Validation of the HADS and PSS-10 and a cross-sectional study of psychological status in patients with recurrent aphthous stomatitis.

OBJECTIVES: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross-sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS. METHODS: The validity and reliability of the HADS and PSS-10 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate-to-high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS-10 and bivariate analyses, respectively. RESULTS: A bi-factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS-10 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate-to-high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms. CONCLUSION: The HADS and PSS-10 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group.

The influence of oral health and psycho-social well-being on clinical outcomes in Behçet's disease.

This study was designed to investigate the association of oral ulceration and oral health factors, together with psycho-social well-being in Behçet's disease (BD), and to clarify the importance of psycho-social support of patients in the overall management of BD. The study comprised of a cohort of 146 BD patients (mean age ± SD = 39.65 ± 13.20) and 20 recurrent aphthous stomatitis (RAS) patients (mean age ± SD = 42.32 ± 11.32). Oral ulcer severity score (OUSS), Behçet's disease current activities form (BDCAF), hospital anxiety and depression scale (HADS), and the work and social adjustment scale (WSAS) were investigated. Oral health risk factors were also included. The analysis of variance, regression, and factor analysis were used to scrutinise the data. Almost 73% of patients were at high caries risk in BD and RAS groups. Thirty-nine percent of BD and forty percent of RAS had a score of BPE3 (probing depth 3.5-5.5 mm). Regression analysis revealed that OUSS and WSAS had a positive impact to increase the BDCAF score in BD patients (ß = 0.395, P = 0.001; ß = 0.240, P = 0.019), respectively. Dental health, periodontal health, anxiety, depression, and WSAS variables had strong loadings by factor analysis based on gender and at the time of present and absent of oral ulceration. The main oral ulcer characteristics that had significant influences on the total of oral health quality of life by 68.6% were: size, duration, ulcer-free period, and pain. The results highlighted the significant influence of oral ulceration, patients' oral health, diet, and psycho-social well-being as multi-factorial causes on increasing disease activity in BD patients.

The association between minor recurrent aphthous stomatitis (RAS), children's poor oral condition, and underlying negative psychosocial habits and attitudes towards oral hygiene.

BACKGROUND: Minor Recurrent Aphthous Stomatitis (RAS) represents a disease which is very difficult to prevent. This case-control study focused on possible associations between minor Recurrent Aphthous Stomatitis in children, their oral health, and underlying behavioral indexes of children's attitudes and habits pertaining to (home) oral hygiene, with the further goal of enabling the dentist to prevent these specific kind of lesions, both from a clinical and a broader psychosocial perspective. METHODS: Four hundred one school-children (5-10 years old) in Milan (Italy) were submitted to an intra-oral examination, and interviewed with the aid of a brief psychosocial questionnaire. RESULTS: At the clinical level, statistically significant associations were observed between the presence of decayed teeth and minor Recurrent Aphthous Stomatitis (Odds Ratio: 3.15; 95% CI: lower limit 1.06; upper limit: 9.36; Z-test: 2.07, p = 0.039; Chi-square = 4.71, p = 0.030), and between the Decayed Missing or Filled Teeth (DMFT) index and minor aphthous stomatitis (Odds Ratio: 3.30; 95% CI: lower limit 1.13; upper limit: 9.67; Z-test = 2.18, p = 0.029; Chi-square = 5.27; p = 0.022), both results pointing to a significant increase-by circa 3 times-in the risk of developing minor Recurrent Aphthous Stomatitis in children exposed to the two above-identified factors (i.e., the presence of decayed teeth and a clearly compromised oral condition, as signaled by the DMFT index), if compared with the risk run by their non-exposed counterparts. At the psychosocial level of analysis, statistically significant associations were observed (1) between children's practice of spontaneously brushing teeth when not at home and a comparatively lower (i.e. better) Decayed Missing or Filled Teeth index (Chi-square: 8.95; p = 0.011), and (2) between receiving parental aid (e.g., proper brushing instructions) while practicing home oral hygiene and a significantly reduced presence of decayed teeth (Chi-square = 5.40; p = .067; Spearman's Rho, p = .038). Further, significant associations were also observed between children's reported severity of dental pain and both (a) the presence of decayed teeth (Chi-square = 10.80; p = 0.011), and (b) children's (poor) oral health condition as expressed by the Decayed Missing or Filled Teeth index (Chi-square = 6.29; p = 0.043). Interestingly, specific lifestyles and social status, showed no systematic association to other clinical or psychological/psychosocial indices. CONCLUSIONS: These systematic relations suggest that, in the presence of Recurrent Aphthous Stomatitis in pediatric patients, the dentist should carefully monitor children for potential carious lesions, implement protocols of prevention to control Recurrent Aphthous Stomatitis disease in children affected by caries, and also be particularly aware of the right or wrong habits children may acquire in the course of continued social exchange with their caregivers and peers.

