According to World Health Organization (WHO), stress-related problems will be one of the foremost causes of disability by the end of Year 2020 . Stress can also lead to the incidence of a number of systemic diseases such as diabetes, hypertension and autoimmune diseases etc. Students are being affected by a variety of stressors, such as the strain of academic curriculum, an undecided future and hindrances of incorporating into the system. Medical and dental students, are known to go through extremely intense stress. This may serve as a triggering factor for oral ulcers .
The body responses to stress involves a chain reaction of hormonal and physiological changes. When the body is stressed, a trigger is sent to the hypothalamus and this induces the hypothalamus to further send signals to the anterior pituitary gland and adrenal medulla, thus inducing the production of several hormones including norepinephrine, adrenaline, cortisol which have several effects on the human body, and can over a prolonged period cause a suppression of the host immunity [3, 4].
Aside this numerous effect of stress on our body, stress can also have several effects on the oral environment, these effects can manifest in form of ulceration ranging from mild to very severe forms of ulcers in the oral cavity, which can be very painful and can prevent oral and masticatory functions thereby affecting the everyday life of people who happen to come down with the ulcers. It is a known fact that oral health is essential to general health, and a healthy mouth not only enables nutrition but also enhances social interactions, promotes self-esteem, and feeling of wellbeing, as such various body conditions such as stress can trigger cellular and immunological mechanisms and predispose to various form of ulcers in the oral cavity .
Stress, depression and anxiety are found as the most common cause of oral ulcers among health care students [6, 7] demonstrated a statistically significant association between stressful life events and the onset of recurrent aphthous stomatitis episodes. This finding is corroborated by another study where significant association was shown to exist between stress and oral ulcers in a study group of medical students in India assessed using the perceived stress score to assess their level of stress . Estimated odds of developing oral ulcers was found at to be three times more with a stressful life event. It was also opined in this study that mental stressors were more likely to play etiologic roles in oral ulcers than physical stressors .
Stress has been known to predispose to the following oral ulcerations: oral lichen planus; which is a chronic inflammatory condition characterized by bilateral white striations or plaques on the buccal mucosa, tongue and gingiva . Other ulcers associated with stress include herpes labialis; acute necrotizing ulcerative gingivitis, recurrent aphthous ulcer, recurrent oral erythema multiforme, factitious ulceration (self-inflicted oral lesions) and mucous membrane pemphigoid. [10–13].
Although stress is a phenomenon known to all. However, most people are unaware of the relationship with oral ulcers. Therefore, this study aims to know the awareness of clinical medical and dental students towards stress induced oral ulcer; to determine the most prevalent stress induced oral ulcers among the study population, and the relationship between perceived stress level and prevalence of stress induced oral ulcer. This will enhance the management of stress induced oral ulcers as well as improve treatment outcomes and contribute to the already existing body of knowledge