Is Salivary Α-Amylase a Reliable Indicator of Psychological Status and Quality of Life in Patients with Oral Lichen Planus: a Case-Control Study.

BACKGROUND/AIMS: The objectives of our study were to determine salivary α-amylase activity (stress biomarker) and its association with psychological status and quality of life (QoL), disease duration and intensity of symptoms (pain/burning) in patients with OLP. METHODS: A total of 50 subjects participated in this case-control study: 30 patients with oral lichen planus (OLP); 20 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 am to avoid diurnal fluctuations. Psychological status was assessed using the Croatian validated version of the original Depression, Anxiety and Stress Scale (DASS-21). The impact of oral health on QoL was assessed using the Croatian version of the Oral Health Impact Profile Questionnaire (OHIP-CRO14). RESULTS: There was no statistically significant difference in salivary α-amylase activity between patients with OLP (N=30) and control subjects (N=20) (133813.3 vs. 166815.5 U/L, p=0.314; t-test). Depression, anxiety and stress showed no statistically significant difference between patients with OLP and control subjects (p=0.076, p=0.111, p=0.209; t-test). The patients with OLP had statistically significantly poorer QoL (total) compared to control subjects (p=0.004, t-test). There was a moderate positive correlation between symptom intensity (pain/burning) and poor QoL (total) (r=0.584, p<0.001), the OHIP-CRO14 dimension "physical pain" (r=0.661, p<0.001), "psychological impossibility" (r=0.555, p<0.01), "handicap" (r=0.546, p<0.01). CONCLUSION: Although salivary α-amylase showed no statistically significant difference between patients with OLP and control subjects, the patients with OLP had poorer psychological status (three times higher scores for depression and two times higher scores for anxiety) and poorer QoL compared to the control subjects. Recognising and treating mental disorders in patients with OLP is important in order to break the "vicious circle" and achieve a better QoL in these patients.

How Much Do We Know about Oral Cancer?-An Online Survey.

INTRODUCTION: Oral cancer (OC) is a disease with a high mortality rate due to its late recognition. Since the oral cavity is easily accessible for visual inspection, enabling early diagnosis, the education of healthcare workers about preventive oral examinations is critical. This research aimed to assess the level of participants' OC knowledge, as well as to raise awareness about this diagnosis. MATERIALS AND METHODS: The research was conducted as an online survey among students of dental medicine, students of medicine, doctors of dental medicine and doctors of medicine. The questionnaire was designed solely for the purpose of this study and consisted of 29 questions. The first part of the questionnaire consisted of general questions about the participants, whereas the questions in the second part addressed their knowledge and attitudes towards OC. RESULTS: The surveyed population comprised of 140 dental students, 105 medical students, 159 doctors of dental medicine and 100 medical doctors. The level of knowledge about OC among the participants is not yet satisfactory. The group of dental medicine students scored highest, while medical doctors showed the weakest knowledge. CONCLUSION: Additional education about OC for doctors of dental medicine and medical doctors is needed. This step will improve prevention and increase chances for early detection.

Serum Concentration of Vitamin D in Patients with Oral Lichen Planus.

Objectives: The vitamin D receptor is involved in immunologically mediated diseases such as oral lichen planus. Some studies suggest an association between lower vitamin D concentrations and a higher risk of inflammatory conditions such as oral lichen planus. The aim of this study was to investigate 1) whether there is a difference in serum vitamin D concentration in patients with oral lichen planus compared to patients in the control group, 2) whether there is a difference in serum vitamin D concentration in patients with erosive compared to non-erosive forms of oral lichen planus, 3) whether there is a difference in serum vitamin D concentration in patients with developed oral cancer and those without cancer. Material and Methods: The study included 68 patients, 34 with oral lichen planus and 34 healthy controls. Fasting venous blood was taken from each participant to determine serum concentrations of vitamin D. Results: The T-test results confirmed a statistically significant lower serum vitamin D concentration in patients with oral lichen planus compared to the control group (p=0.001). According to the results, a statistically significant lower serum vitamin D concentration was found in patients with erosive form OLP. All five patients with oral cancer, which was developed from erosive OLP, had low serum vitamin D concentrations. Conclusions: Determination of serum vitamin D concentration could be important for monitoring OLP patients to prevent the development of severe clinical manifestations of erosive OLP and the conversion of symptomatic lesions to oral cancer.

