Oral Mucositis Clinical Trial
Official title:
The Effect of Lactobacillus Brevis CD2 on Traumatic Oral Lesions Induced by Fixed Orthodontic Appliance: a Randomized Clinical Trial
Introduction: Traumatic oral lesions are common in the beginning of the orthodontic treatment, and pathogenic oral bacteria might be involved. We tested whether the probiotic Lactobacillus brevis CD2 (L brevis) is benefic in this condition. Methods: In a double-blind clinical trial, 20 patients were randomized to 21 days course of lozenges containing L brevis CD2 (4 billion colony-forming units after breakfast, lunch and dinner) or placebo, starting on the day of installation of the fixed orthodontic appliance. Main outcomes were days without oral lesions and oral pain score [ranging between 0 (no pain) and 10 (maximum)]. Oral health related quality of life was measured by OHIP-14 before and after treatments.
Study protocol After signing the informed consent form, the patients underwent an oral
examination and answered about clinical information, oral pain scale, and the OHIP-14
questionnaire. The pain scale was graded between 0 (no pain) and 10 (maximum), Likert
standard. There was also a drawing for the distribution of coded treatments, through a number
taken by the patient from a manila envelope. After the orthodontic appliance installation
session, each patient was instructed to use the coded treatment for the next 21 days, two
gums after breakfast, after lunch and after dinner, totalizing 12 billion UFC of L brevis or
placebo per day. The patient was provided with a diary to note the daily appearance of
lesions and their evolution during the 21-day period, as well as the occurrence of any new
symptoms (potential adverse effect), in addition to proof of the commitment assumed by the
use of the tablets. After 21 days, each patient was reexamined by the author of the study,
who collected the diaries and obtained information regarding the oral examination, oral pain
scale, data on adherence to treatment and self-completion of the OHIP-14.
Statistical analysis Quantitative data are described with mean and standard deviation (or
standard error of the mean) or median and range, while qualitative data are displayed with
absolute and relative frequencies. Student's t-test was used for comparison of quantitative
data between groups, Wilcoxon-Mann-Whitney (WMW) test being employed when the assumptions for
that test were not met. Exact chi-square and Fisher´s exact test (FET) were used for
categorical data. Treatment effect on OHIP-14 was analyzed using a Generalize Estimating
Equations (GEE) model with Poisson distribution and log link, the predictors being treatment,
time (beginning and end of treatment) and interaction treatment*time. The analyses were
performed with softwares GraphPrism version 4.0 and SPSS® (IBM SPSS statistics v18). Sample
size was estimated using WinPEPI v11.65. The P value indicative of significance was < 0.05.
Because the final outcome was prevention or mitigation (not maintenance or augmentation) of
undesirable symptoms, one-tailed tests were used for comparisons between groups respect to
days without oral lesions, oral pain and OHIP-14 scores.
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