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Higher Risk of Gastric Helicobacter pylori Infection in Patients with Periodontitis: A Nationwide Population-Based Retrospective Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111678. [PMID: 34770192 PMCID: PMC8583388 DOI: 10.3390/ijerph182111678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
Periodontitis is the most prevalent chronic inflammatory oral disease that is characterized by tooth loss and is commonly associated with several systemic inflammatory diseases. Some epidemiological studies suggest that those suffering from periodontitis might be at a greater risk of developing gastric Helicobacter pylori (Hp) infection; however, evidence that showing the association between periodontitis and the risk of gastric Hp infection is less clear. We conducted a large-scale, population-based study in Taiwan with a 13-year follow-up period to evaluate the risk of gastric Hp in a periodontitis patient cohort. To conduct this study, we used epidemiological data from the Taiwanese Longitudinal National Health Insurance Research Database (NHIRD) from 2000 to 2013. We selected 134,474 participants (64,868 males and 69,606 females with a minimum age of 20 years), with and without periodontitis, and matched patient cohort groups for age, sex, index year, and co-morbidities. The Cox proportional hazards regression model was used to examine the risk of gastric Hp infection in patients with periodontitis. Patients with periodontitis exhibited a higher risk of developing gastric Hp infection compared to those individuals/groups without periodontitis (1.35 vs. 0.87 per 1000 person-years, adjusted the hazards ratio (aHR 1.52), and 95% confidence intervals (CIs) 1.38–1.67, p < 0.001). The risk of gastric Hp infection persisted even after stratifying by age (aHR = 1.96 (1.79–2.13) for 50–64 years and 1.70 (1.49–1.94) for ≥65 years), gender (aHR = 1.20 (1.11–1.29) for men), and presence of comorbidities of hypertension (aHR = 1.24 (1.11–1.38)), hyperlipidemia (aHR = 1.28 (1.14–1.42)), COPD (aHR = 1.45 (1.31–1.61)), CLD (aHR = 1.62 (1.47–1.77)) and CKD (aHR = 1.44 (1.04–1.99)). Overall, our findings showed that periodontitis patients have a greater risk for gastric Hp than individuals without periodontitis. Clinicians should perform regular good oral hygiene practices, along with newer treatments, for patients with periodontitis, especially those at higher risk of gastric Hp infection.
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Dentists Are at a Higher Risk for Oral Helicobacter pylori Infection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3945189. [PMID: 32695813 PMCID: PMC7361889 DOI: 10.1155/2020/3945189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/06/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023]
Abstract
Oral cavity has been taken as one of the major reservoirs for Helicobacter pylori, the bacteria responsible for gastric infection and cancers. Dentists are frequently exposed to saliva; thus, theoretically, they are at a higher risk for oral H. pylori infection. In the present study, to test this hypothesis and to find out the potential factors associated with the increased risk, a cross-sectional study was carried out on a large scale of dentists (N = 90) and nondentist controls (N = 110). By using nested polymerase chain reaction to amplify a specific DNA fragment of H. pylori, we found 7.27% of saliva samples from the nondentist group and 16.67% of saliva samples from the dentist group were oral H. pylori positive, and the difference between groups was statistically significant (χ2 = 4.292, p = 0.038). Importantly, however, after stratifying enrolled subjects with factors which might interfere with the comparison of H. pylori detection rate between groups, we still observed a higher H. pylori frequency in the dentists than that in the controls in subgroups, including those with good individual hygiene, healthy lifestyle, and physical condition, as well as those living with families to be gastric disease free and not sharing meals with H. pylori-positive persons, respectively. Moreover, the frequency of clinical practice per week of the investigated dentists was closely associated with an oral H. pylori infection risk. Our data indicates that dentists are at a higher risk for H. pylori infection, and intensive attention needs to be paid on this issue.
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Abu-Lubad M, Alzoubi H, Jarajreh D, Sawalqa AA, Bruggemann H, Albataineh E, Aqel A, Al-Zeer M. Analysis of Helicobacter pylori Genotypes Amongst Jordanians' Dental Plaque Samples. Gastroenterology Res 2018; 11:46-51. [PMID: 29511406 PMCID: PMC5827902 DOI: 10.14740/gr947w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) infection has been associated with gastritis, gastric ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer. The prevalence of H. pylori virulence genes have been studied in different populations and from different sources of samples but their prevalence has not been studied in dental plaque in Jordanian people; therefore, the aim of this study was to determine the genotypes of H. pylori isolated from dental plaque samples. Methods Dental plaque samples were collected from 60 Jordanian volunteers. The genotypes of H. pylori virulence genes including the cytotoxin-associated gene A (cagA) and the vacuolating toxin (vacA) were determined using polymerase chain reaction (PCR). Results The cagA gene was detected in 14 (23.3%) samples, while vacA was detected in all volunteers enrolled in this study (100%). The most prevalent vacA alleles were m2 and s1 in 54 (90%) and 55 (91.7%) of volunteers, respectively. Compared to the other combinations including the most virulent vacA genotype s1/m1 which was detected in 11 (18.2%) of volunteers, the most prevalent vacA allelic combinations were s1/m2 and s2/m2 in 56 (93.3%) and 27 (45%) of volunteers, respectively. Conclusions These results indicate a significant carriage of virulent H. pylori strains among Jordanian people in their dental plaques, which increases the possible transmission of these strains among them. In addition, the studying of the genotypic pattern of H. pylori virulence genes in the dental plaque could represent an essential tool for infection prevention and predicting the severity and prognosis of H. pylori gastric infection.
