Skip to main content

Advertisement

SpringerLink
Log in

Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population.

Materials and methods

This study was conducted on 10,520 participants aged 35–70 years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained.

Results

The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50 years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low.

Conclusions

It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Edgar NR, Saleh D, Miller RA (2017) Recurrent aphthous stomatitis: a review. J Clin Aesthet Dermatol 10(3):26–36

  2. Chiang C-P, Yu-Fong Chang J, Wang YP, Wu YH, Wu YC, Sun A (2019) Recurrent aphthous stomatitis–etiology, serum autoantibodies, anemia, hematinic deficiencies, and management. J Formos Med Assoc 118(9):1279–1289

  3. Wiriyakijja P, Fedele S, Porter S, Mercadante V, Ni Riordain R (2017) Patient-reported outcome measures in recurrent aphthous stomatitis: a critical assessment of quality properties. Oral Dis 23(8):1168–1179. https://doi.org/10.1111/odi.12726

    Article  PubMed  Google Scholar 

  4. Cui RZ, Bruce AJ, Rogers RS III (2016) Recurrent aphthous stomatitis. Clin Dermatol 34(4):475–481. https://doi.org/10.1016/j.clindermatol.2016.02.020

    Article  PubMed  Google Scholar 

  5. Najafi F, Rezaei S, Hajizadeh M et al (2020) Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study. ArchPublic Health 78(1):1–11. https://doi.org/10.1186/s13690-020-00457-4

    Article  Google Scholar 

  6. Du Q, Ni S, Fu Y, Liu S (2018) Analysis of dietary related factors of recurrent aphthous stomatitis among college students. Evid Based Complement Alternat Med 2018:1–7. https://doi.org/10.1155/2018/2907812

  7. Ajmal M, Ibrahim L, Mohammed N, Al-Qarni H (2018) Prevalence and psychological stress in recurrent aphthous stomatitis among female dental students in Saudi Arabia. Clujul Medical 91(2):216–221. https://doi.org/10.15386/cjmed-840

  8. Ślebioda Z, Dorocka-Bobkowska B (2019) Systemic and environmental risk factors for recurrent aphthous stomatitis in a Polish cohort of patients. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii 36(2):196–201. https://doi.org/10.5114/ada.2018.74638

    Article  PubMed  Google Scholar 

  9. Kaur M, Sahota JK (2018) Recurrent apthous stomatitis-a review. J Adv Med Dent Scie Res 6(4):9–12. https://doi.org/10.21276/jamdsr

  10. Hall A (2019) Aphthous ulcers and Behçet’s disease. In: Atlas of Male Genital Dermatology. Springer: 141–143. https://doi.org/10.1007/978-3-319-99750-6

  11. Plewa MC, Chatterjee K (2018) Aphthous stomatitis. In: StatPearls [Internet]. StatPearls Publishing

  12. Manthiram K, Nesbitt E, Morgan T, Edwards KM (2016) Family history in periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome. Pediatrics 138(3):e20154572. https://doi.org/10.1542/peds.2015-4572

  13. Zain RB (1999) Classification, epidemiology and aetiology of oral recurrent aphthous ulceration/stomatitis. Annal Dent Univ Malaya 6:34–37

  14. Kalpana R (2016) Relation between smoking and recurrent aphthous stomatitis. OralMaxillofac Pathol J 7(2):761–762. https://doi.org/10.5005/jp-journals-10037-1087

    Article  Google Scholar 

  15. Mansour-Ghanaei F, Joukar F, Naghipour MR et al (2019) Cohort Profile: The PERSIAN Guilan Cohort Study (PGCS). Arch Iran Med 22(1):39–45

    PubMed  Google Scholar 

  16. Eghtesad S, Mohammadi Z, Shayanrad A, Faramarzi E, Joukar F, Hamzeh B, Farjam M, Zare Sakhvidi MJ, Miri-Monjar M, Moosazadeh M, Hakimi H, Rahimi Kazerooni S, Cheraghian B, Ahmadi A, Nejatizadeh A, Mohebbi I, Pourfarzi F, Roozafzai F, Motamed-Gorji N, Montazeri SA, Masoudi S, Amin-Esmaeili M, Danaie N, Mirhafez SR, Hashemi H, Poustchi H, Malekzadeh R (2017) The PERSIAN cohort: providing the evidence needed for healthcare reform. Arch Iran Med 20(11):291–295

