Comparative Study of Serum Zinc and Key Hematinic (Vitamin B12, Ferritin, Folate) in Patients with Minor Aphthous Stomatitis and Ulcerative Oral Lichen Planus

Background and Objectives: Minor aphthous stomatitis (MAS) and ulcerative oral lichen planus (OLP) are chronic oral conditions with recurrent painful ulceration that significantly affects patients' quality of life. Despite extensive research, the precise etiopathogenesis of these conditions remains incompletely understood. Recent studies have found that a lack of micronutrients and key hematinics, such as zinc, vitamin B12, ferritin, and folate, may be associated with the start, severity, and recurrence of MAS and OLP. This study aimed to assess the association between these deficiencies and the occurrence of MAS and OLP compared with healthy controls. Materials and Method: A cross-sectional, case-control study was conducted at Hawler Medical University/College of Dentistry in Erbil City, Iraq. From November 2024 to June 2025, a total of 160 participants were included: 40 patients with MAS, 40 with OLP, and 80 age- and gender-matched healthy controls. Serum levels of zinc, vitamin B12, ferritin, and folate were measured alongside hematologic indices (Hb, HCT, MCV). Data were analyzed using appropriate statistical tests. Results: Both the MAS and OLP groups had much lower levels of zinc, vitamin B12, ferritin, and folate (p<0.05). Hematologic indices (Hb, HCT, MCV) were also lower in patients but still within the low-normal range. This finding suggests that subclinical hematinic deficiencies may exist, despite the absence of overt anemia. A female predominance and middle-age distribution were noted in both patient groups. When directly comparing MAS and OLP patients, the OLP group exhibited more pronounced deficiencies across all measured micronutrient and hematinic parameters, except folate, which showed higher levels of deficiency in MAS cases. Conclusion: Subclinical micronutrient deficiencies may play a role in the pathogenesis of MAS and OLP. Routine nutritional assessment of zinc and key hematinics may improve diagnosis and management strategies for these chronic oral conditions. Keywords: Hematinic indices, Minor aphthous ulcer, Nutritional deficiency, Oral lichen planus