Psychological problems and quality of life of patients with oral mucosal diseases: a preliminary study in Chinese population.

BACKGROUND: Psychological problems might play important roles in oral mucosal diseases such as recurrent aphthous ulcers (RAU), oral lichen planus (OLP), burning mouth syndrome (BMS), but the relevance to patients' quality of life remained controversial. The aim of this study was to investigate the psychological problems and oral health-related quality of life in patients with RAU, OLP, and BMS in China, to assess the relationship between psychological problems and quality of life. METHOD: Thirty-nine RAU patients, 45 OLP patients, 15 BMS patients and 45 healthy controls were enrolled in the study. Hospital Anxiety and Depression Scale (HADS) were chosen to analyze the patients' psychological problems. Oral Health Impact Profile (OHIP-14) was used to measure the OHRQoL. The scores of HADS and OHIP-14 were used to analyze the relationship between psychological problems and the quality of life of oral mucosa patients. RESULTS: Each of OHIP-14 scores and HADS scores in RAU, OLP, BMS was higher than the control group, and there was significant difference in the patients groups with the control cases(P < 0.05). OHIP-14 score of RAU was the highest in three patient groups. Its OHRQoL was lowest in the three groups, which had statistical significance (P < 0.05). Positive correlations existed between the psychological problems and the quality of life of the three patient groups (rs > 0, P < 0.05), except for the depression of the BMS group (rs = 0.168, P = 0.395). CONCLUSION: Patients with oral mucosal diseases such as RAU, OLP, and BMS had higher levels of anxiety, depression, and lower quality of life. The patient's psychological problems were related to their quality of life, suggesting that the psychological state of patients with oral mucosal disease need more attention.

Patient-reported outcome measures in recurrent aphthous stomatitis: A critical assessment of quality properties.

OBJECTIVES: To analyse the range of existing patient-reported outcome measures (PROMs) used in studies of recurrent aphthous stomatitis (RAS) and to evaluate their quality properties via the assessment of psychometric properties and interpretability. MATERIALS AND METHODS: Electronic databases were searched to identify relevant publications related to PROMs used in RAS. Publications were selected based on predefined criteria. All identified PROMs were then classified by measuring concepts and assessed for instrument characteristics and evidence for quality properties for RAS patients. RESULTS: Twenty-eight PROMs were used in studies of RAS patients. Instruments focused upon oral symptoms (n = 4), psychosocial status (n = 15) and quality of life (n = 9). Five PROMs (Oral Health-related Quality of Life-UK, Chronic Oral Mucosal Disease Questionnaire, Oral Health Impact Profile-14, Medical Outcome Study Short Form-36 and Mumcu's composite index) were found to have some evidence of psychometric performance. No PROMs showed evidence for interpretability of their scores in RAS patients. CONCLUSION: There was a wide range of PROMs used in clinical studies of RAS. The majority of these PROMs lack evidence of measurement properties and interpretability for RAS patients. Further studies are required to confirm whether these instruments are suitable and useful for this patient group.

Evaluation of the content quality of websites for recurrent aphthous ulcers and oral lichen planus.

BACKGROUND: The Internet is one of the most popular resources for people to obtain medical information; however, only a limited number of studies have reported the quality of the available health information related to oral mucosal diseases. The present study aimed to evaluate the quality of information on websites for recurrent aphthous ulcers (RAU) and oral lichen planus (OLP), in both Chinese and English. METHODS: Common search engines, BaiDu, Google, and Yahoo in Chinese; and Bing, Google, and Yahoo in English were used to identify websites providing content related to the oral mucosal diseases. The first 100 links for keywords "recurrent aphthous ulcers" and "oral lichen planus" were visited and content was downloaded within 24 h. Two separate trained researchers use the validated DISCERN rating instrument and JAMA benchmarks to evaluate the content. The rating scores were analyzed and the quality was assessed according to the scores and content of websites. RESULTS: A total of 145 websites for RAU and 128 of OLP were analyzed. Based on the DISCERN instrument, the quality of the content in websites for both diseases, whether in English or Chinese, was not high, generally scoring 2 to 3 (max. 5). Only 13 of the RAU websites and 21 of the OLP websites fulfilled the four criteria of the JAMA benchmarks. Generally, the scores of the English websites were higher than those of the Chinese websites. During the twelve searches, only four (Yahoo of RAU in Chinese, Bing and Yahoo of RAU in English, and Google of OLP in Chinese) showed moderate correlation between the website's ranking and their rating scores. People cannot obtain high quality medical information if they only look at the top ranked sites on the viewing lists. Websites belonging to universities or medical centers had relatively higher scores compared with the others. CONCLUSIONS: The quality of the content on websites relating to RAU and OLP in Chinese and English was moderate. More good quality websites and information are needed in the future.

