Indian J Gastroenterol DOI 10.1007/s12664-015-0569-0


Association between periodontal disease and oral and gastric Helicobacter pylori infection S. Sujatha 1 & Umesh M. Jalihal 2 & Shivani Sharma 1

# Indian Society of Gastroenterology 2015

Helicobacter pylori (H. pylori) has been found in the oral cavity and stomach and its infection is one of the most frequent worldwide with a carriage rate been 20 % to 80 % among adults in the developed world and more than 90 % in the developing world [1]. It is a microaerophillic gramnegative spiral organism, designated as a type I carcinogen and an important gastrointestinal pathogen associated with gastritis, peptic ulcers and gastric carcinoma [2]. H. pylori can be isolated from the oral cavity, dental plaque, dorsum of the tongue and salivary secretions and its colonization is said to increase in the presence of periodontal disease. Gastric reinfection following successful treatment could be due to recolonization from the dental plaque. We aimed to determine if any association exists between periodontal disease and oral and gastric H. pylori infection within a predefined Indian population using a questionnaire, periodontal examination and rapid urease testing of dental plaque. This study was conducted by the Oral Medicine and Radiology Department at our institution. Forty patients between the age group of 45±15 years undergoing endoscopy guided biopsy for dyspeptic symptoms formed the study group. Periodontal examination was performed and plaque samples collected from all the subjects followed by endoscopy. Biopsy samples obtained by endoscopy and oral plaque

* Shivani Sharma [email protected] 1

Department of Oral Medicine, Diagnosis and Radiology, M S Ramaiah Dental College and Hospital, MSRIT Post, Bangalore 560 054, India


Department of Gastroenterology, M S Ramaiah Medical College and Hospital, MSRIT Post, Bangalore 560 054, India

samples were subjected to rapid urease test (RUT) using BPylo Dry^ test kit. Also, the endoscopy obtained gastric biopsy samples were sent for histopathological examination. Of the 40 patients, 32 had periodontitis and 8 had healthy periodontal condition. The reported results indicate that among the periodontitis group, endoscopy guided biopsy was positive for H. pylori in 28 (70 %) cases, whereas in the periodontally healthy group, only four cases were positive. Statistical analysis was done using Fisher’s exact test; p-value was 0.037 and there was a statistically significant association between periodontal disease and gastric H. pylori infection. Also, 26 out of 32 (81 %) periodontitis patients were positive for H. pylori in oral plaque samples using RUT and among the periodontally healthy group, only two subjects were positive for it. There was a statistically significant association between periodontal disease and oral plaque H. pylori (p= 0.005). It is found that H. pylori has the ability to coaggregate to Fusobacterium nucleatum and Fusobacterium periodonticum which are early and late oral colonizers among periodontitis patients, justifying the fact that dental plaque serves as a reservoir for this pathogen. Periodontal inflammation helps in colonization of this species in urease rich subgingival biofilm which serves as selective ecological niche for the urease-producing bacteria helping in recolonization and reinfection in gastric mucosa. The presence of this organism in plaque may be intermittent, perhaps occurring as the result of gastroesophageal reflux. Bacteriologic culture and histological staining of tissue are the conventional methods among the many invasive and non-invasive techniques used in diagnosis of H. pylori infections. We used RUT in our study for the detection of H. pylori as it is a simple, cheap and rapid diagnostic technique [3]. It has been reported that gastric H. pylori eradication rate is doubled if both antiH. pylori therapy and periodontal therapy are instituted

Indian J Gastroenterol

together rather than anti-H. pylori therapy alone [4]. This not only reduces the economic burden of the treatment but also lowers the risk of increasing the resistance of H. pylori to antibiotics [5]. Since it has been found that the primary extragastric reservoir for H. pylori is the oral cavity, both the dental plaque and the saliva could act as reservoirs and have implications on infection and reinfection. Hence, treatment modalities such as plaque control measures should be employed for the complete management of H. pylori-associated gastric disease. Because periodontal disease is associated with the increased colonization of H. pylori, its oral detection could be used as a possible biomarker and a primary diagnostic aid for detection of gastric infections.

References 1.


3. 4.


Chitsazi MT, Fattahi E, Farahani RMZ, Fattahi S. Helicobacter pylori in the dental plaque: is it of diagnostic value for gastric infection? Med Oral Pathol Oral Cir Bucal. 2006;11:E325–8. Gebara ECE, Pannuti C, Faria CM, Chehter L, Mayer MPA, Lima LAPA. Prevalence of Helicobacter pylori detected by polymerase chain reaction in the oral cavity of periodontitis patients. Oral Microbiol Immunol. 2004;19:277–80. Berry V, Sagar V. Rapid urease test to diagnose Helicobacter pylori infection. JK Sci. 2006;8:87–8. Al Sayed A, Anand PS, Kamath KP, Patil S, Preethanath RS, Anil S. Oral cavity as an extragastric reservoir of Helicobacter pylori. ISRN Gastroenterol. 2014;2014:261369. Song HY, Li Y. Can eradication rate of gastric Helicobacter pylori be improved by killing oral Helicobacter pylori? World J Gastroenterol. 2013;19:6645–50.

Association between periodontal disease and oral and gastric Helicobacter pylori infection.

Association between periodontal disease and oral and gastric Helicobacter pylori infection. - PDF Download Free
94KB Sizes 0 Downloads 21 Views