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Affiliation(s)
- Mohammad Abu-Lubad
- Department of Medical Microbiology and Immunology, Mutah University Faculty of Medicine, Karak, Jordan
| | - Hamed Alzoubi
- Department of Medical Microbiology and Immunology, Mutah University Faculty of Medicine, Karak, Jordan
| | - Dua'a Jarajreh
- Department of Medical Microbiology and Immunology, Mutah University Faculty of Medicine, Karak, Jordan
| | - Alaa Al Sawalqa
- Royal Medical Services, Amman, Jordan.,Department of Dentistry, King Hussein Medical Center, Amman, Jordan
| | | | - Eman Albataineh
- Department of Medical Microbiology and Immunology, Mutah University Faculty of Medicine, Karak, Jordan
| | - Amin Aqel
- Department of Medical Microbiology and Immunology, Mutah University Faculty of Medicine, Karak, Jordan
| | - Munir Al-Zeer
- Department of Molecular Biology, Max Planck Institute of Infection Biology, Berlin, Germany
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Yee JKC. Are the view of Helicobacter pylori colonized in the oral cavity an illusion? Exp Mol Med 2017; 49:e397. [PMID: 29170474 PMCID: PMC5704198 DOI: 10.1038/emm.2017.225] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 02/06/2023] Open
Abstract
Urea breath test (UBT), as a leading preferred non-invasive diagnostic technology, but may not be able to detect oral H. pylori. With negative results of UBT, the patient may have an oral infection. On the basis of the fact of success, eradication rate may increase by 21% in the 95% Cl range after the elimination of oral H. pylori, the author believes oral H. pylori does exist and the oral cavity is the second colonized site aside its primary site of the stomach. H. pylori migrated out of Africa along with its human host circa 60 000 years ago; they are not lives in stomach only. In this review article, evidence established in recent years studies with use more appropriate technology had been listed and discussed. The author considers the oral cavity is a black hole for H. pylori infection that significant effective on gastroenterology and another medical field. The role of the oral cavity as the source of H. pylori infection is so controvert in past years. It seems like a human being having a second-time face to discover H. pylori in the history.
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Affiliation(s)
- J K C Yee
- Research Lab of Oral H pylori, Everett, WA, USA
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Lukeš P, Pavlík E, Potužníková B, Plzák J, Nártová E, Doseděl J, Katra R, Šterzl I, Betka J, Astl J. Comparison of Helicobacter Pylori Genotypes Obtained from the Oropharynx and Stomach of the Same Individuals – A Pilot Study. Prague Med Rep 2015; 113:231-9. [DOI: 10.14712/23362936.2015.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Helicobacter pylorihas been recently detected in the oral cavity and oropharynx. However, the role it plays in oral and oropharyngeal pathogenesis remains unclear. The virulence ofH. pyloristrains can be distinguished according to the virulence factors genes carried. Our research has been focused on realtime PCR analysis ofcagAandvacAgenes ofH. pyloristrains in tonsils and tonsillar squamous cell cancer and their comparison withH. pyloristrains obtained from the gastric mucosa of the same patients. Urea breath test (UBT) test was used to detect a gastricH. pyloriinfection in 20 patients with previously provenH. pyloriin the oropharynx. Genotyping ofH. pyloriin gastric biopsies was performed in patients with positive gastric infection. Out of 20 patients positive for oropharyngealH. pylori, 8 were positive for concurrent gastricH. pyloriinfection. In 6 of them gastric biopsies were obtained. Comparison of oropharyngeal and stomachH. pylorigenotypes showed important differences. Four of 6 patients had differentH. pyloristrains in the oropharynx and stomach. The differences were found incagAgene as well as invacAgene. The finding of oral presence ofH. pyloriwithout concurrent stomach infection was confirmed using UBT. The results show that more than oneH. pyloristrain can be present in oropharynx and stomach in the same patient. The oropharyngeal infection seems to be independent to the gastric infection.
