Stress as a Cause of Recurrent Aphthous Stomatitis and Its Correlation with Salivary Stress Markers

10.4077/CJP.2017.BAF462

Kirthana Kunikullaya U.；Arun Kumar M.；Vasanthi Ananthakrishnan；Goturu Jaisri

recurrent aphthous stomatitis ； salivary amylase ； salivary cortisol levels ； STAI questionnaire ； Stress

The Chinese Journal of Physiology

60卷4期（2017 / 08 / 31）

226 - 230

英文

Stress causes an increase in cortisol and amylase. Recurrent aphthous stomatitis (RAS) results due to a multitude of causes, amongst which stress is one of the most important. Aim of the study was to estimate the level of stress, serum cortisol, salivary cortisol, amylase and electrolytes in subjects with RAS. Thirty-four subjects with RAS (cases) were compared with 34 controls. Stress was measured using state trait anxiety inventory (STAI). Serum cortisol (radioimmunoassay), salivary cortisol, amylase (enzyme-linked immunosorbent assay, ELISA) and electrolytes (flame photometry) were measured. Statistical analysis was done using SPSS 18.0 version software. The mean STAI scores were 48.71 ± 4.6 in cases and 46.74 ± 6.4 in controls (P = 0.13). The mean salivary cortisol concentration was 3.35 ± 1.8 ng/dl in cases and 3.65 ± 2.5 ng/dl in controls (P = 0.78). The mean salivary amylase was 155.09 ± 116.1 U/ml in cases and 128.74 ± 86.3 U/ml in controls (P = 0.49). The salivary sodium (0.24 ± 0.4 in both groups) and potassium (0.65 ± 0.5 in cases and 0.82 ± 0.4 in controls; P = 0.07) was not different in the two groups (electrolytes in mEq/dl). No correlation was seen between the salivary stress markers and STAI scores. Though stress was higher in RAS group none of the measured parameters were different from the control group. Stress may cause RAS but, in this study, there was no change in the salivary homeostasis.

