Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal
diseases which are diagnosed with recurrent and painful ulcers. The possible association between
psychological factors and salivary stress related factors in patients with aphthous ulcers has been
discussed in various studies. The aim of this study was to evaluate salivary cortisol level, anxiety,
and depression in patients with RAS.
Materials and Methods: In this case control study, 30 patients with RAS and 30 healthy individuals
were enrolled by matching their age and sex. Anxiety and depression were assessed by beck anxiety
inventory and beck depression inventory. Unstimulated saliva of both groups were collected and then
tested by DiaMetra kit and the ELISA method. Data were analyzed by SPSS using an Independent
t‑test and Mann–Whitney test. A statistical significance level of <0.05 was considered.
Results: The mean salivary cortisol in the case group was 5.35 ng/ml and in the control group was
4.73 ng/ml which was not statistically significant (P > 0.05). There was no significant difference in
anxiety and depression level between the two groups (P > 0.05). According to Spearman correlation
coefficient, there was an average, negative, and significant correlation between salivary cortisol and
anxiety and depression scores in the case group (P < 0.05).
Conclusion: This study shows that, although the mean salivary cortisol was slightly higher in
patients with aphthous lesions, anxiety, and depression were not possible factors for RAS. There
was a moderate, negative correlation between salivary cortisol level and stress and anxiety in
patients with RAS.
Key Words: Anxiety, aphthous, cortisol, depression, saliva, stomatiti