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Genetic variation of Helicobacter pylori in the oral cavity and stomach detected using thymine adenine cloning in children with chronic gastritis. Pediatr Infect Dis J 2014; 33:e1-6. [PMID: 23989107 DOI: 10.1097/inf.0000000000000017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the DNA sequence variations of Helicobacter pylori in the oral cavities and stomachs of children with chronic gastritis. METHODS Dental plaques and gargle on 235 patients were obtained before gastroscopy. Gastric H. pylori infection was diagnosed using rapid urease test or Giemsa staining. H. pylori 16S rDNA and CagA gene were analyzed using PCR methods. Thymine adenine cloning-based sequencing was performed in patients with CagA gene positive from oral cavities. The sequence alignments and V1 variable region were evaluated by comparison with the sequence of the standard H. pylori 26695 strain. RESULTS Totally, 46 out of the 235 patients were positive for gastric H. pylori infection. Of the 46 patients, 26 cases had amplified H. pylori 16S rDNA in both oral (plaque and gargle) and gastric samples. Of the 26 cases, 12 patients (46.1%) were positive for the H. pylori CagA gene in the oral samples, which was significantly lower than that in the gastric mucosa (80.8%; P = 0.010). The homology of the complete sequence alignment ranged from 74.0% to 92.1% in the oral and gastric samples. The V1 region alleles (positions 75-99) had 7-22 polymorphisms (homology from 12.0% to 72.0%) in 11 patients between the oral and gastric samples, but had 100% homology in 1 patient. CONCLUSIONS Our study found that distinct H. pylori strains exist in the oral cavities of children, but we would not support the hypothesis that H. pylori in the oral cavities is an important reservoir of gastric H. pylori infections in children.
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Yonezawa H, Osaki T, Hanawa T, Kurata S, Zaman C, Woo TDH, Takahashi M, Matsubara S, Kawakami H, Ochiai K, Kamiya S. Destructive effects of butyrate on the cell envelope of Helicobacter pylori. J Med Microbiol 2011; 61:582-589. [PMID: 22194341 DOI: 10.1099/jmm.0.039040-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Helicobacter pylori can be found in the oral cavity and is mostly detected by the use of PCR techniques. Growth of H. pylori is influenced by various factors in the mouth, such as the oral microflora, saliva and other antimicrobial substances, all of which make colonization of the oral cavity by H. pylori difficult. In the present study, we analysed the effect of the cell supernatant of a representative periodontal bacterium Porphyromonas gingivalis on H. pylori and found that the cell supernatant destroyed the H. pylori cell envelope. As P. gingivalis produces butyric acid, we focused our research on the effects of butyrate and found that it significantly inhibited the growth of H. pylori. H. pylori cytoplasmic proteins and DNA were detected in the extracellular environment after treatment with butyrate, suggesting that the integrity of the cell envelope was compromised and indicating that butyrate has a bactericidal effect on H. pylori. In addition, levels of extracellular H. pylori DNA increased following treatment with the cell supernatant of butyric acid-producing bacteria, indicating that the cell supernatant also has a bactericidal effect and that this may be due to its butyric acid content. In conclusion, butyric acid-producing bacteria may play a role in affecting H. pylori colonization of the oral cavity.
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Affiliation(s)
- Hideo Yonezawa
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Takako Osaki
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Tomoko Hanawa
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Satoshi Kurata
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Cynthia Zaman
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Timothy Derk Hoong Woo
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Motomichi Takahashi
- Miyarisan Pharmaceutical Co. Ltd, Tokyo, Japan
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Sachie Matsubara
- Laboratory for Electron Microscopy, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Hayato Kawakami
- Department of Anatomy, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kuniyasu Ochiai
- Department of Bacteriology, Nihon University School of Dentistry, Tokyo 101-8310, Japan
| | - Shigeru Kamiya
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo 181-8611, Japan
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Assumpção MB, Martins LC, Melo Barbosa HP, Barile KADS, Almeida SSD, Assumpção PP, Corvelo TCDO. Helicobacter pylori in dental plaque and stomach of patients from Northern Brazil. World J Gastroenterol 2010; 16:3033-9. [PMID: 20572307 PMCID: PMC2890944 DOI: 10.3748/wjg.v16.i24.3033] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish whether virulence factor genes vacA and cagA are present in Helicobacter pylori (H. pylori) retrieved from gastric mucosa and dental plaque in patients with dyspepsia.
METHODS: Cumulative dental plaque specimens and gastric biopsies were submitted to histological examination, rapid urease test and polymerase chain reaction (PCR) assays to detect the presence of cagA and vacA polymorphisms.
RESULTS: Detection of H. pylori from dental plaque and gastric biopsy samples was greater by PCR compared to histological examination and the rapid urease test. DNA from H. pylori was detected in 96% of gastric mucosa samples and in 72% of dental plaque samples. Sixty-three (89%) of 71 dental plaque samples that were H. pylori-positive also exhibited identical vacA and cagA genotypes in gastric mucosa. The most common genotype was vacAs1bm1 and cagA positive, either in dental plaque or gastric mucosa. These virulent H. pylori isolates were involved in the severity of clinical outcome.