  17. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, Mohammadi Z, Mahmoudi Z, Shayanrad A, Roozafzai F, Sheikh M, Jalaeikhoo A, Somi MH, Mansour-Ghanaei F, Najafi F, Bahramali E, Mehrparvar A, Ansari-Moghaddam A, Enayati AA, Esmaeili Nadimi A, Rezaianzadeh A, Saki N, Alipour F, Kelishadi R, Rahimi-Movaghar A, Aminisani N, Boffetta P, Malekzadeh R (2018) Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol 187(4):647–655. https://doi.org/10.1093/aje/kwx314

    Article  PubMed  Google Scholar 

  18. Kramer I, Pindborg JJ, Bezroukov V, Infirri JS (1980) Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization. Community dentistry and oral epidemiology 8(1):1–26. https://doi.org/10.1111/j.1600-0528.1980.tb01249.x

  19. Ghanaei FM ,Joukar F, Rabiei M, Daneshzadeh A, Kord Valeshabad A (2013) Prevalence of oral mucosal lesions in an adult Iranian population. Iran Red Crescent Med J 15(7):600–604. https://doi.org/10.5812/ircmj.4608

  20. Al-Johani K (2019) Prevalence of recurrent aphthous stomatitis among dental students: a cross sectional study. J Contemp Dent Pract 20(8):893–895. https://doi.org/10.5005/jp-journals-10024-2630

  21. Gheni Taher M (2018) Prevalence of recurrent aphthous ulceration in the Diyala population. Diyala J Med 15(2):112–118. https://doi.org/10.26505/DJM

  22. Shiva A, Charati JY, Elkaei A, Zamanzadeh M (2019) Prevalence of recurrent Aphthous stomatitis in university students and its relation with anxiety. J Mazandaran Univ Med Sci 29(180):108–112

    Google Scholar 

  23. Böbel TS, Hackl SB, Langgartner D, Jarczok MN, Rohleder N, Rook GA, Lowry CA, Gündel H, Waller C, Reber SO (2018) Less immune activation following social stress in rural vs. urban participants raised with regular or no animal contact, respectively. Proc Natl Acad Sci 115(20):5259–5264. https://doi.org/10.1073/pnas.1719866115

  24. Sawair FA (2010) Does smoking really protect from recurrent aphthous stomatitis? Ther Clin Risk Manag 6:573-577. https://doi.org/10.2147/TCRM.S15145

  25. Bulur I, Onder M (2017) Behçet disease: new aspects. Clin Dermatol 35(5):421–434. https://doi.org/10.1016/j.clindermatol.2017.06.004

    Article  PubMed  Google Scholar 

  26. Ramanathan A, Deepak T, Manjunath M, Krishna S, AG A, Arun A, Lakhani H (2017) A comparative study of oral health status between type 2 diabetics and non diabetic subjects.J Glob Diabetes Clin Metab 2(2):2–5

  27. Rohani B (2019) Oral manifestations in patients with diabetes mellitus. World J Diabetes 10(9):485–489. https://doi.org/10.4239/wjd.v10.i9.485

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mohammed D (2019) Oro-genital aphthous stomatitis: A case of mistaken herpes simplex virus type 2.The Pharma Innovation Journal 8(6):41–43

  29. Dhopte A, Naidu G, Singh-Makkad R, Nagi R, Bagde H, Jain S (2018) Psychometric analysis of stress, anxiety and depression in patients with recurrent aphthous stomatitis-a cross-sectional survey based study. J Clin Exp Dent 10(11):1109–1114

    Google Scholar 

  30. Karaer IC, Urhan A, Reyhani I (2020) Stress and recurrent aphthous stomatitis. Medicine Science 9(1):170–174

  31. Hariyani N, Bramantoro T, Nair R, Singh A, Sengupta K (2020) Depression symptoms and recurrent aphthous stomatitis—evidence from a population-based study in Indonesia. Oral Dis 26(5):948–954. https://doi.org/10.1111/odi.13303

