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Is there any relationship between recurrent oral aphthous stomatitis and prediabetes?
Medical Hypotheses xxx (2013) xxx–xxx
Contents lists available at SciVerse ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Correspondence
Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Evrim Cakir ⇑ Department of Endocrinology and Metabolic Diseases, Amasya Sabuncuoglu Serefettin Training and Research Hospital, Amasya, Turkey
a r t i c l e
i n f o
Article history: Received 7 February 2013 Accepted 26 May 2013 Available online xxxx
a b s t r a c t Periodontal disease has been associated with glycaemia. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesions and is characterized by painful recurrent oral ulcers. However, the exact cause and treatment of RAS is not yet well-known. Furthermore, there is still unknown the relationship between RAS and glycaemia. Prediabetes has shown to have role on worse metabolic profile. However, there is still no data on the relationship between prediabetes and clinical RAS. Therefore, the purpose of this hypothesis is to assess whether the prediabetes aggravate RAS. Ó 2013 Elsevier Ltd. All rights reserved.
Prediabetes has several risk factors including as cardiovascular risk disease, non-alcoholic fatty liver disease (NAFLD). In recent study 2-h post challenge glucose level has been found to be associated with cardiometabolic risk factors and subclinical atherosclerosis [1]. In Lopez et al. study NAFLD has been determined higher in patients with prediabetes and type 2 diabetes mellitus. There is growing evidence on the relationship between prediabetes and worse metabolic profile [2]. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesion and is characterized by painful recurrent oral ulcers [3]. The exact cause of RAS is not yet known [4]. The genetic and environmental factors are thought to have played roles in the development of RAS [5–7]. Furthermore, in recent years stressful life events and thyroid autoimmunity have been shown to cause increased frequency of RAS [8,9]. Additionally, in the recent study, no single treatment was found to be effective in regard to best systemic intervention for RAS. The authors concluded that the treatment for RAS has to be individualized [10]. In relation to present hypotheses in the recent published study periodontal infection was found to be associated with insulin resistance in the sample of diabetes-free adults. It has been observed that geometric mean homeostasis model assessment insulin resistance index (HOMA-IR) levels elevated by 1.04 for every 1 mm periodontal probing depth (PD) rise (P = 0.007) [11]. In several studies insulin resistance was found to be higher in the patients with Behçet’s disease which exist oral mucosal lesions as compared to controls [12,13]. In recent study it has been shown that patients with diabetes mellitus (DM) with hyperglycaemia had a higher risk for develop⇑ Tel.: +90 505 2692468. E-mail address: [email protected]
ment of periodontitis (odds ratio = 2.24). Additionally, hyperglycaemia was found to be positively correlated with clinical attachment loss. Furthermore, patients with diabetes with periodontitis presented higher glycaemia and glycated haemoglobin values in contrast to patients with gingivitis [14]. Oral manifestations of DM exist different types. Uncontrolled hyperglycaemia cause to develop diabetic periodontitis. On the other hand, the treatment of periodontitis is associated with significant improvement in diabetic markers, particularly in HbA1c [15]. These data support the role of glucose metabolism disorders on the periodontal disease including recurrent aphthous stomatitis. In the recent hypothesis that RAS might be a manifestation of metabolic abnormalities particularly hyperglycaemia and insulin resistance. Therefore patients that admitted the hospital with RAS should be screened for diabetes mellitus and prediabetes. Prediabetes increasing cardiovascular disease risk and worse metabolic profile have to be determined and the patients with RAS should be followed up for cardiovascular disease risk. Further studies are needed to evaluate the association between prediabetes and RAS. Conflict of interest Nothing to declare. Acknowledgement Nothing to declare. References [1] Marini MA, Succurro E, Castaldo E, et al. Cardiometabolic risk profiles and carotid atherosclerosis in individuals with prediabetes identified by fasting glucose, postchallenge glucose, and hemoglobin A1c criteria. Diabetes Care 2012;35:1144–9.