CONCLUSION: These pathogenic strains were found simultaneously in dental plaque and gastric mucosa, which suggests that gastric infection is correlated with the presence of H. pylori in the mouth.
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Liu Y, Yue H, Li A, Wang J, Jiang B, Zhang Y, Bai Y. An Epidemiologic Study on the Correlation Between Oral Helicobacter pylori and Gastric H. pylori. Curr Microbiol 2009; 58:449-53. [DOI: 10.1007/s00284-008-9341-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 02/08/2023]
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Sudhakar U, Anusuya CN, Ramakrishnan T, Vijayalakshmi R. Isolation of Helicobacter pylori from dental plaque: A microbiological study. J Indian Soc Periodontol 2008; 12:67-72. [PMID: 20142948 PMCID: PMC2813563 DOI: 10.4103/0972-124x.44098] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 11/04/2008] [Indexed: 12/13/2022] Open
Abstract
AIM The aim of our study was to isolate H. pylori from dental plaque in gastric and duodenal ulcer patients and compare it with dental plaque of healthy subjects. MATERIALS AND METHODS Fifty patients in the age range of 25-50 years who were endoscopically proven cases of duodenal and gastric ulcer were chosen. H. pylorus was isolated from the dental plaque of these patients using culture method and rapid urease test (RUT). It was compared with the dental plaque from control group (25 students). The specificity and sensitivity of RUT was compared with culture method. The oral hygiene index (OHI) score and plaque index were assessed. RESULTS Ten percent positivity was observed in the study group by culture. Though RUT showed 70% positive isolation it is neither a specific test nor a conclusive test as compared to culture. The result correlates with oral hygiene in study population. CONCLUSION Further, more studies are needed to compare RUT and culture, with serology and polymerase chain reactions. The ability to detect H. pylori from dental plaque using these methods offer the potential for the noninvasive test for infection and would aid in support of oral transmission of H. pylori.
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Affiliation(s)
- Uma Sudhakar
- Department of Periodontics, Meenakshi Ammal Dental College, Maher University, Chennai, Tamilanadu, India
| | - C. N. Anusuya
- Department of Periodontics, Meenakshi Ammal Dental College, Maher University, Chennai, Tamilanadu, India
| | - T. Ramakrishnan
- Department of Periodontics, Meenakshi Ammal Dental College, Maher University, Chennai, Tamilanadu, India
| | - R. Vijayalakshmi
- Department of Periodontics, Meenakshi Ammal Dental College, Maher University, Chennai, Tamilanadu, India
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Azevedo NF, Guimarães N, Figueiredo C, Keevil CW, Vieira MJ. A new model for the transmission of Helicobacter pylori: role of environmental reservoirs as gene pools to increase strain diversity. Crit Rev Microbiol 2007; 33:157-69. [PMID: 17653985 DOI: 10.1080/10408410701451922] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Twenty-five years after the first successful cultivation and isolation of Helicobacter pylori, the scientific community is still struggling to understand the way(s) this bacterium is transmitted among the human population. Here, both epidemiologic and microbiologic evidence addressing this matter is reviewed and explored to conclude that most H. pylori successful colonizations are derived from direct person-to-person contact and that even though exposure of humans to H. pylori from environmental sources is a very common event, in most occasions the host is able to fight off infection. In addition, under a new model developed here, we propose that the near elimination of environmental reservoirs is the main responsible for the lower prevalence observed in the more industrialized countries by acting on two levels: by decreasing the number of direct infections and by diminishing the number of intraspecies recombination events for producing strain variation within H. pylori.
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Affiliation(s)
- N F Azevedo
- Institute for Biotechnology and Bioengineering, Centre for Biological Engineering, Universidade do Minho, Braga, Portugal.
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Gebara ECE, Faria CM, Pannuti C, Chehter L, Mayer MPA, Lima LAPA. Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy. J Clin Periodontol 2006; 33:329-33. [PMID: 16634953 DOI: 10.1111/j.1600-051x.2006.00915.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The present study aimed to evaluate if the oral cavity of chronic periodontitis patients can harbor Helicobacter pylori after systemic eradication therapy. MATERIALS AND METHODS Samples of 30 patients (15 with gingivitis and 15 with chronic periodontitis) positive for H. pylori in the stomach were evaluated. Samples were collected 3 months after triple systemic antibiotic therapy from saliva, microbiota from the dorsum of the tongue, supra- and sub-gingival plaque as well as gastric biopsies. DNA of each sample was extracted by the boiling method and used as a template in polymerase chain reaction with the primers JW22/23. RESULTS Eighteen patients (60%) harboured H. pylori in their mouths. Five patients (16.6%) were positive in saliva, two (6.6%) on the dorsum of the tongue, nine (30%) in supra-gingival plaque, 14 (46.6%) in sub-gingival plaque and three (10%) in the stomach. There was no statistically significant difference between study groups. CONCLUSION Eradication of H. pylori after therapy was more effective for the stomach than for the mouth (p<0.001). Mouths of patients with gingivitis or with chronic periodontitis, who are positive for H. pylori in their stomachs, may be considered as reservoirs of these bacteria.
