Correlation between Salivary Cotinine Levels and Cigarette Smoking with Recurrent Aphthous Stomatitis
Keywords:Nicotine, Recurrent aphthous stomatitis, nicotine, smoking
Introduction: Recurrent aphthous stomatitis (RAS) is a widespread oral mucosal disease typified by the
presence of a yellowish-grey base with high margins and flanked by an erythematous halo. RAS typically
crops up in the lining or nonkeratinized mucosa. It has been found that smoking and salivary cotinine (a
metabolic product of nicotine) levels have a protective effect against the occurrence of RAS by increasing
keratinization of the oral mucosa.
Objectives: To identify the effect of smoking and nicotine level on the occurrence of RAS.
Patients and Methods: the study was conducted on 92 male students studying at different Universities of
Baghdad, Iraq, in the period between January to December 2018. The students were thoroughly questioned
about the yearly recurrence rate and healing period of RAS. Data about smoking history; method, average
daily dose, and period of the behaviour were recorded for each student. Salivary Cotinine levels were
measured by the Human Cotinine ELISA Kit and utilising the competitive ELISA technique based on the
protocol of the manufacturer salimetrics assay #1-2002.
Results: The study subjects comprised of 92 male students. Their ages were from 18 to 25 years; the
average age was 21.04 ± 2.2. Forty-two of them were light smokers, and 50 were heavy smokers. They were
subdivided into subgroups according to the duration of smoking (less or more than five years). The annual
recurrence rates and healing period were lower in those who smoked for more than five years than those who
smoked for less than five years with a significant difference in light smokers. Salivary cotinine levels were
significantly higher in a heavy smoker than in light smokers. Period of healing and yearly recurrence rates
were significantly lower in those who had salivary cotinine level more than 200ng/ml than in those with a
Conclusion: The protecting impact of smoking on RAS was solely identified when individuals were heavy
smokers or smoked for longer durations of time and correlated with cotinine levels, according to the available
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