Assessment of Serum Vitamin Levels, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio in Patients with Recurrent Aphthous Stomatitis

Abstract

Recurrent aphthous stomatitis (RAS) is a common mucosal disease. Vitamin deficiencies and inflammatory factors are the etiologic causes; however, the relationship between these causes and the disease remains controversial. In this study, we aimed to compare the serum vitamin and inflammatory markers levels (neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume), in patients with RAS versus healthy controls. We performed a retrospective case-control study. The medical records of 81 patients with RAS and 69 healthy controls who presented to the dermatology clinic and whose neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume, serum iron, ferritin, iron-binding capacity, folic acid, and vitamin B12 levels were examined in the clinic were retrospectively reviewed and compared. The laboratory data of the participants were analyzed using the SPSS version 24.0 software. Statistical significance was set at p < 0.05. There were 81 patients with RAS in the study group and 69 age- and sex-matched healthy individuals in the control group. The mean serum vitamin B12 level was significantly higher in patients with RAS than in healthy controls (p = 0.016). The serum iron level was lower in patients with minor and herpetiform aphthae than in patients with major aphthae (p = 0.042), whereas NLR and PLR were higher in patients with minor aphthae compared with the other groups. NLR was lower in patients with RAS than in the healthy controls (p = 0.013). This study showed that vitamin deficiency does not play a role in the etiology of aphthae and inflammatory activity is not prominent in patients with RAS with normal hematologic status.

This is a preview of subscription content, access via your institution.

Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. 1.

    Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin N Am. 2014;58:281–97. https://doi.org/10.1016/j.cden.2013.12.002.

    Article  PubMed  Google Scholar 

  2. 2.

    Bao ZX, Shi J, Yang XW, Liu LX. Hematinic deficiencies in patients with recurrent aphthous stomatitis: variations by gender and age. Med Oral Patol Oral Cir Bucal. 2018;23:161–7. https://doi.org/10.4317/medoral.21885.

    Article  Google Scholar 

  3. 3.

    Compilato D, Carroccio A, Calvino F, Di Fede G, Campisi G. Haematological deficiencies in patients with recurrent aphthosis. J Eur Acad Dermatol Venereol. 2010;24:667–773. https://doi.org/10.1111/j.1468-3083.2009.03482.x.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Cui RZ, Bruce AJ, Rogers RS 3rd. Recurrent aphthous stomatitis. Clin Dermatol. 2016;34:475–81. https://doi.org/10.1016/j.clindermatol.2016.02.020.

    Article  PubMed  Google Scholar 

  5. 5.

    Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, et al. Mean platelet volume in recurrent aphthous stomatitis and Behcet disease. Angiology. 2014;65:161–5. https://doi.org/10.1177/0003319713503033.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Uluyol S, Kilicaslan S. Diagnostic value of neutrophil-lymphocyte ratios and mean platelet volumes in the activation of recurrent aphthous stomatitis. Indian J Otolaryngol Head Neck Surg. 2019;71:120–3. https://doi.org/10.1007/s12070-017-1059-8.

    Article  PubMed  Google Scholar 

  7. 7.

    Kozlak ST, Walsh SJ, Lalla RV. Reduced dietary intake of vitamin B12 and folate in patients with recurrent aphthous stomatitis. J Oral Pathol Med. 2010;39:420–3. https://doi.org/10.1111/j.1600-0714.2009.00867.x.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Lalla RV, Choquette LE, Feinn RS, Zawistowski H, Latortue MC, Kelly ET, et al. Multivitamin therapy for recurrent aphthous stomatitis: a randomized, double-masked, placebo-controlled trial. J Am Dent Assoc. 2012;143:370–6.

    Article  Google Scholar 

  9. 9.

    Lee YJ, Wang MY, Lin MC, Lin PT. Associations between vitamin B-12 status and oxidative stress and inflammation in diabetic vegetarians and omnivores. Nutrients. 2016;8:118. https://doi.org/10.3390/nu8030118.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Lewkowicz N, Lewkowicz P, Banasik M, Kurnatowska A, Tchórzewski H. Predominance of type 1 cytokines and decreased number of CD4(+) CD25(+high) T regulatory cells in peripheral blood of patients with recurrent aphthous ulcerations. Immunol Lett. 2005;99:57–62.

