MUCOSAL WOUND-HEALING IS IMPAIRED BY EXAMINATION STRESS

Objective: Impairment of wound healing is a well-recognized sequelae o f conditions that alter immune function, including diabetes, jaundice, and advanced age. There is also growing evidence that psychological s tress has adverse consequences for immune function. This study address ed the effects of a commonplace stressor on wound healing. Method: Two punch biopsy wounds were placed on the hard palate of 11 dental stude nts. The first wound was timed during summer vacation, whereas the sec ond was placed on the contralateral side 3 days before the first major examination of the term; thus, each student served as her or his own control. Two independent methods assessed healing (daily photographs a nd a foaming response to hydrogen peroxide). Results: Students took an average of 3 days longer to completely heal the 3.5-mm wound during e xaminations, ie, 40% longer to heal a small, standardized wound. Produ ction of interleukin 1 beta (IL-1 beta) messenger RNA (mRNA) declined by 68% during examinations, providing evidence of one possible immunol ogical mechanism. These differences were quite reliable: No student he aled as rapidly or produced as much IL-1 beta mRNA during examinations as during vacation. Conclusions: These data suggest that even somethi ng as transient, predictable, and relatively benign as examination str ess can have significant consequences for wound healing.