Ethical Approval
The study was registered with the research center, and ethical approval was obtained from the institutional review board (IRB) of Riyadh Elm University (REU). The research registration number was FPGRP/43737001/267.
Study Population
The cross-sectional study targeted the dental students registered at Riyadh Elm University (REU) at all levels (undergraduate, post graduate, and interns). For this, a structured questionnaire was sent randomly by email to all targeted population. The number of respondents was 184, and the response rate was 73.6%.
The exclusion criteria were subjects with special needs, pregnant women, epileptic subjects, subjects with a clinical history of psychosomatic alterations or treatment with psychoactive drugs, and individuals with history of oral surgery (except exodontia, implants, and impactions).
Data collection
Informed consent form and electronic questionnaire were distributed randomly by official administration email through the postgraduate office of REU. The questionnaires had three sections. The first section included demographic data including age, gender, education level, marital status. The second section contained personal information and questions related to Recurrent Aphthous Stomatitis (RAS).11In RAS section, the subjects were asked to report the time of last ulcer experience, the frequency of the ulcer, the number of ulcers in each occurrence, and to determine the area of occurrence.
The third section evaluated the aspects of depression, anxiety, and stress applying the Depression, Anxiety, Stress Scale (DASS 21).12 The DASS 21 is a 21-item self-report questionnaire designed to measure the severity of a range of symptoms common to both depression, anxiety, and stress. The essential function of the DASS is to assess the severity of the core symptoms of depression, anxiety, and stress. Many studies among different populations confirmed that the DASS is comprehensible and sensitive to detecting common mental disorders13, and is a reliable and valid method of assessing features of depression, anxiety, and tension-stress14.
Statistical analysis
The data analysis was performed by using Statistical Packages for Social Sciences version 21.Level of significance was set at < 0.05. Descriptive and inferential statistics were used. Frequency and proportion were used to present all categorical variables. DASS 21 was used as questionnaires to assess the depression, anxiety, and stress of dental students with RAS. Based on the given criteria, the answer options for each question was from 0 = Did not apply to me at all,1 = Applied to me to some degree or some of the time, 2 = Applied to me to a considerable degree, or a good part of time, 3 = Applied to me very much, or most of the time.
DASS 21 was divided into three equal parts for depression, anxiety, and stress (seven questions each), each predictor has an equal total score of 21 points, and the summed score was multiplied by 2 to obtain a total score of 42 points12. Normal categories (not depressed, not anxious, not stressed) were classified by the score range of 0 to 9 and categories with a mental disorder (depressed, anxious, stressed) were classified by the score range of 10 to 42 or from mild to extremely severe. The analyses assessed the relationship between RAS among sociodemographic characteristics and DAS by using a chi-square test.