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Affiliation(s)
- E C E Gebara
- Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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Olivier BJ, Bond RP, van Zyl WB, Delport M, Slavik T, Ziady C, Terhaar Sive Droste JS, Lastovica A, van der Merwe SW. Absence of Helicobacter pylori within the oral cavities of members of a healthy South African community. J Clin Microbiol 2006; 44:635-6. [PMID: 16455932 PMCID: PMC1392704 DOI: 10.1128/jcm.44.2.635-636.2006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 11/11/2005] [Accepted: 12/06/2005] [Indexed: 02/08/2023] Open
Abstract
Our study aimed to evaluate the oral cavity as a reservoir from where Helicobacter pylori may be transmitted. Histology and PCR amplification were performed. Eighty-four percent of the stomach biopsies tested positive; however, H. pylori was not detected in dental samples, indicating the absence of H. pylori within the oral cavity.
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Affiliation(s)
- Brenda J Olivier
- Department of Internal. Medicine and Gastroenterology, University of Pretoria, P.O. Box 1649, Faerie Glen, Pretoria, South Africa
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Dowsett SA, Kowolik MJ. Oral Helicobacter pylori: can we stomach it? CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:226-33. [PMID: 12799325 DOI: 10.1177/154411130301400307] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Helicobacter pylori infection is one of the most common in man. The bacterium primarily resides in the human stomach, where it plays a significant role in gastric disease. If the spread of H. pylori is to be prevented, an understanding of the transmission process is essential. The oral cavity has been proposed as a reservoir for gastric H. pylori, which has been detected by culture and PCR in both dental plaque and saliva. This review will discuss the evidence for the role of the oral cavity in the transmission of gastric H. pylori. Moreover, the difficulties encountered in addressing this topic, possible directions for future research, and the implications for the dental profession are discussed.
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Affiliation(s)
- S A Dowsett
- Indiana University School of Dentistry, Department of Periodontics and Allied Dental Programs, 1121 West Michigan Street, Indianapolis, IN 46202, USA
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Luman W, Zhao Y, Ng HS, Ling KL. Helicobacter pylori infection is unlikely to be transmitted between partners: evidence from genotypic study in partners of infected patients. Eur J Gastroenterol Hepatol 2002; 14:521-8. [PMID: 11984150 DOI: 10.1097/00042737-200205000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION We postulated that the oro-oral route of transmission between spouses could be an important route of transmission of Helicobacter pylori. AIMS To estimate the prevalence of different genotypes of H. pylori as distinguished by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in our local population, and to compare the genotypes of H. pylori isolated from patients and their spouses. METHODS Gastric biopsies were obtained from 183 dyspeptic patients during endoscopy. PCR for H. pylori was carried out using the uceC gene for amplification, and PCR products were digested further for RFLP analysis using the enzyme MboI. Spouses of H. pylori-positive index cases were screened for the infection using serological testing; if found to be positive serologically, endoscopy and gastric biopsies were performed for genotypic study of the micro-organism. For couples with indistinguishable H. pylori strain on RFLP with restriction endonuclease MboI, the process of RFLP was repeated with digestion of the PCR products using restriction endonuclease HhaI. RESULTS We established our PCR technique to be 89.5% sensitive and 95.5% specific. Eighty-nine subjects were found to be H. pylori positive by PCR, and eight different genotypic strains were found according to our RFLP analysis. Two genotypes accounted for 80.8% of the cases. Sixteen of 31 spouses tested serologically for H. pylori were positive. All 13 spouses who agreed to undergo endoscopy were PCR positive for H. pylori. Five couples shared indistinguishable H. pylori genotypes, but this strain was also the commonest genotype in our local population, as based on RFLP with restriction endonuclease MboI. Further RFLP on the PCR products on these five couples using restriction endonucleases HhaI showed that the H. pylori isolated from these five couples were of different strains. CONCLUSION The oro-oral route of transmission between spouses is unlikely to be an important mode for H. pylori infection.
