Lactic acid and lactoferrin in the treatment of recurrent aphthous stomatitis

Abstract Introduction Recurrent aphthous stomatitis (RAS) repeated inflammatory ulcers of the oral mucosa, although being noncontagious and self-limiting can produce symptoms adversely affect the patient’s quality of life. Owing to their healing supportive and immune modulator effects, lactic acid and lactoferrin are considered promising remedies that can be used to manage RAS. Aim To assess the effectiveness of 5% lactic acid mouth wash and systemically administered lactoferrin in the treatment of minor RAS and evaluate the benefits that can be gained when using both together. Patients and methods Thirty patients with early-onset RAS, aged between 20 and 50 years, were randomly divided into three groups (10 patients in each group). Group I was treated with 5% lactic acid mouthwash (5 ml, three times daily) for 3 months. Group II was treated with 100 mg of lactoferrin granules dissolved in ¼ glass of milk or water, twice daily, for 3 months. Group III received both lactic acid and lactoferrin treatments. The effects of the treatments and group comparisons were assessed clinically by calculating the recurrence rate at baseline, 1 month, and 3 months later; the severity of pain and lesion size on day 1 and day 5; the average duration of ulcer episodes; and final results. Immunologically, by determining the concentration of vascular endothelial growth factor at baseline, 1 month, and 3 months. Results There was a statistically significant reduction in lesion size and pain perception with group I, but no change in any of the other metrics. Even though the lesion size was reduced and all other metrics showed substantial changes, group II did not demonstrate a significant change in the degree of pain sensation. All clinical indicators showed a marked improvement in group III, which is in line with the improvements seen in the immunologic parameters. No statistically significant difference was seen between the three groups at base line measurements. At every follow-up time point: the group I and group III compared favorably with respect to reducing pain and decreasing lesion size, but there was no difference between the two groups (II, III) in terms of rate of recurrence, average ulcer duration, or immunologic parameters. Conclusion Lactic acid 5% mouth wash and lactoferrin are natural, safe, and effective remedies for management of RAS without any observed side effects.