Recurrent aphthous stomatitis (RAS): a preliminary within-subject study of quality of life, oral health impacts and personality profiles.

BACKGROUND: RAS may affect quality of life and impacts oral health and daily activities; consequently, psychological factors, dental needs and patients' perceptions. Professionals should understand this relation to adequately manage oral ulcers. This study aimed at investigating the relationship between oral health impacts, oral health-related quality of life and psychological profiles in patients with recurrent aphthous stomatitis (RAS). METHODS: Fifty-three patients (30 men and 23 women, mean age: 31.1 ± 10.1 years) with RAS participated in this study. During ulcer episodes, participants completed Hospital Anxiety and Depression Scale (HAD), Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI), Oral Health Impact Profile (OHIP-14) and United Kingdom Oral Health-Related Quality of Life measure (OHQoL-UK) proformas. Patients completed OHIP-14 and OHQoL-UK again when they were ulcer-free. The statistically significance levels were set at P ≤ 0.05. RESULTS: During ulcer episodes, patients reported worse oral health impacts and an inferior quality of life in comparison with ulcer-free times (P < 0.0001). Higher OHIP scores were significantly associated with higher HAD depression (P = 0.036) and anxiety (P = 0.012) scores. NEO-FFI scores had no significant relations with OHIP and OHQoL-UK scores (P > 0.05). During ulcer-free periods, no relationships were detected between OHIP, OHQoL-UK, HAD and NEO-FFI scores (P > 0.05), except between OHQoL-UK and conscientiousness scores (P = 0.05). CONCLUSIONS: RAS increased the negative oral health impacts on patients and consequently lowered their quality of life. Stressful situations and conditions (including anxiety and depression), rather than inherent personality profiles and stable psychological traits, were related to oral health impacts and quality of life in patients with RAS.

Anxiety, Depression and Quality of Life among Patients with Recurrent Aphthous Ulcers.

BACKGROUND: Recurrent aphtous ulcers (RAUs) are of the most painful and common oral mucosal diseases with uncertain etiology including trauma, genetics, stress, immune dysfunction, and vitamin deficiencies. The aim of this study was to investigate the relationship between oral health impacts, patients' oral health-related quality of life and anxiety and depression in patients with recurrent aphtous ulcers. SUBJECTS AND METHODS: Sixty patients were diagnosed RAU (30 men and 30 women, mean age: 29.5 ± 9.6 years) and sixty controls, who matched the patients with age and gender, participated in this study. Participants completed hospital anxiety and depression (HAD) scale, oral health impact profile (OHIP-14), and United Kingdom oral health related quality of life measure (OHQoL-UK). The statistically significance levels were set at p ≤ 0.05. RESULTS: Both patients and controls reported comparable depression and anxiety scores (p > 0.05). Ulcer patients reported worse oral health impacts and inferior quality of life in comparison to controls (p < 0.001). Among both groups, no relationships were detected between HAD scores on one hand and OHIP and/or OHQoL-UK on the other hand (p > 0.05). CONCLUSIONS: Recurrent aphthous ulcers increase the negative oral health impacts on patients and consequently cause inferior quality of life. Stressful situations and conditions (including anxiety and depression) were not related to oral health impacts and quality of life in patients with RAUs.

Management of Recurrent Aphthous Stomatitis in Children.

Recurrent oral ulceration is common and may present in childhood. Causes of recurrent oral ulceration are numerous and there may be an association with underlying systemic disease. Recurrent aphthous stomatitis (RAS) is the most common underlying diagnosis in children. The discomfort of oral ulcers can impact negatively on quality of life of a child, interfering with eating, speaking and may result in missed school days. The role of the general dental practitioner is to identify patients who can be treated with simple measures in primary dental care and those who require assessment and treatment in secondary care. Management may include topical agents for symptomatic relief, topical corticosteroids and, in severe recalcitrant cases, systemic agents may be necessary.