Increased prevalence of oral potentially malignant lesions among Croatian War invalids, a cross-sectional study.

Background: The main objective of this study was to investigate the frequency and type of oral pathological changes, oral subjective symptoms and the knowledge about oral cancer in the population of Croatian military invalids from the Homeland War. Material and Methods: A total of 102 Croatian military invalids from the Homeland War participated in the study. Data were collected on the presence of subjective symptoms in the oral cavity, and a detailed clinical examination of the oral mucosa was performed. Results: Almost half of the participants, 46 (45.1%), reported being smokers, and 64 (62.7%) consumed alcohol daily. Subjective symptoms in the oral cavity were reported by 25 (24.5%) of them. Pathological changes were found in 35 (34.3%) participants, of whom 14 (13.7%) had potentially malignant changes. Pathohistological findings confirmed the diagnosis of a potentially malignant lesion in 10 subjects and indicated the presence of moderate dysplasia in two, carcinoma in situ in one, and invasive carcinoma in one. Conclusions: Participants didn't show adequate knowledge of risk factors. Forty-one changes in the oral cavity were found in 35 subjects, and as many as 14 were potentially malignant. According to the participants, most dentists and family physicians don't thoroughly and regularly examine their patients' oral mucosa. Key words:Oral cancer, oral lichen planus, leukoplakia, erythroplakia, actinic cheilitis, Croatian Homeland War invalids.

Association between Salivary Cortisol and α-Amylase with the Psychological Profile of Patients with Oral Lichen Planus and Burning Mouth Syndrome: A Case-Control Study.

The aim of our study was to assess the relationship between the concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and the psychological profile of patients with oral lichen planus (OLP) and primary burning mouth syndrome (BMS). A total of 160 subjects participated in this case-control study: 60 patients with OLP; 60 patients with primary BMS; and 40 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 a.m. Salivary biomarkers were analyzed by enzyme-linked immunosorbent assays (ELISAs). Psychological assessment was evaluated with the Depression, Anxiety, and Stress Scale (DASS-21). The patients with primary BMS had higher salivary cortisol concentrations and α-amylase activity (0.52 vs. 0.44 µg/dL; 160,531 vs. 145,804 U/L; one-way analysis of variance (ANOVA) with post hoc Scheffe test) compared with patients with OLP. The patients with primary BMS had statistically significant higher scores for depression, anxiety, and stress compared with patients with OLP and control subjects (p < 0.001, Kruskal-Wallis test). There was a strong positive correlation between anxiety and depression, stress and depression, and stress and anxiety in patients with OLP and BMS (p < 0.001 and p < 0.001, respectively; Spearman's correlation). There was a good positive correlation between symptom intensity (pain/burning) and psychological profile (depression, anxiety, stress) in patients with primary BMS (r = 0.373, p = 0.003; r = 0.515, p < 0.001; r = 0.365, p = 0.004, respectively; Spearman's correlation). This case-control study is the first to compare the psychoendocrinological profile of patients with two different oral diseases. The patients with BMS showed a higher concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and a stronger association with mental disorders compared with patients with OLP. However, an interdisciplinary psychoneuroimmunological approach is equally important in both patient groups (OLP and BMS), regardless of whether mental disorders are the cause or the consequence.

Application of Inositol Hexaphosphate and Inositol in Dental Medicine: An Overview.

Phosphorylated inositol hexaphosphate (IP6) is a naturally occurring carbohydrate, and its parent compound, myoinositol (Ins), is abundantly present in plants, particularly in certain high-fiber diets, but also in mammalian cells, where they regulate essential cellular functions. IP6 has profound modulation effects on macrophages, which warrants further research on the therapeutic benefits of IP6 for inflammatory diseases. Here, we review IP6 as a promising compound that has the potential to be used in various areas of dentistry, including endodontics, restorative dentistry, implantology, and oral hygiene products, due to its unique structure and characteristic properties. Available as a dietary supplement, IP6 + Ins has been shown to enhance the anti-inflammatory effect associated with preventing and suppressing the progression of chronic dental inflammatory diseases. IP6 in dentistry is now substantial, and this narrative review presents and discusses the different applications proposed in the literature and gives insights into future use of IP6 in the fields of orthodontics, periodontics, implants, and pediatric dentistry.

