Ulceração aftosa recorrente no Ambulatório de Estomatologia da UNIFESP / Recurrent aphtous stomatitis in Stomatology Clinic UNIFESP (Universidade Federal de São Paulo)

Introdução e objetivo: A ulceração aftosa recorrente (UAR) é uma doença inflamatória bucal crônica de distribuição mundial, cuja prevalência varia entre 5% e 66%, com média de 30%, e continua representando problema clínico sem solução satisfatória. Apesar da etiopatogenia da UAR ainda ser desconhecida, ela é considerada doença multifatorial, na qual componentes genéticos, microbiológicos e imunológicos concorrem simultaneamente ou sequencialmente para o surgimento e evolução das lesões ulcerativas. Alguns fatores são apontados como modificadores ou desencadeantes das UAR, entre eles os mais estudados estão as alterações hormonais, estresse, traumatismos locais e nutricionais (deficiências de vitamina B12, ácido fólico e ferro). O objetivo deste artigo foi delinear o perfil dos pacientes com UAR acompanhados no Ambulatório de Estomatologia da UNIFESP, no período de 1999 a 2009. Foi elaborado um questionário, assim como um banco de dados para coletar e gerenciar as características clínicas da UAR dos pacientes. Resultados: O tipo mais comum de afta era o tipo minor (92%), o sítio de maior acometimento das lesões era a mucosa jugal (21%), seguida pela mucosa labial, 90% dos pacientes eram não fumantes, em 50% dos pacientes encontramos história familiar de UAR e apenas 28% dos pacientes relacionaram o estresse ao surto de aftas. Apenas 45% dos pacientes relataram piora com alimentação. Conclusões: Concluiu-se que os principais fatores associados à ocorrência da UAR foram predisposição familiar e alimentação e de forma negativa o uso do tabaco.

Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial

PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS: The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5 percent). Dapsone was prescribed for a total of nine patients, of whom eight (89 percent) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90 percent), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60 percent), of whom one patient showed complete remission. CONCLUSION: The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

Psychological stress and recurrent aphthous stomatitis

INTRODUCTION AND OBJECTIVES: Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS. METHOD: Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist. RESULTS: There was a higher level of psychological stress among RAS group patients when compared to the control group (P < 0.05). CONCLUSION: Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.