The role of anxiety, depression, and psychological stress on the clinical status of recurrent aphthous stomatitis and oral lichen planus.

BACKGROUND: In spite of all the efforts, recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) still have unexplained etiology. The role of anxiety, depression, and psychological stress in occurrence and intensity of symptoms in RAS and OLP patients has been investigated in this study. METHODS: A total of 110 patients with RAS in the acute phase and 112 patients with OLP also in acute phase participated in this study. All patients filled out questionnaires related to the primary disease (RAS/OLP) after which they took the following psychological tests: Beck Depression Inventory (BDI), The State-Trait Anxiety Inventory (STAI), and Ways of Coping Questionnaire (WCQ). RESULTS: According to multiple regression analysis, in patients with RAS, the highest correlation was found between results of the pain intensity and STAI test (ß= 0.66; p < 0.000). In the patients with OLP, the highest correlation was found between the level of hyperkeratosis and WCQ test (ß = 0.53; P < 0.000), inflammation and results of BDI test (ß = 0.33; P < 0.002), and results of dynia test and STAI test (ß = 0.31; P < 0.004). CONCLUSIONS: In this study, a high correlation between anxiety, depression, and psychological stress with symptoms of RAS and OLP has been observed.

Sleep quality and perceived stress levels in Chinese patients with minor recurrent aphthous stomatitis: a cross-sectional questionnaire-based survey.

OBJECTIVES: This cross-sectional study aimed to evaluate sleep quality and perceived stress levels in Chinese patients with active minor recurrent aphthous stomatitis (MiRAS) lesions, as well as to investigate the potential relationship between sleep quality and perceived stress levels and the risk of MiRAS episodes. METHODS: The study population consisted of individuals recruited from a Chinese cohort who underwent medical and oral examinations from March 2022 to August 2023. All participants completed a set of uniform anonymous questionnaires, which included sociodemographic characteristics, clinical information, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI) and the Perceived Stress Scale (PSS-14). Statistical analysis was conducted using the independent sample t test, Mann-Whitney U test, Pearson's chi-square test and Pearson's correlation analysis. After adjusting for potential confounders (age, gender, marital status, and education level), multivariate logistic regression analyses were performed to assess the associations of sleep quality and perceived stress levels with the risk of MiRAS episodes. Additionally, restricted cubic spline curves were constructed to visualize these correlations. RESULTS: A total of 329 eligible volunteers participated in the study, comprising 122 Chinese MiRAS patients and 207 healthy controls without MiRAS. Compared to healthy participants, MiRAS patients exhibited significantly higher PSQI and ISI scores (p = 0.000). However, no statistically significant difference was observed between the two groups regarding PSS-14 scores or its two subscales (p > 0.05). Multiple regression analysis indicated that lower sleep quality was significantly associated with an increased risk of MiRAS episodes (p = 0.000), whereas no statistically significant relationship was found between perceived stress levels and the risk of MiRAS episodes (p > 0.05). CONCLUSION: Maintaining a regular bedtime and improving sleep quality may contribute to reducing the incidence and recurrence of MiRAS, while psychological intervention may be ineffective for MiRAS patients.

Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral mucosal diseases, affecting approximately 20% of the general population, with prevalence rates ranging from 0.5% to 68% across different countries. MiRAS is classified as the most common type of RAS, accounting for about 85% of RAS patients. Previous studies have identified several potential predisposing factors, including trauma, psychological disorders, genetic susceptibility, immune dysregulation, hormonal imbalance, and microbial flora disorders. However, the definitive etiology of RAS remains unknown to date. This study assessed sleep quality and perceived stress levels in Chinese patients with active MiRAS lesions using standardized measures, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Perceived Stress Scale (PSS-14). The results indicated that MiRAS patients had significantly higher PSQI and ISI scores compared to healthy controls, regardless of age, gender, marital status, or education level. However, no statistically significant difference was observed between the two groups concerning PSS-14 scores and its subscales. Furthermore, better sleep quality was found to be moderately associated with a reduced risk of MiRAS episodes, while perceived stress levels did not show a significant relationship with the risk. Findings from this study suggest that maintaining proper bedtime routines and improving sleep quality may help reduce both the incidence and recurrence rates of MiRAS.