The Association between the Level of Advanced Glycation End Products and Objective Skin Quality Parameters.

Advanced glycation end products (AGEs) represent an endogenously produced or exogenously derived group of compounds derived from nonenzymatic glycation. Recent experimental studies are suggesting that AGEs could play an important role in the skin's quality and its aging process. Hence, the aim of this study was to clinically evaluate the AGEs and skin quality parameters across different age groups in the general population. The study included 237 participants. Melanin, erythema, hydration, friction and transepidermal water loss (TEWL) were evaluated using noninvasive probes, while AGEs were evaluated using a skin autofluorescence reader. There was a significant positive correlation between AGEs and the amount of melanin (p < 0.001), erythema (p < 0.001) and TEWL (p < 0.001), while there was a significant negative correlation between AGEs and hydration (p < 0.001) and friction (p < 0.001). After dividing the sample into three groups depending on their age, in all three groups, there was a significant positive correlation between AGEs and the melanin count (p < 0.001) and TEWL (p < 0.001), while there was a significant negative correlation between AGEs and skin hydration (p < 0.001). Multiple linear regression analysis showed that the level of AGEs as a dependent variable retained a significant association with age (p < 0.001), melanin (p < 0.001), erythema (p = 0.005) and TEWL (p < 0.001) as positive predictors. Moreover, AGEs retained a significant association with skin hydration (p < 0.001) and friction (p = 0.017) as negative predictors. These outcomes imply that AGEs could be linked with the complex physiology of the skin and its aging process.

Lipid Profiles and Cardiovascular Risk in Patients with Oral Lichen Planus.

BACKGROUND: It has been reported that dyslipidemia prevalence and cardiovascular disease risk were increased in subjects with oral lichen planus diagnose. On the other hand, so far, there is no available data on the topic of cardiovascular risk (CVR) in subjects with oral lichen planus (OLP). The main aim of this study, due to lack of any other study covering this topic, was to investigate lipid profile and assess CVR in patients with OLP. MATERIALS AND METHODS: To create a routine lipid profile, we collected triglyceride serum levels, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol from 63 OLP patients and 63 healthy people representing control subjects. For every patient their individual cardiovascular risk was measured. RESULTS: In comparison with the tested control subjects, patients with OLP had all parameters of the lipid profile elevated, with no differences of statistical importance. Furthermore, the experimental (OLP) and control groups shared similar mean values of the lipid profile parameters. CONCLUSIONS: The association of OLP with cardiovascular risk was not established and further studies with more subjects involved are required to validate this connection.

Knowledge of Dental Students from Croatia, Slovenia, and Bosnia and Herzegovina about Dental Care of Oncology Patients.

The central role of the dentist in the treatment of oncology patients is to care for the patient's oral cavity before, during, and after radio/chemotherapy. The aim of this research was to determine the knowledge of dental students from five universities in three neighboring countries, Croatia (Split, Rijeka, and Zagreb), Bosnia and Herzegovina (Sarajevo), and Slovenia (Ljubljana), about oncology patients' dental care. A total of 140 students in their fourth, fifth, and sixth year of dental medicine studies participated in this research. A questionnaire with 36 specific questions was designed for this research and included questions about dental care of oncologic patients before, during, and after the oncology therapy. Most students are familiar with the incidence and most common type of head and neck tumors, while knowledge about tumor treatment and the side-effects of radiation therapy and/or chemotherapy is weak. Students did not show satisfactory knowledge about osteoradionecrosis, which is the most serious side-effect of radiotherapy; therefore, the emphasis on additional education should be greatest in this area. Teaching staff should be aware of lack of student knowledge and try to offer more information and practice in providing dental care for oncology patients.

Inflammatory Markers and Incidence of other Autoimmune Diseases in Patients with Oral Lichen Planus.

