Treatment of oral ulceration with lactobacillus tablets

Treatment of oral ulceration with lactobacillus tablets Report

of forty

cases

Leonard Rapoport, Baltimore, illd.

B.S., D.D.X., and Walter I. Levine, D.D.S.,

R

eports of “new” forms of treatment for herpetic and aphthous stomatitis are almost as recurrent as the disease entities themselves. Most articles begin with a presentation of some historical background in which are enumerated the previously used and generally unsuccessful forms of treatment, ranging from the caustics and escharotics to the antihistaminics, steroids, and gamma globulin. There also have been genuine doubts and misgivings on the part of many practitioners concerning the actual diagnosis of the condition being treated. It is thought that herpes simplex is a viral disease characterized by vesicular groups, either single or multiple, filled with clear fluid. These are found on slightly raised inflammatory bases and commonly occur on skin, mucous membranes, and conjunctiva. Herpes may be cultivated by tissue culture and a.nimal inoculation and is serologically identifiable. Immunity is definitely not to be assumed as a result of the presence of antibodies, since more frequently than not attacks follow one another. As a matter of fact, previous attacks may predispose to others, and lesions very often recur at the same site. Smallpox vaccination for treatment of herpetic and aphthous stomatitis is now held to be generally valueless, and the use of steroids is frowned upon and considered by many to be responsible for triggering further outbreaks, particularly of dendritic ulcers. Aphthous stomatitis, on the other hand, is not caused by the herpes virus. It is caused by an as yet unidentified agent, reaction, or virus, although the antibody titer for the herpes virus is raised in its presence. Barile and co-workers1 recently reported the isolation of pure cultures of a transitional L form of bacteria from lesions of three patients with aphthous ulcerations and suggested a relationship between these L forms and the pathogenesis of the disease. 591

592

Rapoport and Leaine

Herpes is a DNA virus and is consclqucntl~ (l~~I)cnd~~nt,on tll\J Irrctabolistn of the host. Inasmuch as the nuclei of lluman cells a~’ c~ssc~nti;rll>-all I)h’A, it is hypothesized that cellular resistanc+ci breaks down ancl the I-irus snbstitut,cs or “insinuates” its nucleic acid. porvc~rtin, 11’tllcl ~11s I’unction itlltl initiating the manufacture of virus materials. In 1938 .Dodd and co-workers2 idrutific~d the virus of horpctic stomatitis and hence established the etiology of t,llr tlisc>asc. Smith” states that the virus has bun rocovercd from the nloath and stool for periods of as long as 25 days aftclr the, appearance oi’ oral lesions. The proscnce of neutralizing antibodirls is dc~norrstrablc by t,he fourth or fifth day after Onset

and,

as

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matter

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fad,

iS

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the

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(Jf

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5

years of age. This latter fact may explain the frequent, recurrence of tbc disease. Tho virus probably is quiescent within the cells until some stimulus goads it into activity. This may account for the Erequclnt outhrcaks of’ hcrpctic lesions following trauma, colds, menstruation, stress, eta. CLINICAL

STUDY OF TREATMENT

WITH

LACTOBACILLUS

TABLETS

Lactinex” contains a standardized viable culture of Lactobacillm nScidoyhilus and Lactobacillus hulgaricus. The product is available in two forms-tablets and granules, with one packet of’ granules containing the same amount of culture as four tablets. In this study, only tal)l(aIs w’crc’ employed. Patients were instructed to take from two to four tablets three times daily, depending upon the severity of the disease, the physical size of the patients, and the whim of the clinician. The>- WVI’Cfurther instructed to take the tablets for at least 2 days and, in many instanecs, for 3 days. The tablets were not ingested whole but were chcwc~d and swallowed with a mouthful of milk. Investigation

Our only concern was whether or not there was actual improvement in the lesions, and patients were asked either to ret,urn to the office or to report b-v telephone regarding success of treatment. No check was made as to the accurac.v of the patients’ findings; nor wcrc double-blind or other statistical research tools employed. Patients were frankly t,oJd that the material was being administered in the hope that it, would clear up or at least lessen the discomfort caused by their oral lesions. For purposes of rrcord, it was decided that no patients whose lesions were more than 3 days old would ho treated with the preparation. It was also decided that unless the patient reported definite and unequivocal relief of pain within 48 hours the result would be considered negative. COMMENTS

In an extremely high percentage of cases, the soreness of the ulcerations was relieved within 48 hours after the administration of Lactinex tablets. In a large number of cases the lesions themselves disappeared or became significantly *Supplied by Hymen,

Westcott

& Dunning, Tnc., Baltimore, Md.

Lactobacillus

Volume 20 Number 5

593

tablets for oral ulceration

Table I Relief

pain

No. of patients

Male

Female

40

18

22

of

within 48 h0zll.S

38

Dtiappearan&e of

lesions within 5 day8 0f treatment

36

Positive results 38

Negative results 2

smaller. No definite percentage can be affixed to this latter finding, however, not return to the office for examination but simply since many patients reported their subjective findings by telephone. Whether psychic factors were involved in the results is not within the purview of this article. Certainly, the identity and purpose of the drug used were not withheld from the patients. In any event, it appeared that Lactinex tablets brought about a statistically notable number of remissions from attacks of herpetic a.nd aphthous ulcerations. It is also worth noting that, a large number of sufferers returned voluntarily to the ofice and asked for further supplies of the material for use in subsequent herpetic outbreaks. No records, however, were kept concerning this form of therapy.

did

CONCLUSION On the basis of clinical observations and results admittedly arrived at without the use of controls or double-blind techniques, we believe that a viable mixture of L. a.cid.ophih and L. bu.lga.ricus in tablet form may be of value in treating the pain and ulceration of herpetic and aphthous stomatitis. The rationale for the pharmacologic behavior of these preparations must be considered virtually empirical. REFERENCES

1. Barile, M. F., Graykowski, E. A., Driscoll, E. J., and Riggs, D. B.: L Form of Bacteria Isolated From Recurrent Aphthous Stomatitis Lesions, ORAL SURG., ORAL MED. & ORAL PATH. 16: 1395-1402, 1963. %. Dodd, K., Johnston, L. M., and Buddingh, G. J.: Herpetic Stomatitis, J. Pediat. 12: 95-102, 1938. 3. Smith, J. F.: The Clinical Use of Triamcinolone Acetonide in the Treatment of Herpes Simplex of the Oral Mucous Membranes, ORAL SCRG., ORAL MED. & ORAL PATH. 16: 150. 153, 1963. 866 West Thirty-Sixth

St.