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Affiliation(s)
- W Luman
- Department of Gastroenterology, Singapore General Hospital, Singapore
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Abstract
BACKGROUND About half of the world population is infected with H. pylori, but the transmission and the source of this infection are still unclear. Recently, dental plaque (DP) and saliva have been implicated as possible sources of H. pylori infection. This study was done to investigate the detection rates of H. pylori in the DP and saliva by use of PCR depending on H. pylori infection state of gastric mucosa. METHODS In 46 subjects, gastric H. pylori colonization was evaluated with CLO test, microscopy of Gram stained mucosal smear, culture and histology after modified Giemsa staining in the antrum and body, respectively. A patient was regarded as H. pylori positive if one or more of the four aforementioned test methods demonstrated H. pylori colonization of the gastric mucosa. For detection of H. pylori in the DP and saliva, PCR assay was done with ET4-U and ET4-L primers. To estimate the sensitivity and specificity of this PCR, H. pylori positivity was evaluated in the antrum and body, separately. RESULTS The sensitivity of mucosal PCR was 50.0% (27/54) and the specificity 86.8% (33/38). When a subject was regarded as H. pyloi positive, if either antrum or body mucosal H. pylori was is positive, the positive rate of mucosal PCR was 62.1% (18 subjects) in the 29 H. pylori-positive and 17.6% (3 subjects) in the 17 H. pylori-negative subjects. DP PCR was positive in 2 of 29 H. pylori-positive subjects (6.9%) and none in the 17 H. pylori-negative (0%). Saliva PCR was positive in 4 of 14 H. pylori-positive subjects (28.6%) and none of 6 H. pylori-negative (0%). CONCLUSION The detection rates of H. pylori in DP and saliva by PCR were rather low, 6.9% and 28.6%, respectively, and these rates might have been underestimated by low sensitivity of the PCR method used in this study. However, the results that H. pylori was found in the DP and saliva suggest that the oral cavity can perform a role as a reservoir of H. pylori in Korea.
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Affiliation(s)
- N Kim
- Department of Internal Medicine, Kangnam General Hospital, Public Corporation, Seoul, Korea
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18
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Slater E, Owen RJ, Williams M, Pounder RE. Conservation of the cag pathogenicity island of Helicobacter pylori: associations with vacuolating cytotoxin allele and IS605 diversity. Gastroenterology 1999; 117:1308-15. [PMID: 10579972 DOI: 10.1016/s0016-5085(99)70281-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Specific regions of the cag pathogenicity island (PAI) believed to enhance the virulence of Helicobacter pylori, as well as vacuolating cytotoxin gene alleles and IS605 inserts, were investigated to define diversity within infecting strain populations from patients with peptic ulcer disease and from healthy individuals. METHODS The H. pylori studied comprised 67 isolates from 26 subjects and 14 reference strains. Specific polymerase chain reaction assays were used to test for cagA and picB in the cagI region, the virD4 homologue in the cagII region, IS605 in the genome and in the cag PAI, the "empty site" indicating absence of the cag PAI, and different vacA gene alleles. RESULTS Most (89%) subjects were infected by H. pylori with a contiguous cag PAI. No intermediate forms were found. IS605 was not detected within the cag PAI of any strain but was present elsewhere in the genomes of strains from 62% of subjects. Twenty individuals were infected with genotypically conserved populations of H. pylori. Six subjects had mixed infections, and in 3 of these cag(+)/cag(-) variants were present. CONCLUSIONS The cag PAI-positive H. pylori was a feature of most infected individuals, irrespective of severity of associated disease. Combined genotyping showed that 8 individuals (31%) had mixed infections, which suggests that strain population structure may be an additional contributing factor in disease development.
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Affiliation(s)
- E Slater
- Laboratory of Enteric Pathogens, Central Public Health Laboratory, London, England
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19
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Qureshi H, Ahmed W, Arain G, Syed S, Mehdi I, Alam SE. Correlation of histology, CLO, dental plaque, and saliva in patients undergoing upper GI endoscopy. Am J Gastroenterol 1999; 94:861-2. [PMID: 10086692 DOI: 10.1111/j.1572-0241.1999.0861a.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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21
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Andersen RN, Ganeshkumar N, Kolenbrander PE. Helicobacter pylori adheres selectively to Fusobacterium spp. ORAL MICROBIOLOGY AND IMMUNOLOGY 1998; 13:51-4. [PMID: 9573823 DOI: 10.1111/j.1399-302x.1998.tb00751.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Helicobacter pylori strains ATCC 43504 and ATCC 43629 were tested for their ability to coaggregate with 79 strains of bacteria representing 16 genera. All except two of the strains were of human origin, and most of the strains were isolated from the oral cavity. The helicobacters failed to coaggregate with all strains except the fusobacteria. Several coaggregations were partially or completely inhibited by lactose. Strong coaggregation was seen with each of four subspecies of Fusobacterium nucleatum and with Fusobacterium periodonticum ATCC 33693, all of human dental plaque origin. In contrast, the helicobacters failed to coaggregate with non-plaque isolates, Fusobacterium mortiferum ATCC 25557 and Fusobacterium ulcerans ATCC 49185. Heat treatment of the fusobacteria inactivated their ability to coaggregate, whereas heating of the Helicobacter partners had no effect, suggesting the presence of an adhesin on the fusobacteria and a corresponding receptor on the helicobacters. The potential ability of H. pylori to colonize the oral cavity by adhering selectively to the ubiquitous fusobacteria gives credence to the possibility that dental plaque may serve as a reservoir for this pathogen outside of the stomach.
