Hematological and Biochemical Alterations in Patients with Recurrent Aphthous Stomatitis
Hematological Alterations in Patients with Recurrent Aphthous Stomatitis
DOI:
https://doi.org/10.54393/pjhs.v6i7.3149Keywords:
Recurrent Aphthous Stomatitis, Oral Ulcers, Hematological Parameters, Vitamin B12 Deficiency, Iron Deficiency Anemia, Folate Levels, Inflammatory BiomarkersAbstract
Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by painful, recurring ulcers. Its etiology remains multifactorial, with potential links to hematological and biochemical imbalances. Objectives: To compare the hematological and biochemical profiles of adult patients with and without recurrent aphthous stomatitis (RAS) attending the outpatient department of a teaching hospital in Hyderabad, Pakistan. Methods: A total of 130 participants were enrolled using a non-probability convenience sampling method, with 65 individuals in the RAS group and 65 healthy controls. Standardized clinical oral examinations were conducted to evaluate the presence, number, and location of ulcers in RAS patients, while controls were examined to confirm the absence of oral mucosal lesions. Under sterile conditions, 6 mL of blood was collected from each participant for hematological and biochemical analyses, including serum levels of cortisol, ferritin, iron, folic acid, and vitamin B12, measured using an auto-analyzer. Results: Independent t-tests revealed significantly higher cortisol levels in RAS patients (459.2 ± 49.6 nmol/L) compared to controls (232.4 ± 119.4nmol/L, p=0.001). Conversely, ferritin, iron, and folic acid levels were significantly lower in the RAS group (p=0.001). Hemoglobin (12.9 ± 2.1g/dL vs 14.0 ± 1.4g/dL, p=0.001) and hematocrit (37.88 ± 8.14% vs 40.85 ± 5.81%, p=0.018) were also significantly lower in RAS patients, while differences in RBC, WBC, and platelet counts were not statistically significant. Conclusions: These findings suggest potential connections between RAS and altered specific biochemical and hematological markers, including cortisol, ferritin, iron, folic acid, hemoglobin, and hematocrit.
References
Rivera C. Essentials of recurrent aphthous stomatitis. Biomedical Reports. 2019 Aug; 11(2): 47-50. doi: 10.3892/br.2019.1221.
Chiang CP, Chang JY, Wang YP, Wu YH, Wu YC, Sun A. Recurrent Aphthous Stomatitis–Etiology, Serum Autoantibodies, Anemia, Hematinic Deficiencies, and Management. Journal of the Formosan Medical Association. 2019 Sep; 118(9): 1279-89. doi: 10.1016/j.jfma.2018.10.023.
Plewa Mc and Chatterjee K. Aphthous Stomatitis. Statpearls; Statpearls Publishing: Treasure Island, Fl, USA. 2022.
Rawlings N and Willis A. Oral Ulceration-Clinical Feature. Journal of the Irish Dental Association. 2023 Apr. doi: 10.58541/001c.74191.
Balakhane S. What Is Aphthous Stomatitis? What Are the Possible Causes and Treatments? The Science Journal of the Lander College of Arts and Sciences. 2024; 17(2): 16-20.
Mirzaei M, Zarabadipour M, Mirzadeh M. Evaluation the relationship between psychological profile and salivary cortisol in patients with recurrent aphthous stomatitis. Dental Research Journal. 2021 Jan; 18(1): 50. doi: 10.4103/1735-3327.318945.
Ajmal M, Ibrahim L, Mohammed N, Al-Qarni H. Prevalence and Psychological Stress in Recurrent Aphthous Stomatitis Among Female Dental Students in Saudi Arabia. Clujul Medical. 2018 Apr; 91(2): 216. doi: 10.15386/cjmed-840.
Verma S, Srikrishna K, Shalini K, Sinha G, Srivastava P. Recurrent Oral Ulcers and Its Association with Stress Among Dental Students in The Northeast Indian Population: A Cross-Sectional Questionnaire-Based Survey. Cureus. 2023 Feb; 15(2). doi: 10.7759/cureus.34947.
Bouri S and Martin J. Investigation of Iron Deficiency Anemia. Clinical Medicine. 2018 Jun; 18(3): 242-4. doi: 10.7861/clinmedicine.18-3-242.
Bao Zx, Shi J, Yang Xw, Liu Lx. Hematinic Deficiencies in Patients with Recurrent Aphthous Stomatitis: Variations by Gender and Age. Medicina Oral, Patologia Oral Y Cirugia Bucal. 2018 Feb; 23(2): E161. doi: 10.4317/medoral.21885.
Velliyagounder K, Chavan K, Markowitz K. Iron Deficiency Anemia and its Impact on Oral Health—A Literature Review. Dentistry Journal. 2024 Jun; 12(6): 176. doi: 10.3390/dj12060176.
Wieczorek K, Targonskaya A, Maslowski K. Reproductive Hormones and Female Mental Wellbeing. Women. 2023 Sep; 3(3): 432-44. doi: 10.3390/women3030033.
Madkour Gg, El Refaie I. Salivary Levels of Α-Amylase & Cortisol in Patients with Recurrent Aphthous Ulceration. Egyptian Dental Journal. 2018 Jul; 64(3-July (Oral Medicine, X-Ray, Oral Biology and Oral Pathology)): 2391-7. doi: 10.21608/edj.2018.76816.
Vandana S, Kavitha B, Sivapathasundharam B. Salivary Cortisol and Dehydroepiandrosterone as Oral Biomarkers to Determine Stress in Patients with Recurrent Aphthous Stomatitis. Journal of Oral and Maxillofacial Pathology. 2019 May; 23(2): 213-7. doi: 10.4103/jomfp.JOMFP_282_18.
Aslam A, Hassan Sh, Khan Da, Chaudhary Ma. Psychological Stress Associated with Aphthous Ulcers and Temporomandibular Disorders. Pakistan Armed Forces Medical Journal. 2017 Jun; (3): 453.
Sandnes M, Ulvik Rj, Vorland M, Reikvam H. Hyperferritinemia—A Clinical Overview. Journal of Clinical Medicine. 2021 May; 10(9): 2008. doi: 10.3390/jcm10092008.
Shabbir R, Malik A, Yasmin R, Zaman A, Iqbal Y, Gul A, Rahim A. Significance of Iron Deficiency in Recurrent Aphthous Stomatitis. Pakistan Oral and Dental Journal. 2021 Mar; 41(1): 11-4.
Obeagu Ei. Iron Homeostasis and Health: Understanding its Role Beyond Blood Health–A Narrative Review. Annals of Medicine and Surgery. 2025 Jun; 87(6): 3362-71. doi: 10.1097/MS9.0000000000003100.
Lavaee F, Ranjbar Z, Jalalian M, Amiri Ma. Comparison of the Sex Hormones’ Serum Level in Women with Recurrent Aphthous Stomatitis and Healthy Population: A Cross-Sectional Study. BioMed Central Oral Health. 2021 Oct; 21(1): 551. doi: 10.1186/s12903-021-01812-9.
Lešić S, Ivanišević Z, Špiljak B, Tomas M, Šoštarić M, Včev A. The Impact of Vitamin Deficiencies on Oral Manifestations in Children. Dentistry Journal. 2024 Apr; 12(4): 109. doi: 10.3390/dj12040109.
Rasi A, Zamanian A, Mehran G, Ezati A, Rastin V, Karimi S. Comparing the Effect of Injectable Vitamin B with Conventional Oral Treatment on Aphthous Stomatitis. Journal of Skin and Stem Cell. 2018 Jun; 5(1-2). doi: 10.5812/jssc.69052.
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