The effect of dietary habits on the development of the recurrent aphthous stomatitis.

BACKGROUND: The aim was to assess the relationship between the dietary habits and development of recurrent aphthous stomatitis.
MATERIALS AND METHODS: Two groups (30 patients with RAS who have been following dietary habits and not associated with systemic disease or hematologic abnormalities, and the control group consist of 28 patients without recurrent aphthous stomatitis).
RESULTS: A Mann-Whitney test (P>0.05) shows no significance difference between the patients with RAS and the control group. Both groups eating similar food such as cheese, cow's milk, tea, lemon, coffee, orange, apple, yoghurt, and tomato, spicy food, but the patients with RAS ate specific foods containing (pH) like; oranges and lemons more frequently than the control group.
CONCLUSION: Dietary habits have no important role in development of RAS but can lay a minor role in the pathogenesis of RAS either by causing hypersensitivity or by deficiency of some vitamins and minerals.

INTRODUCTION

Recurrent aphthous stomatitis RSA is a common oral disorder occurring in up to 25-30 of population. The etiology of this disease is unknown; therefore many predisposing factors may have an important role in development of RAS such as heredity, bacteriology, trauma, endocrinology, and nutrition. Also many studies have demonstrated that iron, folate; vitamin B1, B2, B6, B12 deficiencies, and sensitivity to some foods in patients with RAS.1 This study is aimed to evaluate the relationship between dietary habits and RAS.

MATERIALS AND METHODS

A total of 50 patients have refereed to my clinic complaining of RAS. Only 30 patients out of 50 participated in this study.

All of those 30 patients (17 male, 13 female, maximum age 45 years, minimum age 22 years) have followed dietary habits . The patients with RAS and the control group were assessed and questioned by the specialist in nutrition about the daily intake frequencies of some foods which are frequently consumed in Syria, and their effects on RAS. The Research Ethics Committee at Alfarabi College of dentistry provided a favorable ethical opinion.

The medical history of those patients has demonstrated that RAS occurred at least more than four times per years.

Twelve patients out of 50 were not included in this study because some of those patients have hematologic abnormalities or systemic disease. Also eight patients out of 50 were not included in this study because they do not follow any dietary programmers.

The control group consists of 28 patients without recurrent aphthous stomatitis.

Statistics analysis

A Mann–Whitney test and correlation test have been used.

RESULTS

All the clinical data of the participant patients in this study is shown in Table 1.

Table 1

Clinical features of recurrent aphthous stomatitis

The range of the patient's age is (22-45), the maximum age is 45, and minimum is 22.

The Mann–Whitney test (P>0.05) shows that there was no significance difference between the patients with RAS and the control group; moreover, the patients with RAS were found to eat similar foods like cheese, cow's milk, tea, lemon, coffee, orange, yoghurt and tomato, spicy food; but the patients with RAS ate specific foods containing (ph) like oranges and lemons more frequently than the control group Table 2. Also the correlation test has shown there was no correlation between the age and gender and occurrence of RAS for the patients with RAS followed dietary habits.

Table 2

Comparison of the types of food for patients with RAS and the control group

DISCUSSION

Safadi2 has reported that 82% of the participant patients claimed that the RAS interfered with food eating and swallowing. Some researchers have indicated that the development of RAS is associated with the use of some certain foods: Cows’ milk, gluten, chocolate, nuts, cheese.3–6 Eversole et al.7 found no significant association between RAS and three specific food (tomatoes, strawberries, and walnuts). Wilson8 has noted an increased prevalence of atopy among RAS patients.

Wray5 has mentioned that there is no significant difference in the incidence of atopy in RAS patients compared with the normal population. Hay and Reade9 have demonstrated that there is relationship between RAS and consuming some food items such as figs, cheese, tomato, tomato sauce, vinegar, lemon, pineapple, milk, cheese, wheat flour. They have concluded that the removal of the dietary habits can reduce the frequency of RAS. Wright et al.10 reported that the food allergy was a significant factor in the development of RAS, but they did not find a relationship between gluten containing foods and the occurrence of RAS. Ogura et al.,11 have mentioned that the patients with RAS consume foods containing calcium, iron, vitamin B1, and vitamin C less frequently than the control patients and concluded that the deficiencies of some vitamins and minerals might play a role in the pathogenesis of RAS. Kozlak et al.12 have suggested that consuming sufficient amounts of the vitamins B12 and folate may be a useful strategy to reduce the number and/or duration of RAS episodes.

CONCLUSION

Dietary habits have no important role in development of RAS but can be playing a minor role in the pathogenesis of RAS either by causing hypersensitivity or by deficiency of some vitamins and minerals.

This study has shown that RAS patients ate acidic pH-containing foods like oranges and lemons more frequently than controls and this might have initiated RAS lesions as irritation factors. The other patients might have hypersensitivity to specific food such as yoghurt and tomato, and spicy food.