Psychological Factors, Serum Trace Elements, and Clinical Features of Factitious Oral Ulcers in Children and Adolescents: A Cross-Sectional Study.

OBJECTIVE

This study examined associations between psychological factors, serum zinc/iron levels, and clinical features of factitious oral ulcers in children (3-16 years).

METHODS

A cross-sectional analysis of 69 patients (78.3% male) from two Chinese hospitals assessed ulcer characteristics, pain (VAS), micronutrient levels, and psychological scores (SCARED, DSRSC, CPRS, SDQ). Statistical analysis used nonparametric tests and correlation analysis (SPSS 26.0).

RESULTS

Zinc deficiency (37.7%) correlated with longer disease duration (12.0 vs. 6.0 months, p = 0.035) and shorter ulcer-free intervals (60.0 vs. 95.2 days, p = 0.040). Zinc levels inversely linked to emotional symptoms (r = -0.416, p = 0.022) but positively to prosocial behavior (r = 0.526, p = 0.003). Pain intensity associated with anxiety (VAS: 4.0 vs. 3.0, p = 0.025) and psychosocial distress (r = 0.461, p = 0.010). Older children (8-16 years) had longer disease duration (12.0 vs. 3.6 months, p < 0.001) and higher zinc deficiency (47.5% vs. 24.1%, p = 0.048). Iron showed paradoxical associations with emotional symptoms (r = 0.452, p = 0.012) and prosocial behavior (r = -0.382, p = 0.037).

CONCLUSION

Zinc deficiency and psychological factors critically influence the chronicity of FOU. Multidisciplinary care combining micronutrient supplementation and behavioral interventions is recommended.