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Previous issue date: 2011-12-20 === Recurrent aphthous ulceration (RAU) is one of the most prevalent disease of the oral mucosa, but the mechanism that leads to the development of this lesion remains unknown. Psychological changes such anxiety and stress have been investigated and appear to exhibit, in some patients, an association with the disease. Stress causes dysregulation of the immune system and is related to elevated levels of cortisol and a decrease in dehydroepiandrosterone (DHEA) levels. In the present study, patients with RAU were investigated with regard to stress and anxiety levels, as well as salivary concentrations of the hormones cortisol and DHEA. The sample consisted of 60 individuals of both sexes, aged between 18 and 50 years and distributed into two groups: 30 patients with RAU and 30 patients without history of the disorder, matched by sex and age. Stress symptoms were assessed using the Lipp s Inventory of Stress Symptoms (LISS) and for anxiety the Beck Inventory of Anxiety (BAI). The saliva specimens were collected in the morning, in the afternoon and at night on the same day. In the RAU group, the specimens were collected on two occasions, in the presence and after remission of the lesions. The salivary concentrations of cortisol and DHEA were determined in duplicate by radioimmunoassay with a specific analytical kit for each hormone. The case patients exhibited higher anxiety scores (p=0.001), besides a greater prevalence of stress (p=0.004). Cortisol levels were significantly higher in the case group in the presence of the lesion in the morning (p=0.008) and afternoon (p=0.001) when compared to the same RAU patients in remission. The cortisol/DHEA ratio was also higher in the case patients in the presence of lesions when compared to the remission phase in the afternoon (p=0.007). There was no significant difference in DHEA levels between the groups. Based on the results obtained, it can be concluded that, in the sample investigated, stress and anxiety are more elevated in patients with RAU. In these individuals, salivary cortisol levels were increased in the presence of lesions, but did not differ when compared to the patients without the disorder. DHEA levels did not differ in patients with RAU in the presence or in remission of the lesion, or between RAU patients and control patients. There is a need for further studies to determine whether stress and anxiety, as well as elevated cortisol levels, have an influence on the etiopathogenesis of recurrent aphthous ulceration. === A ulcera??o aftosa recorrente (UAR) ? uma das doen?as mais prevalentes da mucosa bucal, mas o mecanismo que desencadeia seu desenvolvimento permanece desconhecido. Altera??es psicol?gicas como ansiedade e estresse t?m sido investigadas e parecem exibir, em alguns pacientes, associa??o com a doen?a. O estresse promove desregula??o do sistema imune e est? relacionado a eleva??o dos n?veis de cortisol e diminui??o dos de desidroepiandrosterona (DHEA). No presente estudo, foram investigados n?veis de estresse e de ansiedade empacientes com UAR, bem como as concentra??es salivares dos horm?nios cortisol e DHEA. A amostra foi constitu?da por 60 indiv?duos de ambos os sexos, com idades entre 18 e 50 anos, distribu?dos em dois grupos: 30 pacientes com UAR e 30 pacientes sem hist?rico da doen?a, emparelhados por sexo e idade. Para a investiga??o dos sintomas de estresse foi utilizado o Invent?rio de Sintomas de Stress de Lipp (ISSL) e para a ansiedade, o Invent?rio de Ansiedade de Beck (BAI). As amostras de saliva foram coletadas pela manh?, ? tarde e ? noite, no mesmo dia. No grupo-caso, as coletas foram realizadas em dois momentos, em presen?a e ap?s a remiss?o das les?es. As concentra??es salivares de cortisol e DHEA foram analisadas em duplicata por radioimunoensaio com Kit anal?tico espec?fico para cada horm?nio. Os pacientes-caso exibiram escores de ansiedade (p=0,001) mais elevados, al?m de preval?ncia superior de estresse (p=0,004). No grupo-caso, os n?veis de cortisol foram significativamente superiores em presen?a de les?o, nos turnos da manh? (p=0,008) e da tarde (p=0,001), quando comparados ? fase de remiss?o da UAR. O ratio cortisol/DHEA tamb?m foi superior nos pacientes-caso em presen?a de les?o quando comparado ? fase de remiss?o, no turno da tarde (p=0,007). N?o houve diferen?a significativa quanto aos n?veis de DHEA entre os grupos analisados. Com base nos resultados obtidos, pode-se concluir que, na amostra investigada, o estresse e a ansiedade s?o mais elevados em pacientes com UAR. Nestes indiv?duos, os n?veis de cortisol salivar aumentam em presen?a de les?o, mas n?o diferem quando comparados aos de pacientes sem a doen?a. Os n?veis de DHEA n?o diferem em pacientes com UAR em presen?a ou em remiss?o de les?o, nem quando comparados aos de pacientes-controle. Outros estudos s?o necess?rios no sentido de elucidar se o estresse e a ansiedade, bem como se a 7 eleva??o dos n?veis de cortisol exercem influ?ncia na etiopatog?nese da ulcera??o aftosa recorrente.
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