The evaluation of depression and anxiety levels of mothers of patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome and familial Mediterranean fever.

OBJECTIVE: Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome and familial Mediterranean fever (FMF) are autoinflammatory disorders typically characterized by recurrent fever attacks. These recurrent fever attacks can lead to depression and anxiety in mothers of these patients. This study aimed to compare the depression and anxiety levels in mothers of PFAPA and FMF patients. METHODS: This study is a cross-sectional observational study. 48 mothers of children with FMF and 70 mothers of children with PFAPA participated in the study. Mothers in these two groups were compared in terms of anxiety and depression by using the validated Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS: Depression and anxiety scores of mothers were found to be similar in FMF and PFAPA groups. Moderate or high level of anxiety was seen in 32% of mothers of patients with PFAPA and 27% of mothers of patients with FMF. 23% of mothers of patients with PFAPA were evaluated as having moderate or severe depression, and 18% of mothers of patients with FMF were evaluated as having moderate depression. There was no statistically significant difference between the duration, frequency of attacks, recurrent hospitalizations, sociodemographic characteristics, and inventory scores. CONCLUSION: Depression and anxiety scores of mothers with children diagnosed with FMF and PFAPA are similar. These two diseases affect families psychosocially at similar levels. It is important to provide psychosocial support to families.

Reliability and validity of the Chinese version of the chronic oral mucosal diseases questionnaire.

INTRODUCTION: The aim of this study was to evaluate the reliability and validity of the Chinese version of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ). METHODS: A consecutive sample of 200 patients with chronic oral mucosal diseases was enrolled to complete the questionnaire after its translation and cross-cultural adaptation. The reliability of the Chinese version of COMDQ was determined through internal consistency and test-retest methods. The construct validity of COMDQ was analysed by exploratory factor analysis (EFA). RESULTS: Cronbach's alpha value for the total COMDQ score was 0.894, and the test-retest intraclass correlation coefficient value for the total COMDQ score was 0.83. The EFA extracted four factors, which accounted for 67.89% of the variance. All items showed adequate factor loadings, ranging from 0.487 to 0.947. CONCLUSION: The results suggest that the Chinese version of the COMDQ has satisfactory psychometric properties and is applicable to patients with chronic oral mucosal diseases in China.

Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common and painful oral mucosal disease. Possible etiologies include genetics, vitamin deficiencies, trauma, immune dysfunction, and stress. The goal of this study was to examine the relationship between the occurrence, type, and magnitude of stressful events and the onset and duration of RAS episodes. METHODS: One hundred and sixty subjects with a history of RAS completed a weekly phone survey for up to 1 year, providing data on the occurrence of RAS episodes and details of any stressful events they experienced during the previous week. During RAS episodes, subjects also completed daily paper diaries that recorded incidence and duration of the RAS episode. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors. RESULTS: Stressful life events were significantly associated with the onset of RAS episodes (P < 0.001), however, not with the duration of the RAS episodes. Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04-3.62). When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54-4.72) than physical stressors (OR = 1.44; 95% CI = 1.04-1.99) on the occurrence of RAS episodes. RAS episodes did not occur more frequently or last longer with increasing stress severity. CONCLUSIONS: In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors.

Impacts of recurrent aphthous stomatitis on quality of life of 12- and 15-year-old Thai children.

PURPOSE: To assess the prevalence and characteristics of oral impacts attributed to recurrent aphthous stomatitis (RAS) in 12- and 15-year-olds Thais. METHODS: A national oral health survey was conducted. Child-OIDP and OIDP indices were used to collect oral impacts in 1,100 12- and 871 15 year olds. RESULTS: RAS-related impacts were reported in 24.7% of 12 and 36.2% of 15 year olds. Girls were more likely than boys to report RAS-related impacts. Among all perceived causes of oral impacts, RAS ranked second for 12 and first for 15 year olds. Among 12 and 15 years olds, 79.8 and 86.8% respectively had impacts on eating, 81.0 and 84.4% on cleaning teeth and 51.7 and 60.3% on emotional stability. For individual children, impacts affected between 1-6 daily performances. Impacts were of 'little' and 'moderate' intensity for 12 and 15 year olds, respectively. RAS-related impacts occurred mostly in combination with impacts from other oral conditions. Combined with other oral conditions, the impacts were worse, in terms of score, intensity and extent, than when RAS occurred alone. CONCLUSIONS: RAS-related impacts were common in 12- and 15-year-old Thai children and mostly affected eating, cleaning teeth and emotional stability. RAS tended to occur with other conditions leading to more severe, more extensive impacts on quality of life.