0306-9877/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.mehy.2013.05.035
Please cite this article in press as: Cakir E. Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Med Hypotheses (2013), http://dx.doi.org/10.1016/j.mehy.2013.05.035
2
E. Cakir / Medical Hypotheses xxx (2013) xxx–xxx
[2] Ortiz-Lopez C, Lomonaco R, Orsak B, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care 2012;35:873–8. [3] Brostoff J, Challacombe SJ. Food allergy and intolerance. London: Saunders; 2002. [4] Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med 2012;41:577–83. [5] Wardhana, Datau EA. Recurrent aphthous stomatitis caused by food allergy. Acta Med Indones 2010;42:236–40. [6] Messadi DV, Younai F. Aphthous ulcers. Dermatol Ther 2010;23:281–90. [7] Chattopadhyay A, Shetty KV. Recurrent aphthous stomatitis. Otolaryngol Clin North Am 2011;44:79–88. v. [8] Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med 2012;41:149–52. [9] Ozdemir IY, Calka O, Karadag AS, Akdeniz N, Ozturk M. Thyroid autoimmunity associated with recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol 2012;26:226–30.
[10] Brocklehurst P, Tickle M, Glenny AM, et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 2012;9:CD005411. [11] Demmer RT, Squillaro A, Papapanou PN, et al. Periodontal infection, systemic inflammation, and insulin resistance: results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999–2004. Diabetes Care 2012;35:2235–42. [12] Kim SK, Choe JY, Park SH, Lee SW, Lee GH, Chung WT. Increased insulin resistance and serum resistin in Korean patients with Behcet’s disease. Arch Med Res 2010;41:269–74. [13] Erdem H, Dinc A, Pay S, Simsek I, Turan M. Peripheral insulin resistance in patients with Behcet’s disease. J Eur Acad Dermatol Venereol 2006;20:391–5. [14] Botero JE, Yepes FL, Roldan N, et al. Tooth and periodontal clinical attachment loss are associated with hyperglycemia in patients with diabetes. J Periodontol 2012;83:1245–50. [15] Straka M. Oral manifestations of diabetes mellitus and influences of periodontological treatment on diabetes mellitus. Bratisl Lek Listy 2011;112:416–20.
Please cite this article in press as: Cakir E. Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Med Hypotheses (2013), http://dx.doi.org/10.1016/j.mehy.2013.05.035
Contents lists available at SciVerse ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Correspondence
Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Evrim Cakir ⇑ Department of Endocrinology and Metabolic Diseases, Amasya Sabuncuoglu Serefettin Training and Research Hospital, Amasya, Turkey
a r t i c l e
i n f o
Article history: Received 7 February 2013 Accepted 26 May 2013 Available online xxxx
a b s t r a c t Periodontal disease has been associated with glycaemia. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesions and is characterized by painful recurrent oral ulcers. However, the exact cause and treatment of RAS is not yet well-known. Furthermore, there is still unknown the relationship between RAS and glycaemia. Prediabetes has shown to have role on worse metabolic profile. However, there is still no data on the relationship between prediabetes and clinical RAS. Therefore, the purpose of this hypothesis is to assess whether the prediabetes aggravate RAS. Ó 2013 Elsevier Ltd. All rights reserved.
Prediabetes has several risk factors including as cardiovascular risk disease, non-alcoholic fatty liver disease (NAFLD). In recent study 2-h post challenge glucose level has been found to be associated with cardiometabolic risk factors and subclinical atherosclerosis [1]. In Lopez et al. study NAFLD has been determined higher in patients with prediabetes and type 2 diabetes mellitus. There is growing evidence on the relationship between prediabetes and worse metabolic profile [2]. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesion and is characterized by painful recurrent oral ulcers [3]. The exact cause of RAS is not yet known [4]. The genetic and environmental factors are thought to have played roles in the development of RAS [5–7]. Furthermore, in recent years stressful life events and thyroid autoimmunity have been shown to cause increased frequency of RAS [8,9]. Additionally, in the recent study, no single treatment was found to be effective in regard to best systemic intervention for RAS. The authors concluded that the treatment for RAS has to be individualized [10]. In relation to present hypotheses in the recent published study periodontal infection was found to be associated with insulin resistance in the sample of diabetes-free adults. It has been observed that geometric mean homeostasis model assessment insulin resistance index (HOMA-IR) levels elevated by 1.04 for every 1 mm periodontal probing depth (PD) rise (P = 0.007) [11]. In several studies insulin resistance was found to be higher in the patients with Behçet’s disease which exist oral mucosal lesions as compared to controls [12,13]. In recent study it has been shown that patients with diabetes mellitus (DM) with hyperglycaemia had a higher risk for develop⇑ Tel.: +90 505 2692468. E-mail address: [email protected]
ment of periodontitis (odds ratio = 2.24). Additionally, hyperglycaemia was found to be positively correlated with clinical attachment loss. Furthermore, patients with diabetes with periodontitis presented higher glycaemia and glycated haemoglobin values in contrast to patients with gingivitis [14]. Oral manifestations of DM exist different types. Uncontrolled hyperglycaemia cause to develop diabetic periodontitis. On the other hand, the treatment of periodontitis is associated with significant improvement in diabetic markers, particularly in HbA1c [15]. These data support the role of glucose metabolism disorders on the periodontal disease including recurrent aphthous stomatitis. In the recent hypothesis that RAS might be a manifestation of metabolic abnormalities particularly hyperglycaemia and insulin resistance. Therefore patients that admitted the hospital with RAS should be screened for diabetes mellitus and prediabetes. Prediabetes increasing cardiovascular disease risk and worse metabolic profile have to be determined and the patients with RAS should be followed up for cardiovascular disease risk. Further studies are needed to evaluate the association between prediabetes and RAS. Conflict of interest Nothing to declare. Acknowledgement Nothing to declare. References [1] Marini MA, Succurro E, Castaldo E, et al. Cardiometabolic risk profiles and carotid atherosclerosis in individuals with prediabetes identified by fasting glucose, postchallenge glucose, and hemoglobin A1c criteria. Diabetes Care 2012;35:1144–9.
0306-9877/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.mehy.2013.05.035
Please cite this article in press as: Cakir E. Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Med Hypotheses (2013), http://dx.doi.org/10.1016/j.mehy.2013.05.035
2
E. Cakir / Medical Hypotheses xxx (2013) xxx–xxx
[2] Ortiz-Lopez C, Lomonaco R, Orsak B, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care 2012;35:873–8. [3] Brostoff J, Challacombe SJ. Food allergy and intolerance. London: Saunders; 2002. [4] Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med 2012;41:577–83. [5] Wardhana, Datau EA. Recurrent aphthous stomatitis caused by food allergy. Acta Med Indones 2010;42:236–40. [6] Messadi DV, Younai F. Aphthous ulcers. Dermatol Ther 2010;23:281–90. [7] Chattopadhyay A, Shetty KV. Recurrent aphthous stomatitis. Otolaryngol Clin North Am 2011;44:79–88. v. [8] Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med 2012;41:149–52. [9] Ozdemir IY, Calka O, Karadag AS, Akdeniz N, Ozturk M. Thyroid autoimmunity associated with recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol 2012;26:226–30.
[10] Brocklehurst P, Tickle M, Glenny AM, et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 2012;9:CD005411. [11] Demmer RT, Squillaro A, Papapanou PN, et al. Periodontal infection, systemic inflammation, and insulin resistance: results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999–2004. Diabetes Care 2012;35:2235–42. [12] Kim SK, Choe JY, Park SH, Lee SW, Lee GH, Chung WT. Increased insulin resistance and serum resistin in Korean patients with Behcet’s disease. Arch Med Res 2010;41:269–74. [13] Erdem H, Dinc A, Pay S, Simsek I, Turan M. Peripheral insulin resistance in patients with Behcet’s disease. J Eur Acad Dermatol Venereol 2006;20:391–5. [14] Botero JE, Yepes FL, Roldan N, et al. Tooth and periodontal clinical attachment loss are associated with hyperglycemia in patients with diabetes. J Periodontol 2012;83:1245–50. [15] Straka M. Oral manifestations of diabetes mellitus and influences of periodontological treatment on diabetes mellitus. Bratisl Lek Listy 2011;112:416–20.
Please cite this article in press as: Cakir E. Is there any relationship between recurrent oral aphthous stomatitis and prediabetes? Med Hypotheses (2013), http://dx.doi.org/10.1016/j.mehy.2013.05.035