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Affiliation(s)
- R N Andersen
- Oral Infection and Immunity Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland 20892-4350, USA
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22
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Jordan RC, Diss TC, Millson C, Wilson M, Speight PM. Absence of Helicobacter pylori DNA in salivary lymphoepithelial lesions. J Oral Pathol Med 1997; 26:454-7. [PMID: 9416576 DOI: 10.1111/j.1600-0714.1997.tb00015.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Helicobacter pylori is a common cause of chronic gastritis and has been implicated as the main agent responsible for the development of lymphomas of mucosa associated lymphoid tissue (MALT) in the stomach. An uncommon cause of salivary gland swelling is salivary lymphoepithelial lesion (SLEL), which shows histological features of acquired MALT and is associated with the development of MALT-type lymphomas. Since H. pylori has been identified in the oral cavity, we hypothesised that this organism might act as a potential antigen for the development of MALT in salivary glands. Routinely processed biopsies of 20 SLEL were screened for H. pylori DNA using a sensitive two-stage PCR technique to amplify the 16S ribosomal RNA gene. Immunoglobulin heavy chain gene monoclonality was determined by amplifying the VDJ gene using a nested PCR technique. All SLEL had histological features of organised MALT and 14 cases showed Ig heavy chain gene monoclonality consistent with MALT lymphoma. None of the SLEL contained H. pylori DNA. In contrast to the putative role of H. pylori as an antigenic stimulus in gastric MALT lymphomas, it appears not to play a role locally in the development of MALT or MALT lymphomas of the salivary gland.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Bacterial/immunology
- Cadherins/genetics
- DNA Nucleotidyltransferases/genetics
- DNA, Bacterial/analysis
- Female
- Gastritis/microbiology
- Gene Amplification
- Helicobacter Infections/diagnosis
- Helicobacter pylori/genetics
- Helicobacter pylori/immunology
- Helicobacter pylori/isolation & purification
- Humans
- Immunoglobulin Heavy Chains/genetics
- Lymphatic Diseases/microbiology
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- RNA, Ribosomal, 16S/genetics
- Salivary Gland Diseases/microbiology
- Salivary Gland Neoplasms/immunology
- Salivary Gland Neoplasms/microbiology
- Salivary Gland Neoplasms/pathology
- Stomach Neoplasms/microbiology
- VDJ Recombinases
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Affiliation(s)
- R C Jordan
- Department of Laboratory Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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23
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Peach HG, Pearce DC, Farish SJ. Helicobacter pylori infection in an Australian regional city: prevalence and risk factors. Med J Aust 1997; 167:310-3. [PMID: 9322776 DOI: 10.5694/j.1326-5377.1997.tb125076.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the prevalence of Helicobacter pylori infection and potential risk factors for infection in an adult Australian population. DESIGN Cross-sectional study. SETTING Ballarat, a major regional city in Victoria (population, 78,000; 92% bom in Australia), November 1994 to July 1995. PARTICIPANTS 217 adults randomly selected from the electoral roll. MAIN OUTCOME MEASURES H. pylori IgG antibody status by enzyme immunoassay; amount of dental plaque; sociodemographic and other potential risk factors; odds ratios for risk factors determined by logistic regression analysis. RESULTS Age-standardised prevalence of H. pylori infection was 30.6%. After adjustment for age, sex and socioeconomic index, positive H. pylori status was significantly associated with increasing number of tooth surfaces with a high plaque score (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7), increasing number of years in a job with public contact (OR, 1.7; 95% CI, 1.3-2.3), blood group B antigen (OR, 3.1; 95% CI, 1.1-9.1), and having lived in a household with more than six members during childhood (OR, 2.5; 95% CI, 1.1-5.5). Negative H. pylori status was significantly associated with increasing education, having ever lived on a farm, and having teeth scaled less than once a year. CONCLUSIONS H. pylori infection is common. Dental plaque may be a reservoir for H. pylori, which is probably transmitted by person-to-person contact, and blood group B antigen may predispose to infection. Community education about effective oral hygiene and adoption of good hygiene practices by those with regular public contact may be important to prevent acquisition and transmission of H. pylori.
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Affiliation(s)
- H G Peach
- Department of Public Health and Community Medicine, University of Melbourne, Ballarat Health Services Base Hospital, VIC.