1. Albanidou-Farmaki, E.,Poulopoulos, A.K.,Epivatianos, A.,Farmakis, K.,Karamouzis, M.,Antoniades, D.(2008).Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis.Tohoku J. Exp. Med.,214,291-296.
2. Alshahrani, S.,Baccaglini, L.(2014).Psychological screening test results for stress, depression, and anxiety are variably associated with clinical severity of recurrent aphthous stomatitis and oral lichen planus.J. Evid. Based Dent. Pract.,14,206-208.
3. Arun, K.M.,Vasanthi, A.,Jaisri, G.(2014).Stress in academia manifested as aphthous ulcers.Int. J. Basic Appl. Med. Sci.,4,273-277.
4. Bosch, J.A.,de Geus, E.J.C.,Veerman, E.C.I.,Hoogstraten, J.,Nieuw Amerongen, A.V.(2003).Innate secretory immunity in response to laboratory stressors that evoke distinct patterns of cardiac autonomic activity.Psychosom. Med.,65,245-258.
5. Chatterton, R.T.,Vogelsong, K.M.,Lu, Y.C.,Ellman, A.B.,Hudgens, G.A.(1996).Salivary alpha-amylase as a measure of endogenous adrenergic activity.Clin. Physiol. Oxf. Engl.,16,433-448.
6. de Kloet, E.R.,Vreugdenhil, E.,Oitzl, M.S.,Joëls, M.(1991).Brain corticosteroid receptor balance and homeostatic control.Front. Neuroendocr.,12,95-164.
7. Field, E.A.,Allan, R.B.(2003).Review article: oral ulceration-aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic.Aliment. Pharmacol. Ther.,18,949-962.
8. Fountoulakis, K.N.,Papadopoulou, M.,Kleanthous, S.,Papadopoulou, A.,Bizeli, V.,Nimatoudis, I.,Iacovides, A.,Kaprinis, G.S.(2006).Reliability and psychometric properties of the Greek translation of the state-trait anxiety inventory form Y: preliminary data.Ann. Gen. Psychiatry,5,2.
9. Gallo, C. de B.,Mimura, M.A.M.,Sugaya, N.N.(2009).Psychological stress and recurrent aphthous stomatitis.Clinics,64,645-648.
10. Ganong, W.F.(2012).Review of Medical Physiology.McGraw Hill Lange.
11. Karthikeyan, P.,Aswath, N.(2016).Stress as an etiologic co-factor in recurrent aphthous ulcers and oral lichen planus.J. Oral. Sci.,58,237-240.
12. Kirschbaum, C.,Hellhammer, D.H.(1994).Salivary cortisol in psychoneuroendocrine research: recent developments and applications.Psychoneuroendocrinology,19,313-333.
13. Laura, J. Julian(2011).Measures of anxiety.Arthritis Care Res,63
14. Maruyama, Y.,Kawano, A.,Okamoto, S.,Ando, T.,Ishitobi, Y.,Tanaka, Y.,Inoue, A.,Imanaga, J.,Kanehisa, M.,Higuma, H.,Ninomiya, T.,Tsuru, J.,Hanada, H.,Akiyoshi, J.(2013).Differences in salivary alpha-amylase and cortisol responsiveness following exposure to electrical stimulation versus the Trier social stress tests.PLoS One,7,e39375.
15. McCartan, B.E.,Lamey, P.J.,Wallace, A.M.(1996).Salivary cortisol and anxiety in recurrent aphthous stomatitis.J. Oral. Pathol. Med.,25,357-359.
16. Mohammad, R.,Mashlah, A.,Abou-Hamed, H.,Abou-Rabii, I.(2017).Salivary flow among patients with minor recurrent aphthous stomatitis.J. Dent. Res.
17. Munck, A.,Guyre, P.M.,Holbrook, N.J.(1984).Physiological functions of glucocorticoids in stress and their relation to pharmacological actions.Endocr. Rev.,5,25-44.
18. Nadendla, L.K.,Meduri, V.,Paramkusam, G.,Pachava, K.R.(2015).Relationship of salivary cortisol and anxiety in recurrent aphthous stomatitis.Indian J. Endocrinol. Metab.,19,56-59.
19. Nater, U.M.,La Marca, R.,Florin, L.,Moses, A.,Langhans, W.,Koller, M.M.,Ehlert, U.(2006).Stress-induced changes in human salivary alpha-amylase activity - associations with adrenergic activity.Psychoneuroendocrinology,31,49-58.
20. Nater, U.M.,Rohleder, N.,Gaab, J.,Berger, S.,Jud, A.,Kirschbaum, C.,Ehlert, U.(2005).Human salivary alpha-amylase reactivity in a psychosocial stress paradigm.Int. J. Psychophysiol.,55,333-342.
21. Payne, L.A.,Hibel, L.C.,Granger, D.A.,Tsao, J.C.I.,Zeltzer, L.K.(2014).Relationship of salivary alpha amylase and cortisol to social anxiety in healthy children undergoing laboratory pain tasks.J. Child Adolesc. Behav.,2
22. Rohleder, N.,Wolf, J.M.,Maldonado, E.F.,Kirschbaum, C.(2006).The psychosocial stress-induced increase in salivary alphaamylase is independent of saliva flow rate.Psychophysiology,43,645-652.
23. Sahu, G.K.,Upadhyay, S.,Panna, S.M.(2014).Salivary alpha amylase activity in human beings of different age groups subjected to psychological stress.Indian J. Clin. Biochem.,29,485-490.
24. Schwab, K.O.,Heubel, G.,Bartels, H.(1992).Free epinephrine, norepinephrine and dopamine in saliva and plasma of healthy adults.Eur. J. Clin. Chem. Clin. Biochem.,30,541-544.
25. Skosnik, P.D.,Chatterton,R.T., Jr.,Swisher, T.,Park, S.(2000).Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress.Int. J. Psychophysiol.,36,59-68.
26. Takai, N.,Yamaguchi, M.,Aragaki, T.,Eto, K.,Uchihashi, K.,Nishikawa, Y.(2004).Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults.Arch. Oral Biol.,49,963-968.
27. Tamura, A.,Maruyama, Y.,Ishitobi, Y.,Kawano, A.,Ando, T.,Ikeda, R.,Inoue, A.,Imanaga, J.,Okamoto, S.,Kanehisa, M.,Ninomiya, T.,Tanaka, Y.,Tsuru, J.,Akiyoshi, J.(2013).Salivary alphaamylase and cortisol responsiveness following electrical stimulation stress in patients with the generalized type of social anxiety disorder.Pharmacopsychiatry,46,225-260.
28. van Stegeren, A.,Rohleder, N.,Everaerd, W.,Wolf, O.T.(2006).Salivary alpha amylase as marker for adrenergic activity during stress: effect of betablockade.Psychoneuroendocrinology,31,137-141.