    Article  PubMed  Google Scholar 

  32. Ryan M, Baumann RJ, Miller CS, Baker C (2002) Valproate-associated stomatitis. J Child Neurol 17(3):225–227. https://doi.org/10.1177/088307380201700315

    Article  PubMed  Google Scholar 

  33. Srivastav R, Chaurasia P, Bhardwaj A, Hyanki D (2019) Comparative study of effect of stress on headache in medical and non-medical students. Int J Physiol 7(3):145–149. https://doi.org/10.5958/2320-608X.2019.00103.3

    Article  Google Scholar 

  34. Bung S, Saile H, Laessle R (2017) Depression, stress symptoms, and cortisol awakening response in female adolescents with chronic headache. Adolescent Psychiatry 7(2):105–111

  35. Khare P, Sharva V, Handa H, Amit K, Jain M (2017) Association of recurrent aphthous stomatitis and psychological stress in school going teenagers of Bhopal city, Central India: a descriptive study. Indian Journal of Multidisciplinary Dentistry 7(2):82–86. https://doi.org/10.4103/ijmd.ijmd-23-17

    Article  Google Scholar 

  36. AL-Omiri MK, Karasneh J, Alhijawi MM, M.A Zwiri A, Scully C, Lynch E, (2015) Recurrent aphthous stomatitis (RAS): a preliminary within-subject study of quality of life, oral health impacts and personality profiles. J Oral Pathol Med 44(4):278–283. https://doi.org/10.1111/jop.12232

  37. Mehdipour M, Zenooz AT, Sohrabi A, Gholizadeh N, Bahramian A, Jamali Z (2016) A comparison of the effect of triamcinolone ointment and mouthwash with or without zinc on the healing process of aphthous stomatitis lesions. Journal of dental research, dental clinics, dental prospects 10(2):87–91. https://doi.org/10.15171/joddd.2016.014

Download references

Funding

This study was supported financially by Guilan University of Medical Sciences, Rasht, Iran.

Author information

Authors and Affiliations

  1. Department of Dermatology, School of Medicine Guilan University of Medical Sciences, Rasht, Iran

    Abbas Darjani

  2. GI Cancer Screening and Prevention Research center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

    Farahnaz Joukar & Fariborz Mansour-Ghanaei

  3. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences , Razi Hospital, Sardar-Jangle Ave., Rasht, 41448-95655, Iran

    Mohammareza Naghipour, Mehrnaz Asgharnezhad & Fariborz Mansour-Ghanaei

Authors
  1. Abbas Darjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Farahnaz Joukar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammareza Naghipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehrnaz Asgharnezhad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fariborz Mansour-Ghanaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Abbas Darjani, Farahnaz Joukar, Fariborz Mansour-Ghanaei, and Mohammareza Naghipour were involved in the study planning and data analysis. Mehrnaz Asgharnezhad collected data and contributed to data interpretation. Abbas Darjani, Farahnaz Joukar, and Fariborz Mansour-Ghanaei wrote the initial draft of the manuscript, and Abbas Darjani, Farahnaz Joukar, Fariborz Mansour-Ghanaei, and Mehrnaz Asgharnezhad contributed toward its final version. All authors read and approved the final version.

Corresponding author

Correspondence to Fariborz Mansour-Ghanaei.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The PGCS design was approved by the ethics committees at the Ministry of Health and Medical Education, the Digestive Diseases Research Institute (Tehran University of Medical Sciences), and also Guilan University of Medical Sciences (P/3/132/215).

Informed consent

Before participation, all participants received oral and written study information and signed a written consent form.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Clinical relevance

Patients with underlying diseases, including rheumatic disease, depression, chronic headaches, diabetes mellitus, and epilepsy should pay special attention to oral health to prevent RAS. The practitioner should pay attention to the management of the underlying disease of RAS patients.

This manuscript has not been published in whole or in part and is not under consideration elsewhere.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Darjani, A., Joukar, F., Naghipour, M. et al. Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study. Clin Oral Invest 25, 711–718 (2021). https://doi.org/10.1007/s00784-020-03611-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03611-y

Keywords

Search

Navigation