Use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial

Recurrent aphthous stomatitis is a common disorder of the oral cavity, affecting mainly young people. It is characterized by small ulcers which can be very painful and generally heal spontaneously within 7–14 days. There is currently no therapy that can provide rapid healing. This study evaluated the efficacy and rapidity of response of a lozenge containing Lactobacillus brevis CD2. 30 patients were randomized to take 4 lozenges a day of active product or placebo for 7 days. Signs and symptoms as well as laboratory parameters in the saliva were assessed at the start of the study and after 7 days of treatment. The study demonstrated the efficacy and the rapidity of response of the Lactobacillus brevis CD2 lozenges in resolving the clinical signs and symptoms of aphthous stomatitis, with a significantly rapid improvement of pain. This is the first study confirming the efficacy of a probiotic product in this pathology. 1. Introduction Recurrent aphthous stomatitis (RAS) is characterized by spontaneously self-limiting ulcerations of the mucosa of the oral cavity. The lesions can be single or multiple and generally affect the nonkeratinized mucosa of the cheeks, the soft palate, the fauces, the mouth floor, the tongue, and the gums. This pathology can be observed in 20–30% of the population and most commonly affects the higher social classes [1, 2]. The highest incidence is among young people between 10 and 20 years of age, the severity and frequency of ulcers decreasing with age [3–6]. Genetic predisposition is also involved; if both parents suffer from recurrent aphthous stomatitis, the probability of an early onset of such pathology is as high as 90%, but this probability falls to 10% if only one parent suffers from it [7]. Recurrent aphthous stomatitis can be divided into three categories according to the characteristics of the ulcer: major, minor, and herpetiform. The major form is characterized by painful ulcers (>10？mm) which erode the mucosa creating deep ulcers located on the palate, tonsils, pharynx, or tongue, which generally heal—often forming a scar—within 2 weeks, but can sometimes take months. The minor form is the most common and represents about 80% of all cases of recurrent aphthous stomatitis. Clinically, it presents painful, small (5–10？mm), well-defined ulcers, which are round or oval in shape; they usually affect the buccal or labial mucosa and heal in about 7–10 days. The herpetiform type is named after its likeness to Herpes Simplex Virus (HSV) ulcerations. Recurrences can generally be observed every 1–4 months, but some patients