Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal disorders. The aim of the study was to determine any association between anxiety levels and concentrations of salivary and serum cortisol in patients with RAS. It has been suggested that stress with its presumed effects on the immune system, constitutes one of the major causative agents of RAS. The concentrations of salivary and serum cortisol were measured in 38 patients with recurrent aphthous stomatitis, and 38 healthy controls. Salivary and serum cortisol levels were measured using a Luminenscent Immunoassay (LIA) method. Anxiety levels were evaluated using Spielberger's State-Trait Anxiety Inventory which measures both trait anxiety as a general aspect of personality (STAI-T) and state anxiety as a response to a specific situation (STAI-S). The salivary cortisol levels were 1.44 (+/- 0.58) microg dl(-1) in RAS patients and 0.91 (+/- 0.56) microg dl(-1) in controls (p = 0.001), while the serum cortisol levels were 3.13 (+/- 1.59) microg dl(-1) in RAS patients and 1.89 (+/- 1.11) microg dl(-1) in controls (p = 0.001). The state anxiety levels (STAI-S) were 48.85 (+/- 9.7) in RAS group and 39.45 (+/- 7.5) in control group (p = 0.001). The trait anxiety levels (STAI-T) were 49.78 (+/- 13.02) in RAS group and 38.49 (+/- 10.31) in control group (p = 0.001). Salivary and serum cortisol concentrations and state and trait anxiety levels in RAS were significantly higher than those in the control group. Our results suggest that stress may be involved in the pathogenesis of RAS.

Detection, enumeration and characterization of T helper cells secreting type 1 and type 2 cytokines in patients with recurrent aphthous stomatitis.

One of the factors involved in the pathogenesis of recurrent aphthous stomatitis (RAS) is a cell-mediated immune response in which several cytokines seem to play a major role. The aim of this study was to detect, enumerate and characterize T helper cells which are secreting type 1 cytokines (interleukin [IL]-2, IL-12, interferon [IFN]-gamma, and tumor necrosis factor [TNF]-alpha) and type 2 cytokines (IL-4, IL-5, IL-6, and IL-10) in the peripheral blood of patients with RAS. Thirty-two patients in the active phase of RAS (14 men and 18 women) and 40 healthy individuals participated in the study. T helper (T) cells were detected and characterized using Elispot assay. T cells secreting IL-2, IL-12 or IFN-gamma were increased in patients with RAS compared with the controls (p < 0.05, p < 0.001 and p < 0.001, respectively). T cells secreting TNF-alpha in RAS patients and controls were not statistically different (p > 0.05). T cells secreting IL-10 were increased in patients with RAS compared with the controls (p < 0.05). T cells secreting IL-4 were decreased in patients with RAS compared with the controls (p < 0.001), No statistical difference was observed between T cells secreting IL-5 or IL-6 in patients with RAS and controls. Our findings suggest that the increased numbers of T cells secreting type 1 cytokines may influence the immune response against RAS. Whether this action is of etiological importance or epigenetic phenomenon is a question that needs to be answered.