    CAS  Article  Google Scholar 

  11. 11.

    Lopez-Jornet P, Camacho-Alonso F, Martos N. Hematological study of patients with aphthous stomatitis. Int J Dermatol. 2014;53:159–63.

    CAS  Article  Google Scholar 

  12. 12.

    Olson JA, Feinberg I, Silverman S Jr, Abrams D, Greenspan JS. Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol. 1982;54:517–20. https://doi.org/10.1111/j.1365-4632.2012.05751.x.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Piskin S, Sayan C, Durukan N, Senol M. Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol. 2002;16:66–7.

    CAS  Article  Google Scholar 

  14. 14.

    Polat M, Bugdayci G, Kaya H, Oğuzman H. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26:97–100.

    PubMed  Google Scholar 

  15. 15.

    Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26:372–6.

    Article  Google Scholar 

  16. 16.

    Ślebioda Z, Krawiecka E, Szponar E, Dorocka-Bobkowska B. Haematinic deficiencies and patient clinical profiles in Polish patients with recurrent aphthous stomatitis (RAS). J Oral Pathol Med. 2018;47:531–7. https://doi.org/10.1111/jop.12703.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Singh M. Daily supplementation of recommended dose of multivitamin does not reduce the frequency and duration of recurrent aphthous ulcers. J Evid Based Dent Pract. 2013;13:27–8. https://doi.org/10.1016/j.jebdp.2013.01.005.

    Article  PubMed  Google Scholar 

  18. 18.

    Sun A, Chen HM, Cheng SJ, Wang YP, Chang YJ, Wu Y, et al. Significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high homocysteine level with recurrent aphthous stomatitis. J Oral Pathol Med. 2015;44:300–5. https://doi.org/10.1111/jop.12241.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Volkov I, Rudoy I, Freud T, Sardal G, Naimer S, Peleg R, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009;22:9–16. https://doi.org/10.3122/jabfm.2009.01.080113.

    Article  PubMed  Google Scholar 

  20. 20.

    Terzi S, Dursun E, Özgür A, Yiğit E, Özergin-Coşkun Z, Çelebi-Erdivanl Ö, et al. Status of neutrophils, lymphocytes and platelets in patients with recurrent aphthous stomatitis: a retrospective study. Iran J Otorhinolaryngol. 2016;28:421–4.

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Karaer IC. Mean Platelet Volume, Neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio as inflammatory markers in patients with recurrent aphthous stomatitis. Eurasian J Med. 2020;52:38–40.

    CAS  Article  Google Scholar 

Download references

Code Availability (Software Application or Custom Code)

Not applicable

Author information

Affiliations

Authors

Contributions

Hatice Kaya Özden: conception and design, acquisition of data, and analysis and interpretation of data; drafting the article; and revising it critically for important intellectual content and final approval of the version to be published. Yesim Kara Akpınar: analysis and interpretation of data; revising it critically for important intellectual content; and final approval of the version to be published.

Corresponding author

Correspondence to Hatice Kaya Ozden.

Ethics declarations

Ethics Approval

The study was approved by the local ethic committee (26.06.2018-002). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. “This article does not contain any studies with animals performed by any of the authors.”

Consent to Participate

Not applicable.

Consent for Publication

Not applicable

Conflict of Interest

The authors declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medicine

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kaya Ozden, H., Akpinar Kara, Y. Assessment of Serum Vitamin Levels, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio in Patients with Recurrent Aphthous Stomatitis. SN Compr. Clin. Med. 3, 606–610 (2021). https://doi.org/10.1007/s42399-021-00783-w

Download citation

Keywords

  • Mean platelet volume
  • Neutrophil-to-lymphocyte ratio
  • Platelet-to-lymphocyte ratio
  • Recurrent aphthous stomatitis
  • Vitamin B12