Pathway to gleeful mouth is a cheerful tummy & reposeful mind: A silver lining link

1. DEPARTMENT OF ORAL & MAXILLOFACIAL PATHOLOGY Pathway to gleeful mouth is a cheerful tummy & reposeful mind: A silver lining link By, Roshini Shetty MDS, Certified Forensic Odontologist, Certified Laser Dentist, Researcher with patented innovations, Medical writer.

2. INTRODUCTION • Recurrent Aphthous stomatitis (RAS) is a common & painful oral mucosal pathosiswhich is a poorly understood clinical entity.

3. Etiopathogenesis Thought to be of a multifactorial etiology Precipitating factors Microbial factors Local trauma Local & systemic conditions Stress Genetic Drugs Nutritional Hormonal change Immunological

5. STUDY Is there a link?

6. Our study…. …is inspired by various clinical trials [1-9] trying to deliberately improve the quality of life of RAS patients by constant and enthusiastic research into the subject. • Our Motto being, “ Community improvement by RAS perishment”

7. PURPOSE OF THE STUDY • Assess the prevalence of RAS among medical and paramedical students of a Health University • Analyze the stress level in the affected individuals using validated ‘Depression anxiety stress scale’ (DASS) • To make a preliminary analysis of the link between gastrointestinal diseases and RAS

8. METHODOLOGY Questionnaire based survey • To assess the prevalence of RAS among health professionals • A total of 1400 students between 18-27 years age group studying in medical, dental and various paramedical courses of Yenepoya University were personally interviewed.

9. 2) To record the general details • Students who gave positive history for RAS were included in the study as study group • Questionnaire with the questions related to possible predisposing factors, etiological factors and clinical parameters was distributed among these selected subjects to record the details.

10. 3) To assess the Depression, Anxiety and stress level in the study group • Validated, ‘DASS’ questionnaire was administered to the selected subjects when they had active lesions during the study period.

11. 4) To assess the gastrointestinal health status of subjects in the study group • ‘Gastrointestinal health questionnaire’ was administered to the selected subjects to record the details.

12. DASS SCORING AND GRADING SCALE

13. GASTROINTESTINALPROBLEMS SCORING AND GRADING

14. RESULTS • The data collected was analyzed using descriptive statistics. 7.8% Percentage

16. 70.5% 21.9% 7.6%

17. 91.54% 8.45% 0%

18. 15% 15% 9% 10%

19. 15.6% 12.6% 2%

20. 9.4% 92.3% 87.6%

21. Percentage of students who reported that there was correlation between their RAS and stress was 64% but when DASS was administered to the study group it was found that actually only 48% developed RAS during stress

22. Percentage of students in the study group who developed RAS during Depression, Anxiety and stress

24. 3.6% 0%

25. DISCUSSION 1) Prevalence & significant clinical parameters obtained • Studies[1,2]show high prevalence of RAS in health professionals as high as 50 to 80 % but our study showed relatively low prevalence of 7.8% • Similar to previously conducted studies by investigators like Huling LB et al and Koybasi S et al, our study also shows that RAS is painful and interferes with eating and speech thus affecting the quality of life of RAS patients. • HulingLB, Baccaglini L, ChoquetteL,Feinn RS. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med. 2012 ;41(2):149-52. • KoybasiS et al.Recurrentaphthous stomatitis: investigation of possible etiologic factors. American Journal of Otolaryngology–Head and Neck Medicine and Surgery 27 (2006) 229– 232

26. Tharakji B et al have related diet and RAS. In our study, we found 12.6% subjects reported history of RAS on consumption of spicy food • Since relation between prodromal symptoms & RAS was high in our study, effective intervention during this stage could prevent ulcers from progressing further. TharakjiB et al.Effects of dietary habits on the development of RAS. Nigerian medical journal;2012;53: 194

27. 2) Stress relation • Many investigators[2,3,4]have tried to find out the correlation of RAS and stress with varying results • In our study we found that the number of people who assume that their RAS is related to stress is more compared to people whose RAS & stress has the most probable correlation

28. Few past studies conducted during 1977 [5,6]have reported that stress in the form of lecturer-student relationship and working environment in health professionals have contributed as a main role as a stressor and subsequent development of RAS • These studies report high occurrence of stress related RAS among dental students but our study shows that prevalence as well as stress related RAS was least among dental students. • More interactive learning, structured curriculum and a more friendly lecturer-student relationship in the recent times may have contributed to the low level of stress related RAS occurrence

29. 3) Gastrointestinal health & RAS relation • Various studies[1,7,8]show variable results in regard to the association of RAS with gastrointestinal problems with few showing well established convincing evidence linking the both while others concluding no apparent etiological link between the two. • In our study, we found moderately high percentage of students with RAS presumably due to associated gastrointestinal problems with moderate severity. • As RAS are most of the times treated without a definite diagnosis, we emphasize the need to search & screen for underlying systemic illness in the differential diagnosis of RAS, so that it would immensely contribute to permanently cure RAS rather than a symptomatic treatment.

30. CONCLUSION There are many intriguing aspects in the relationship of stress, gastrointestinal problems and RAS, the major part of which has to be unveiled still through more dedicated studies in future.

31. “A goal is a dream with a deadline.” Napoleon Hill • Hope our dream to prevent RAS occurrence will meet the deadline soon with success. THANKYOU 3rd Prize in 33rd Annual conference of Indian Association of Biomedical Scientists

32. REFERENCE 1)KoybasiS et al.Recurrentaphthous stomatitis: investigation of possible etiologic factors. American Journal of Otolaryngology–Head and Neck Medicine and Surgery 27 (2006) 229– 232 2)SafadiR. Prevalence of recurrent aphthous ulceration in Jordanian dental patients. BMC Oral Health 2009; 9:31 3) Huling LB, Baccaglini L, ChoquetteL,Feinn RS. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med. 2012 ;41(2):149-52. 4)GaphorM. Clinical observation of recurrent aphthous stomatitis in Sulaimania.JBaghColl Dentistry 2009; 21(1): 74-79 5) Gallo et al. Academic stress and RAS in health professionals. Clinics;1977:67(2):135 6) WillcockSM, Daly MG, Tennant CC and Allard BJ. Burnout and psychiatric morbidity in new medical graduates. The Medical Journal of Australia 2004; 181(7): 357 – 360. 7)Field E & Allan R. Review article: oral ulceration aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Aliment PharmacolTher 2003; 18: 949–962. 8)YaşarS, Yaşar B, Abut E, SerdarZ.Clinical importance of celiac disease in patients with recurrent aphthous stomatitis. Turk J Gastroenterol. 2012 Feb;23(1):14-8. 9)TharakjiB et al.Effects of dietary habits on the development of RAS.Nigerian medical journal;2012;53: 194