Mucosal Wound Healing Is Impaired by Examination Stress

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Abstract
Impairment of wound healing is a well-recognized sequelae of conditions that alter immune function, including diabetes, jaundice, and advanced age. There is also growing evidence that psychological stress has adverse consequences for immune function. This study addressed the effects of a commonplace stressor on wound healing. Two punch biopsy wounds were placed on the hard palate of 11 dental students. The first wound was timed during summer vacation, whereas the second 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 and a foaming response to hydrogen peroxide). Students took an average of 3 days longer to completely heal the 3.5-mm wound during examinations, ie, 40% longer to heal a small, standardized wound. Production of interleukin 1 [small beta, Greek] (IL-1 [small beta, Greek]) messenger RNA (mRNA) declined by 68% during examinations, providing evidence of one possible immunological mechanism. These differences were quite reliable: No student healed as rapidly or produced as much IL-1 [small beta, Greek] mRNA during examinations as during vacation. These data suggest that even something as transient, predictable, and relatively benign as examination stress can have significant consequences for wound healing.