Vitamin D Levels in Patients With Recurrent Aphthous Stomatitis

Aynure Öztekin; Coşkun Öztekin

Disclosures

BMC Oral Health. 2018;18(186) 

In This Article

Abstract and Introduction

Abstract

Background: Lower serum vitamin D levels, a major public health problem worldwide, has been found to be associated with various infectious diseases, cancers, autoimmune and dermatological diseases. The serum levels of vitamin D in patients with recurrent aphthous stomatitis are not clear. We investigated the vitamin D levels in patients with recurrent aphthous stomatitis.

Methods: Forty patients with recurrent aphthous stomatitis (Group I) and 70 healthy controls (Group II) included in the study. The characteristics of aphthous lesions (duration of disease and remission, frequency, diameter and number of the lesions) and demographics of the participants were recorded. Serum 25-hydroxycholecalciferol levels were measured using electrochemiluminescence binding method.

Results: There was no statistically significant difference between the groups in terms of age (p = 0.06) and sex (p = 0.4). Other baseline characteristics were not significantly different between the groups (p > 0.05 for all). The mean diameter of aphthous lesions was 0.5 (0.4–0.6) cm and the mean number of lesions was 2.2 ± 1.5. Serum vitamin D levels were 11 ± 7.04 ng/ml in Group I and 16.4 ± 10.19 ng/ml in Group II. Serum vitamin D levels were significantly lower in patients with recurrent aphthous stomatitis (p = 0.004).

Conclusions: The present study showed lower vitamin D levels in patients with recurrent aphthous stomatitis compared to healthy controls.

Introduction

Aphthous stomatitis is the painful ulcers of the oral mucous membranes. These idiopathic noninfectious lesions are characterized by recurrent painful attacks (commonly known as "canker sores"). Aphthous stomatitis affects approximately 20% of the general population.[1] Risk factors include local trauma, emotional or physiologic stress, allergy, toxin exposure, vitamin deficiency, poor oral hygiene, menstruation, and alterations in the oral flora.[1]

Recent studies investigated the role of several vitamins including vitamin B1, B2, B6, B12 and folic acid in the etiopathogenesis of recurrent aphthous stomatitis.[2–5] Nolan et al.[2] found that 28% of 60 patients with recurrent oral ulcers had a deficiency in at least one of the B1, B2, and B6 vitamins. Replacement therapy in these deficient individuals with recurrent oral ulcers displayed a significant improvement within 1 month. Lalla et al.[6] evaluated the effect of daily multivitamin supplementation (vitamins A, B1, B2, B3, B5, B6, B9, B12, C, D, and E) on the number and duration of recurrent aphthous stomatitis episodes but found no significant improvement in the number or duration of episodes. In contrast, Petersen et al.[7,8] reported significant improvement in the number of recurrent aphthous lesions using combination vitamin/herbal supplement even in the absence of serologic vitamin deficiency.

Vitamin D is a fat-soluble secosteroid and functions primarily in the regulation of the calcium and phosphorus balance.[9] Recent studies over the past years have revealed a broader role of vitamin D; not only in skeletal and cardiovascular disorders but also in cancers, central nervous system diseases, infections, autoimmune, and dermatological disorders.[10] It is known that the risk factors for the development of autoimmune diseases are a mosaic, which includes family history, genetic predisposition, hormonal status and environmental features. In accordance, lower vitamin D levels and vitamin D receptor polymorphism has been suggested as important risk factors for the development of autoimmune diseases.[11] Previous studies indicate that innate and acquired immunity play an important role in the development of recurrent aphthous stomatitis.[12]

The role of vitamin D deficiency in patients with recurrent aphthous stomatitis is not well known. The aim of the present study is to investigate the serum levels of vitamin D in patients with recurrent aphthous stomatitis.

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