Further reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire.

OBJECTIVE: To test the reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), in measuring the quality of life (QofL) in patients with chronic oral mucosal conditions. METHODS: A random sample of 160 patients with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis received a copy of the COMDQ. A subset of 100 patients received the questionnaire on two further occasions, 2 weeks and 3 months later. Statistical tests were carried out to evaluate the test-retest reliability and responsiveness of this instrument. RESULTS: This study has demonstrated that the COMDQ has good test-retest reliability with an intraclass correlation coefficient of 0.81 and is responsive to changes in the patients' overall conditions. CONCLUSION: In conclusion, this study has further demonstrated the reliability and responsiveness of the COMDQ in assessing QofL in patients with chronic oral mucosal diseases.

Generic and oral quality of life is affected by oral mucosal diseases.

BACKGROUND: The generic and oral health-related quality of life (QoL) has provided opportunity for investigation of the interrelations among generic health, oral health, and related outcomes. The purpose of this study was to identify the generic and oral QoL in the patients with oral mucosal disease (OMD). METHODS: Five hundred and thirty-eight OMDs were recruited in this study. The instruments applied were Chinese version of the 36-item short form health survey (SF-36) and the short-form of Oral Health Impact Profile (OHIP-14). RESULTS: The mean score of sum OHIP-14 was significantly higher in the patients with OMD (10.81 ± 9.01) compared with those in the healthy subjects (HS) (6.55 ± 6.73) (p < 0.001, Mann-Whitney U test). 56.51% of the OMD patients and 12.94% of the HS reported at least one oral negative impact (p < 0.001, Chi-square test). The overall mean score of SF-36 was significantly lower in the patients with OMD (74.54 ± 12.77) compared with those in the HS (77.97 ± 12.39) (p = 0.021, t-test). CONCLUSIONS: Administration of specific and generic questionnaires of QoL can provide us a detailed picture of the impact of OMDs on patients, and both generic and oral QoL were impaired in the patients with OMD.

Psychological status and recurrent aphthous ulceration.

Recurrent aphthous ulceration (RAU) are a disease of an unknown etiology and mediated through T-cell lymphocytes. Evidence suggests that RAU is connected with chronic bowel disease, haematinic deficiencies, AIDS, food hypersensitivity and severe stress. The aim of this study was to determine whether differences in anxiety and depression could be seen in patients with RAU during acute phase and remision period and in comparison to the healthy controls. There were 30 patients with RAU (age range 36.27 +/- 15.308) and 30 controls aged 29.83 +/- 9.082. Every participant with RAU fullfilled STAI and Beck Depression Inventory II test during acute phase and during remission period as well as controls. Statistical analysis was performed by use of descriptive statistics and t-test. There are no differences in the level of depression and stress between the two phases of the RAU (acute versus remission period) as well as in comparison to the controls. Patients with acute RAU are more anxious than patients with RAU during remission period. We might conclude that psychological disturbances do not preceed the development of RAU and that the patients with acute RAU are more anxious when compared to the condition when they do not have RAU due to the discomfort they experience.

Recurrent aphthous stomatitis: stress, trait anger and anxiety of patients.

In this case-control study, recent stress and trait anger/anxiety of otherwise healtlhy patients with active recurrent aphthous stomatitis were compared to those of dental patients with no history of RAS (controls). RAS group reported more angry/anxious feelings than controls (2.11 +/- 0.38/1.84 +/- 0.30, respectively; p < 0.001), and more recent stress (2.81 +/- 1.36/1.96 +/- 1.02; p < 0.01). Among subjects with high angriness/ anxiety, RAS subjects showed higher stress level (p < 0.005). The study revealed that anger/anxiety level mediates the relationship between stress level and RAS.

Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.

OBJECTIVE: To explore the experience of daily life of persons with chronic oral mucosal conditions. METHODS: Purposive sampling was used to recruit patients from the Oral Medicine Unit of Cork University Dental School and Hospital. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non clinical setting. Focus groups were mixed with regard to gender, age, chronic oral mucosal condition, time since diagnosis and severity. A total of 24 patients took part, including patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, recurrent aphthous stomatitis and orofacial granulomatosis. RESULTS: Analysis of the interviews revealed that patient views could be divided into the following themes - biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation and issues for the healthcare professionals. CONCLUSION: Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.