INTRODUCTION: Oral lichen planus (OLP) is a chronic immune, inflammatory disease of the oral cavity of a still unknown etiology. MATERIALS AND METHODS: The study involved 63 subjects diagnosed with oral lichen planus and 63 subjects without pathologic changes in the oral mucosa who were classified as controls. All subjects were given a detailed medical history at first screening. The medical history of the presence of other autoimmune disease in all subjects was supported by medical records. A sample of venous blood was taken from each subject in order to determine sedimentation rate (SE) and leukocyte count (L) using standard laboratory procedures, and serum C-reactive protein (CRP) concentration values ​​were determined as well. STATISTICAL ANALYSIS: The methods of descriptive statistics, χ2-test, the Fisher's exact test, and the Student's t-test were used in the statistical processing of the results. The results were interpreted at a significance level of P <0.05. RESULTS: For all three measured inflammatory markers, there were no statistically significant differences in the number of subjects with elevated values ​​between the test and control groups (P = 0.364 for SE; P = 1.000 for CRP and P = 0.219 for L). The prevalence of other autoimmune disease in the OLP group was higher than in the control group, with statistical significance, and the most common was cutaneous lichen in nine subjects (14.29%) with OLP and celiac disease seven subjects (11.11%). CONCLUSIONS: The results showed that there was no significant difference in the average values of the investigated inflammatory markers in blood (SE, CRP and L) between patients with OLP and control subjects, while a significantly higher incidence of other autoimmune diseases in patients with OLP was demonstrated.

The role of parental anxiety, depression, and psychological stress level on the development of early-childhood caries in children.

BACKGROUND: It is important to understand how the psychological status of parents affects oral health in children. AIM: This study aimed to assess the level of depression, anxiety, and stress of parents whose children have early-childhood caries. DESIGN: The study included 235 children and their parents who visited the Dental clinic at the School of Medicine of the University of Split between October 2016 and July 2017. The dental status of each child was recorded, while parents filled out the Depression Anxiety Stress Scale questionnaire and the questionnaire related to the demographic characteristics, questions related to child's habits of the tooth brushing, eating sweets. RESULTS: Multiple regression analysis showed that the incidence of active caries in the children was statistically significantly related not only to the level of parent depression (ß = -0.289; P = 0.040) but also the level of anxiety (ß = 0.186; P = 0.038) and stress (ß = -0.120; P = 0.036). The dmft index in the examined children was negatively significant associated with the parental level of depression (ß = -0.305; P = 0.032). CONCLUSION: Considering the results of our research it is essential to emphasize the need for better health education of parents.

Antimicrobial effectiveness of polyhexamethylene biguanide on Enterococcus faecalis, Staphylococcus epidermidis and Candida albicans.

Aim To evaluate the antimicrobial activity of 0.2% polyhexamethilene biguanide (PHMB) in root canal models infected with Enterococcus faecalis, Candida albicans and Staphylococcus epidermidis. PHMB was compared in these tests with 2.5% NaOCl and 0.2% CHX. Methods Prepared models of 50 human root canals (n=50) were immerged in mixed, four- weeks old culture that consisted of E .faecalis, S. epidermidis and C. albicans. Roots were randomly divided into three groups: one with 30 (n=30) and two with 10 (n=10) samples. Samples were treated with polyhexamethylene biguanide (PHMB) (0.2%), sodium hypochlorite (NaOCl) (2.5%) and chlorhexidine (CHX) (0.2%), respectively. Root dentin was sampled before and after the tretment with these solutions. Colony- forming units (CFU) were counted to asses the antimicrobial effects of three solutions on viability of selected microrganisms in specimens before and after the treatment.T-test was used for comparison of results between specimens before and after the treatment, while Newman-Keuls test was used for pairwise comparison at p=0.05. Results The PHMB was significantly more efficient in reducing the number of all three tested microorganisms. NaOCl and CHX made only statistically significant (p<0.05) difference in case of E. faecalis and S. epidermidis. In the case of C. albicans, this difference was not statistically significant due to the small number of positive samples and high initial dispersion of results. Conclusion Both solutions PHMB and NaOCl were successful in eliminating E. faecalis and S. epidermidis from the mature dentin biofilm, CHX was not successful enough.

Different Protocols of Photobiomodulation Therapy of Hyposalivation.

