Salivary levels of TNF-α in patients with recurrent aphthous stomatitis: A cross-sectional study

Abstract

Background. Recurrent aphthous stomatitis (RAS) is a disorder characterized by recurring ulcers involving the oral mucosa in patients with no other signs of disease. The current concept of etiopathogenesis is that RAS is a clinical syndrome with several possible etiologies. The process seen in RAS is probably initiated through an as yet unidentified antigenic stimulation of the mucosal keratinocytes, which stimulates secretion of T-cell activation cytokines interleukins and tumor necrosis factor alpha (TNF-alpha). TNF-alpha causes inflammation by its effect on endothelial cell adhesion and neutrophil chemotaxis. The rele-vance of TNF-alpha to the pathogenesis of RAS has stemmed from the observations that anti- TNF-alpha drugs such as thalidomide and pentoxifylline have been found to be effective in the treatment of RAS. Therefore, the present study was an attempt to measure the levels of salivary TNF-alpha in patients with RAS, which will reflect the local production of cytokines at the site of the disease. The aim was to evaluate the salivary levels of TNF-alpha in patients with recurrent aphthous stomatitis. Methods. The study comprised of 60 subjects, of whom 30 clinically proven RAS patients of either sex were selected as cases and 30 healthy, age- and gender- matched subjects were selected as controls. After taking informed consent, 5 mL of unstimulated saliva were collected from both the study and control group subjects. Determination of salivary TNF-alpha levels was carried out by Enzyme-Linked Immunosorbent Assay (ELISA) and expressed in pg/mL. Statistical analysis of the RAS and control groups was carried out using unpaired t-test. Gender-wise comparison of salivary TNF-alpha levels in the study and control groups was carried out using one-way ANOVA. Results. Mean salivary TNF-alpha levels were significantly higher in the RAS group compared to the control group (P<0.001). It was also revealed that the mean salivary TNF-alpha levels in females were significantly higher than in males in the study group (PP<0.05). Conclusion. It is fair to suggest that TNF-alpha plays a very important mediatory role in the pathogenesis of RAS and may play an important role in the search for a definitive treatment for the disease.