharmacy students in Kerman
with RAS resulting in decreased presentation and University to determine the prevalence of RAS
absorption of serotonin and affecting depression using Cattle test. The anxiety level of subjects was
and anxiety [14]. As mentioned earlier, classified as no anxiety and mild, moderate and
psychological factors may have a positive severe anxiety. It was reported that patients with
correlation with development of RAS, which may RAS were more anxious than those with no history
[ Downloaded from jida.ir on 2025-02-02 ] T8/T4 lymphocytes and decreases efficacy of the designed by Derrogate in 1980 and includes 90
be due to the effect on the immunity system.
of RAS [20].
Recent studies suggest that secretion of The SCL-90 questionnaire is a tool to assess
psychological and mental status of subjects. It was
corticosteroids due to stress changes the ratio of
questions. This test assesses the psychological
immune system. As the result, chemotaxis and

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