OBJECTIVE: Photobiomodulation (PBM) therapy has proved to be effective for a wide range of oral pathologies including oral dryness, but the literature still lacks reports of clinical trials and protocols. The purpose of our study was to evaluate the effects of different wavelengths of PBM on salivation in patients suffering from hyposalivation aiming at determination of optimal treatment protocol. MATERIALS AND METHODS: This study included 30 patients whose major salivary glands were treated with low-intensity diode laser BTL2000 (Medical Technologies, s.r.o., Czech Republic) during 10 consecutive days. Patients were randomly assigned into two groups, each of 15 patients, and treated with PBM of 830 nm and PBM of 685 nm, respectively. The whole unstimulated and stimulated saliva quantities were measured each day during 10 days, before and after laser treatment, and at 10th day after treatment was ended. RESULTS: Results have shown that the laser treatment significantly improves salivation (p < 0.0001) in both groups after 10 days treatment. The salivation also remains improved 10 days after the end of treatment. The patients treated with PBM of 830 nm have had continuously higher values of quantity of saliva. CONCLUSIONS: Our results have shown that both laser wavelengths were effective in increasing salivary flow rate, and the improvement in salivation was statistically significant. The effect of treatment could be observed 10 days after the completion of treatment, thus providing evidence not only of stimulative effect but also indicating regenerative potential of PBM therapy.

Antimicrobial efficacy of probiotic-containing toothpastes: an in vitro evaluation.

Aim To evaluate, in vitro antimicrobial ability of two probiotic toothpastes (one containing Lactobacillus paracasei, other containing Lactobacillus acidophilus) and one toothpaste without probiotic separately, and in a combination with two different mouthrinses (one containing essential oils and the other containing hexitidine). Methods Antimicrobial susceptibility was checked by using the ditch method and Clinical Laboratory Standard Institute (CLSI) guidelines. Two different toothpastes with probiotic, toothpaste without probiotic and two different mouthrinses were tested against the following selected microorganisms: Candida albicans, Candida tropicalis, Enterococcus faecalis, Streptococcus salivarius and Staphylococcus aureus. Kruskal-Wallis test and MannWhitney U test were used for the statistical analysis (p≤ 0.05). Results Probiotic toothpastes had better inhibitory effect than toothpaste without probiotic in the case of Candida albicans (p=0.043) and Streptococcus salivarius (p=0.043). In all cases, toothpastes had stronger inhibition capacity than mouthrinses (p≤0.05). Conclusion Probiotic toothpastes, as a relatively new concept in the prevention of oral infectious diseases such as caries and periodontal disease, can contribute to the prevention of oral infectious diseases.

Involvement of IGF-2, IGF-1R, IGF-2R and PTEN in development of human tooth germ - an immunohistochemical study.

Insulin-Like Growth Factor 2 (IGF-2) is a peptide hormone essential for prenatal growth and development. IGF-2 exerts its mitogenic effects via Insulin-Like Growth Factor 1 Receptor (IGF-1R), and is eliminated by binding to Insulin-Like Growth Receptor 2 (IGF-2R). IGF-2 is also negatively regulated by Phosphatase and Tensin Homolog (PTEN), a phosphatase mutated in various tumors. Not much is known about the interplay between these factors during human odontogenesis. In this study, expression patterns of IGF-2, IGF-1R, IGF-2R and PTEN were analyzed by double immunofluorescence in incisor human tooth germs during the foetal period of development between the 7th and 20th gestational week. Throughout the investigated period, IGF-2 was mostly expressed in enamel organ, whereas mild to moderate expression of PTEN could be seen in dental papilla and parts of enamel organ. Expression of IGF-1R was ubiquitous and displayed strong intensity throughout the entire enamel organ. In contrast, expression of IGF-2R had rather erratic pattern in enamel organ and dental papilla alike. Expression patterns of IGF-2, IGF-1R, IGF-2R and PTEN in highly proliferative cervical loops, as well as in differentiating pre-ameloblasts and pre-odontoblasts of cusp tip region during the early and late bell stages when enamel organ acquires definitive shape, indicate importance of these factors in crown morphogenesis of human incisor. Taken together, our data suggest the involvement of IGF-2, IGF-1R, IGF-2R and PTEN in temporo-spatial patterning of basic cellular processes (proliferation, differentiation) during normal tooth development. They are also relevant for improving knowledge of molecular basis of human odontogenesis.

The prevalence of celiac disease in patients with geographic tongue.

