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Objectives: Recurrent Aphthous Stomatitis (RAS) is characterized by painful intraoral ulcers of unknown etiology. We conducted an exploratory study to identify the most commonly reported environmental triggers.
Methods: We analyzed preliminary data from an exploratory case series study nested within a larger case-control epidemiologic study. Following IRB approval, participants aged 13 years and older were recruited by advertisements throughout the University of Florida over a 3-month period (June-September 2007). Cases with a lifetime history of idiopathic RAS completed a standardized questionnaire that included the close-ended question: “What do you think is/are the possible cause(s) of your canker sores? (we are interested in your specific case, not what you may have heard from others)”. Participants marked yes/no for each possible answer that included possible triggers and neutral responses: bad teeth, bad gums, acidic foods, too much sugar, diet, stress, lack of sleep, accidental bite/trauma, allergy, other reason or no apparent reason. Descriptive statistics (median, range and %) were performed using SAS v9.1.
Results: Fifty cases were recruited, with 94% completing the study. Participants were 44.7% female, 8.5% Hispanic, 66.0% White, 25.5% Asian, 8.5% other race, aged 19-66 (median age 22 years). The 3 most common answers, with 45/47 cases reporting at least one of them, were: no apparent reason (87.0%), stress (57.4%) and lack of sleep (44.7%). The remaining 2 cases reported acidic foods/diet and too much sugar as the main trigger. The least common answers were bad teeth (8.5%), allergies (8.5%) and other specific reasons (13.0%), e.g. playing the saxophone, indigestion/excessive internal heat, low blood, braces (n=1/each), or being sick (n=2).
Conclusions: Stress and lack of sleep were commonly reported triggers among RAS patients. More in-depth studies are needed on the role of sleep disturbances in RAS onset and their relationship to stress.
Funding: NIH grants R03DE016356, U24DE016509 and M01RR00082.