Are Predisposing Factors Associated with the Severity of Recurrent Aphthous Stomatitis? Insights from a Cross-Sectional Study

Aim: This exploratory study aimed to identify potential predisposing factors associated with the severity of recurrent aphthous stomatitis (RAS). Materials and Methods: An analytical cross-sectional study was conducted with 51 purposively sampled participants diagnosed with RAS in Yogyakarta, Indonesia. Data on potential predisposing factors (family history, smoking, trauma, allergy, menstrual cycle, psychological status via Depression, Anxiety, Stress Scale-21 DASS-21) and clinical parameters (body mass index BMI, hematological profile, and oral hygiene) were collected. RAS severity was categorized as less severe or more severe based on a median split of the ulcer severity score (USS). Chi-square tests and a multivariate binary logistic regression model were used to assess associations. An analytical cross-sectional study was conducted with 51 purposively sampled participants diagnosed with RAS in Yogyakarta, Indonesia. Data on potential predisposing factors (family history, smoking, trauma, allergy, menstrual cycle, psychological status via DASS-21) and clinical parameters (BMI, hematological profile, oral hygiene) were collected. RAS severity was categorized as less severe or more severe based on a median split of the USS. Results: In bivariate analysis, five factors were identified as candidates for the multivariate model (P < 0.25): family history, menstrual cycle, anxiety, stress, and oral hygiene. In the final multivariate model, no factor reached statistical significance (P < 0.05). However, a strong trend was observed for the menstrual cycle, which was associated with a fivefold increase in the odds of more severe RAS (OR = 5.13; 95% confidence interval: 0.99-26.67; P = 0.052). Stress was also associated with a clinically meaningful effect size (Cohen's d = 0.48). Conclusion: Although this study was underpowered to detect statistically significant predictors, the findings suggest that hormonal fluctuations (menstrual cycle) and psychological distress may be clinically relevant contributors to RAS severity. This study highlights the multifactorial nature of RAS and provides a foundation for future, adequately powered research to validate these preliminary associations and develop personalized management strategies. © 2025 Journal of International Oral Health.