BACKGROUND: Geographic tongue (GT) is a benign inflammatory condition usually involving the dorsal surface and lateral borders of the tongue. Numerous etiological factors of GT have been suggested, including immunological factors; genetic; atopic or allergic predisposition; emotional stress; and hormonal disturbances. GT may also coexist as one of the possible manifestations of celiac disease (CD). Therefore, the aim of this study was to investigate the prevalence of CD, positive serologic tests for CD screening, and HLA-DQ presence in patients with GT. METHODS: Tissue transglutaminase antibodies (anti-tTG), antibodies against gliadin (AGA), and human leukocyte antigen (HLA) typing were assessed for 60 GT patients and 60 healthy control subjects. The duodenal biopsy was performed in patients with positive serologic tests. RESULTS: We found that 9 (15%) GT patients were positive for IgA tTG, and in those patients histological changes consistent with CD were confirmed by duodenal biopsy. Only two of them reported the presence of gastrointestinal symptoms. There were statistically significant differences between the GT patients and control group for immunoglobulin (Ig) A tTG (P = 0.03), IgG tTG (P = 0.04), IgA AGA (P = 0.04), and IgG AGA (P = 0.02). CONCLUSION: The results of our study demonstrated the increased prevalence of CD in patients with GT. Therefore, the clinical oral examination should be considered a diagnostic tool, especially in atypical or silent forms of CD, since it may contribute to provide an early diagnosis.

Analysis of expression patterns of IGF-1, caspase-3 and HSP-70 in developing human tooth germs.

AIMS: To analyze expression patterns of IGF-1, caspase-3 and HSP-70 in human incisor and canine tooth germs during the late bud, cap and bell stages of odontogenesis. MATERIALS AND METHODS: Head areas or parts of jaw containing teeth from 10 human fetuses aged between 9th and 20th developmental weeks were immunohistochemically analyzed using IGF-1, active caspase-3 and HSP-70 markers. Semi-quantitative analysis of each marker's expression pattern was also performed. RESULTS: During the analyzed period, IGF-1 and HSP-70 were mostly expressed in enamel organ. As development progressed, expression of IGF-1 and HSP-70 became more confined to differentiating tissues in the future cusp tip area, as well as in highly proliferating cervical loops. Few apoptotic bodies highly positive to active caspase-3 were observed in enamel organ and dental papilla from the cap stage onward. However, both enamel epithelia moderately expressed active caspase-3 throughout the investigated period. CONCLUSIONS: Expression patterns of IGF-1, active caspase-3 and HSP-70 imply importance of these factors for early human tooth development. IGF-1 and HSP-70 have versatile functions in control of proliferation, differentiation and anti-apoptotic protection of epithelial parts of human enamel organ. Active caspase-3 is partially involved in formation and apoptotic removal of primary enamel knot, although present findings might reflect its ability to perform other non-death functions such as differentiation of hard dental tissues secreting cells and guidance of ingrowth of proliferating cervical loops.

Increased prevalence of celiac disease in patients with oral lichen planus.

OBJECTIVES: The aim of this study was to establish the prevalence of celiac disease (CD) in patients with erosive and reticular form of oral lichen planus (OLP) compared to healthy controls. MATERIALS AND METHODS: Tissue transglutaminase antibodies (anti-tTG) and antibodies against gliadin (AGA) were measured in the sera from 56 OLP patients and 57 healthy controls, who also underwent human leukocyte antigen (HLA) typing. The duodenal biopsy was performed in patients with positive serology, and a gluten-free diet was recommended if CD was confirmed. RESULTS: CD was diagnosed in eight OLP patients (14.29 %). Six OLP patients (10.71 %) were positive for immunoglobulin A (IgA) tTG. A statistically significant difference among the forms of oral lichen was observed for the IgA tTG (p = 0.03) and immunoglobulin G (IgG) tTG (p = 0.01). Higher frequencies of HLA-DQ2 and HLA-DQ8 were found in OLP patients compared to the control group. CONCLUSION: The prevalence of CD was higher in patients with OLP than in the control group. Therefore, increased efforts aimed at the early detection and dietary treatment of CD, among antibody-positive OLP patients, are advisable. CLINICAL RELEVANCE: Our study confirmed the increased frequency of CD among OLP patients. CD screening should be considered in OLP patients, since untreated CD can present many complications and reduce a patient's quality of life.

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.