Recurrent aphthous stomatitis in Behçet's disease: clinical featueres and correlation with systemic disease expression and severity

Behçet's disease (BD) is a multisystem disease, in which recurrent aphthous stomatitis (RAS) is a universal finding. We studied the expression of RAS in patients with BD, and the correlation between major or minor RAS and systemic expression and severity of the disease. Thirty-five patients with BD were studied, of whom 13 (37%) had major, 21 (60%) had minor and one (3%) had herpetiform RAS. The frequency of major RAS was significantly higher compared with a control group of patients with idiopathic RAS (37% vs 9%, P<0.05). The BD patients with major RAS had significantly more relapses of oral ulceration in a year, higher numbers of oral ulcers per relapse, and longer duration of aphthous episodes, compared with patients with minor RAS. Oral ulcers also appeared at a significantly younger age in patients with major than with minor RAS. However, the systemic expression of the disease, as well as the disease severity score, were similar in patients with major and minor RAS. The results of this study indicate that major RAS is common in patients with BD, and is associated with a more severe, repeated and prolonged oral disease. Nevertheless, the presence of major RAS in BD does not predict a more severe systemic illness.     

The assessment of oral health-related quality of life by factor analysis in patients with Behcet''s disease and recurrent aphthous stomatitis

BACKGROUND: The aim of the study was to test multidimensional properties of oral health impact profile-14 (OHIP-14) in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS) patients with active oral ulcers. METHODS: Ninety-six BD patients, 28 patients with RAS and 117 healthy controls (HC) were included in this study. In patients with active oral ulcers, the frequency and healing time of ulcers were recorded. Multidimensional properties of OHIP-14 were examined by factor analysis. RESULTS: Factor analysis revealed three subscales and explained 66.49% of overall variance in these patients with active oral ulcers. The score of Subscale 1 was positively correlated with the recurrence of oral ulcers per month (P = 0.037). Subscale 3 scores of the patients treated with colchicine were worse than those treated with immunosuppressives (P = 0.035). CONCLUSIONS: The factor structure of OHIP-14 was found to be reliable and sensitive to clinical parameters and treatment modalities in active patients.     

Association between recurrent aphthous stomatitis and inheritance of a single‐nucleotide polymorphism of the NOS2 gene encoding inducible nitric oxide synthase

J Oral Pathol Med (2011) 40 : 715–720 Background: Recurrent aphthous stomatitis is a common ulcerative disease of the oral mucosa. Recurrent oral aphthous ulceration is also a feature of the more serious and systemic Behçet’s disease. Nitric oxide is a free radical synthesized by one of a family of nitric oxide synthase (NOS) enzymes and is an important regulator of inflammation and immunity. Association of NOS3 gene polymorphisms encoding endothelial nitric oxide synthase has been reported in Behçet’s disease but not recurrent aphthous stomatitis. The aim of this study was to investigate any association between NOS2 gene polymorphisms that encode inducible nitric oxide synthase and recurrent aphthous stomatitis. Methods: This is a case control association study. Eighty‐three Jordanian recurrent aphthous stomatitis patients and 83 age, gender and ethnically matched controls were genotyped for three NOS2 single‐nucleotide polymorphisms, rs10459953, rs1060822 and rs2297518. Chi‐squared analysis was used to compare the allele frequencies and genotypes. Results: There was a significant association between recurrent aphthous stomatitis and inheritance of single‐nucleotide polymorphism rs2297518 (P = 0.006). Although no direct association was demonstrated between rs10459953 or rs1060822 and recurrent aphthous stomatitis, a strong linkage disequilibrium was identified between rs1060822 and rs2297518. Conclusion: Inheritence of a NOS2 single‐nucleotide polymorphism rs2297518 is associated with increased risk of recurrent aphthous stomatitis in a Jordanian population. Confirmatory studies in other populations and investigation of other NOS2 gene polymorphisms will enhance our understanding of the functional basis of this association and help elucidate the role of inducible nitric oxide synthase in recurrent aphthous stomatitis.     

Quality of life and psychological well‐being among endodontic patients: a case‐control study

Background: Much is already known about the consequences of endodontic disease from clinicians’ perspectives; a significant omission is an understanding from patients’ perspectives. This study aimed to determine oral health‐related quality of life (OHQoL) and psychological distress among subjects referred for endodontic care compared to patients in periodontal maintenance. Methods: This was a case‐control study involving 200 patients; 100 patients requiring endodontic treatment and 100 control subjects (periodontal maintenance patients). OHQoL was assessed using the short form Oral Health Impact Profile measure (OHIP‐14) and psychological well‐being using the short form of the General Health Questionnaire (GHQ‐12). Variations in OHIP‐14 and GHQ‐12 scores between the ‘case’ and ‘control’ group were determined, and the magnitude of such differences through effect size (ES) calculations. Results: There were significant differences in OHIP‐14 summary scores between the case and control groups (p < 0.001) and significant differences across all seven domain scores (p < 0.05). The ES was moderate (0.63) with respect to summary OHIP‐14 scores. There were also significant differences in GHQ‐12 scores between the case and control groups (p < 0.05), but the ES was small (0.36). Conclusions: OHQoL and psychological well‐being is compromised among patients seeking endodontic treatment, and to a greater magnitude than patients in periodontal maintenance.     

Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease

Background:  The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD).
Methods:  Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 ± 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 ± 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices.
Results:  No significant difference was found in OHIP-14 scores between patients from UK (22.7 ± 14.4) and Turkey (20.4 ± 14.3) ( P  = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK ( r  = 0.4, P  = 0.04) and the number of oral ulcers in Turkey ( r  = 0.4, P  = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 ± 2.8) compared with that in Turkey (1.5 ± 2.5) ( P  = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK ( P  = 0.000). Similarly, the duration since the last dental visit (5.1 ± 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 ± 23.7 months) ( P  = 0.000).
Conclusions:  Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey.