Personality Traits Related to Aphthous Stomatitis and Necrotizing Ulcerative Gingivitis

Objectives: To compare stress, anger trait and personality attachment style between patients with recurrent aphthous stomatitis (RAS) or necrotizing ulcerative gingivitis (NUG) and controls. Methods: Participants were 26 RAS, 19 NUG patients and 55 randomly selected control dental patients. Mean age of participants was 21.0±3.07 years, with no differences between groups. Exclusion criteria were etiologic local trauma, systemic diseases (e.g., Behçet, celiac, inflammatory bowel diseases, HIV, periodic fever) or medications known to be related to oral ulcers. Subjects completed a battery of psychological questionnaires to assess three psychological traits: stress during the past month, anger trait, and personality attachment style. Results: NUG subjects (15.25±10.23) smoked significantly more cigarettes/day than the RAS (2.35±4.79) and control (2.60±5.17) groups (p<0.001) and reported on more smoking years (4.75±3.43, 1.06±2.11, 1.42±2.58, respectively; p<0.001). Most subjects were categorized as having a secure attachment style (RAS 74.1%, NUG 73.7%, control 83.6%), and only a minority as avoidant (19.2%, 15.8%, 14.5%, respectively) or anxious-ambivalent (3.8%, 10.5%, 1.8%, respectively). RAS (2.12±0.37) and NUG (2.15±0.47) groups reported more anger than controls (1.84±0.30; p<0.001), and more stress during the past month (2.81±1.33, 2.89±1.32, 1.96±1.02, respectively; p=0.001). However, only among subjects with high anger rates, RAS and NUG subjects showed higher stress level than controls (p<0.001). Conclusions: RAS and NUG were associated with anger and situational stress. Although these oral ulcerative conditions have been known for years to be related to stress, the present study revealed that situational stress is related to RAS or NUG only in patients with high anger trait. This can partly explain the inconsistent publications regarding risk factors for these oral conditions.