Page 23 - SPEMD_59-1

rev port estomatol med dent cir maxilofac . 2018;59(1):10-17 15

9.8% associated aphthae with stress-causing events (Table 3), are consistent with the literature, where RAS is described as
showing an odds ratio of 217.55 (36.076;1311.309), i.e., the like- painful and capable of creating difficulties in daily activities
lihood of parents considering that aphthae appeared in their such as talking, laughing and chewing. 4,28,29
children when they were anxious/nervous was manifestly su- In this research, 46.4% of the students had a family history
perior when their children also considered it comparing to of RAS. This percentage is higher than the one presented by
15
those who did not. Gürkan et al., where 35.8% of the patients had a family his-
A significant association was found between the frequen- tory of RAS. This difference might be explained by the fact that
cy of aphthae and gastrointestinal disorders (p = 0.023). How- the studied age groups were more limited in the present re-
ever, the aphthae’s association with allergies or other factors search (3-11 years) in comparison with the ones studied by
such as daily toothbrushing frequency, use of orthodontic ap- Gürkan et al. (2-17 years). The present study also revealed
15
pliance, placement of pens/pencils in the oral cavity and con- that, of both parents, the mother seemed to contribute more
sumption of some foods (vegetables, legumes) was not statis- to the family history of this condition.
tically significant (Table 4). In the young population of this study, 48 participants
Although most of the respondents referred not applying (29.6% of the sample) reported episodes of RAS associated with
any treatment (Figure 4), a marked use of topical drugs was a previous trauma in the oral cavity. The percentage obtained
found, with the pharmacist being the most consulted health- in this regard was lower than the one detected by Wray et al.
8
care professional (Table 5). (43.3%). On the other hand, only 9.8% of the participants re-
ported episodes of stress associated with the occurrence of
aphthae. This result reflects an association between stress and
Discussion RAS less frequent than the one presented by Bratel and Hake-
30
berg, in whose study 15.8% of the patients indicated stress
In this study, 97 children (53.0% of the study population) stat- as a potential etiological factor for aphthae development.
ed having aphthae regularly. Although this is not a real prev- These results may be explained by the fact that the studies
alence, the obtained percentage for aphthae occurrence is found in the literature included samples that were essentially
23
similar to the one described by Rogers, who indicates that composed of adults, whereas the present study focuses on a
the prevalence of RAS may vary between 5% and 50%, de- markedly younger population.
pending on the studied population. According to the same In the present study, a significant association was found
author, females are more affected by this condition. Never- between the frequency of aphthae and gastrointestinal disor-
23
theless, no association was found between aphthae occur- ders. However, the aphthae’s association with allergies, daily
rence and gender in the present study. toothbrushing frequency, use of orthodontic appliance, place-
Most of this research’s participants stated that the number ment of pens/pencils in the oral cavity and consumption of
of lesions in each RAS episode was between 1 and 5. Moreover, some foods (green vegetables and legumes) were not statisti-
most of them also indicated a time of healing of 4 to 7 days. cally significant. Only 6.0% of the studied sample presented
These results suggest that the majority of the participants some gastrointestinal disorders. This percentage is inferior to
31
probably had a minor manifestation of RAS, which, according the one reported in the study by Diaz et al., where 35.8% of
24
to Rogers, is the most common one and is characterized by the studied cases showed gastrointestinal disorders (namely,
a number of lesions between 1 and 5. The corresponding time gastroenteritis, malabsorption syndrome, ulcerous colitis and
of healing is also consistent with the literature. Regarding giardiasis). However, it is important to note that the study by
25
31
the lesions’ localization, this study revealed that RAS appeared Diaz et al. included adult patients, whereas the present re-
in any area of the oral cavity and that the most frequent local- search focused on a much younger population.
ization was the jugal and labial mucosa, which is consistent Regarding the therapies used, most of the parents/guard-
with other studies published by several authors. 3-5,26 ians indicated that they did not apply any type of treatment
27
In the study by Gavic et al., a pain scale of 0 to 10 (with 0 and waited for the lesions to heal spontaneously. These ac-
corresponding to slight pain/burn and 10 corresponding to tions may result from the fact that there is not yet a definitive
32
extreme pain) was applied, with 7 being the most indicated treatment protocol for RAS. According to Ranganath and
32
number, which is close to extreme pain. In the young popula- Pai, this situation is explained by the lack of clinical trials
tion of this study, using a simplified pain scale (from 1 to 5, and the differences in response between different patients.
with 1 corresponding to no pain and 5 to intense pain), the Nevertheless, it may also be explained by the fact that the
most indicated response by the children was number 3 (Table exact etiology of RAS is still unknown. 23
2). These results suggest that in younger age groups the pain Of the group who stated applying some therapy, most used
felt in the presence of these lesions is considered moderate. topical drugs (namely, drugs including hyaluronic acid), which
28
Krisdapong et al. concluded that RAS has an impact on is consistent with the existing literature, where topical drugs are
oral hygiene and dietary habits. The same was verified in this described as the therapy of choice for most patients with RAS. 3,33
study, as approximately 60 of the parents/guardians claimed Regarding the access to these drugs, many of the respondents
that their children avoided brushing the areas affected by aph- had consulted a pharmacist. Only 7.4% of the participants re-
thae. This finding suggests that children do not brush their ported having consulted the dentist, which is a lower percentage
teeth effectively in the areas near the lesions, so as to avoid than what was expected, considering that the dentist is the
the pain. Furthermore, 60.9% of the parents/guardians stated healthcare professional with the most adequate knowledge for
that their children had difficulty chewing food. These findings the diagnosis and treatment of this type of lesions.