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24
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Abstract
Helicobacter pylori is a microaerophilic, motile bacterium, especially adapted to life in the human stomach. The presence of H. pylori in the stomach is strongly associated with chronic gastritis and ulcer disease and is a risk factor for gastric cancers. The microorganism may be transmitted orally and has been detected in dental plaque, saliva, and feces, but the hypothesis that oral microflora may be a permanent reservoir of H. pylori is still controversial. A review of the literature suggests that the recovery of H. pylori in the mouth is probably intermittent, associated with gastroesophageal reflux but not with specific oral disease. Nonetheless, the PCR identification of oral H. pylori may become helpful, particularly in cases of gastritis or ulcer relapse after antimicrobial therapy. Eradication of oral H. pylori by local medication or periodontal procedures would rely on the precise identification of its ecological niche. Within family groups, prophylactic methods should be practiced to avoid oral carriage of H. pylori. The risk of iatrogenic transmission during dental care, however, is already circumscribed by standard professional hygiene procedures.
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Affiliation(s)
- I M Madinier
- Laboratoire de Pathobiologie Orale, Faculté de Chirurgie-Dentaire, Université de Nice, France
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25
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Affiliation(s)
- P Sahay
- Pontefract General Infirmary, UK
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26
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Cammarota G, Tursi A, Montalto M, Papa A, Veneto G, Bernardi S, Boari A, Colizzi V, Fedeli G, Gasbarrini G. Role of dental plaque in the transmission of Helicobacter pylori infection. J Clin Gastroenterol 1996; 22:174-7. [PMID: 8724252 DOI: 10.1097/00004836-199604000-00004] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
With regard to the role of dental plaque in the transmission of Helicobacter pylori infection, data from the literature vary greatly, owing to differences in sample collection and H. pylori-detecting techniques. Using the polymerase chain reaction (PCR), we have determined the incidence of H. pylori colonization in the dental plaque of 31 consecutive patients who underwent gastroscopy. The patients were divided into two groups on the basis of H. pylori infection, determined by Giemsa stain and the rapid urease test: group A made up of 21 H. pylori-positive patients and group B with 10 H. pylori-negative patients. Our PCR assay of dental plaque samples proved negative in all group A subjects but was positive in only one patient in group B. In our study, we found that H. pylori had a low prevalence (3.2%) in the oral cavity, with no significant relationship between gastric mucosa and dental plaque colonization. More comprehensive studies are needed to determine whether dental plaque is an important reservoir in the epidemiology of H. pylori-induced gastric disease.
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Affiliation(s)
- G Cammarota
- Department of Internal Medicine, Service of Gastroenterology, Catholic University of the Sacred Heart, Rome, Italy
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27
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Abstract
A gastroenterologist, treating a patient with H. pylori, must decide whether the unit of treatment is only the ill individual, or the family, perhaps including close contacts. If it is the family and close contacts, is it all family members and contacts, or are there some ages, relationships, or clinical characteristics that increase the risk of transmission to the patient after successful treatment of their infection? In preventing reinfection, the available data suggest: the natural infectious dose has not been determined infection may occur from oral or faecal shedding children are more infectious than adults socio-economic factors are important in any comparison of infection rates food and water seem unlikely vehicles in the developed world travel in the third world may increase risk of infection seropositivity in adults predominantly reflects exposure in childhood infection is frequently with more than one strain reinfections are not more frequent in families with other members infected reinfections are infrequent with strains different from the original strain reinfection might be more frequent in developing countries no need for all family members to be treated to reduce reinfection rates. In considering vaccine, the available data suggest: breast milk IgA can reduce infection rate antibodies induced by vaccine may reduce infection in animals late benefit of childhood vaccination in developed countries probable early benefit of childhood vaccination in developing countries vaccination of already infected adults would have cost-benefit.
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Affiliation(s)
- R A Feldman
- Department of Epidemiology and Medical Statistics, London Hospital Medical College at QMW, UK
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28
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Wahlfors J, Meurman JH, Toskala J, Korhonen A, Alakuijala P, Janatuinen E, Kärkkkäinen UM, Nuutinen P, Jänne J. Development of a rapid PCR method for identification of Helicobacter pylori in dental plaque and gastric biopsy specimens. Eur J Clin Microbiol Infect Dis 1995; 14:780-6. [PMID: 8536726 DOI: 10.1007/bf01690993] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A rapid and simple polymerase chain reaction (PCR) method was developed to detect Helicobacter pylori in gastric biopsy specimens and dental plaque samples. The primers were targeted to the 16S rRNA sequence of Helicobacter pylori strain ATCC 43504. The system was found to have a theoretical detection level of 0.5 to 5 Helicobacter pylori cells in a 5 microliters sample of dental plaque. In the absence of plaque, the detection level was even better: theoretically, 0.05 to 0.5 Helicobacter pylori cells were detected in water suspension. However, this appeared to be due to the presence of free bacterial DNA in the culture used for the sensitivity determination. Thus, the actual sensitivity of the system was found to be fewer than five Helicobacter pylori cells, irrespective of the type of sample used. The method was then used to analyse 29 dental plaque and gastric biopsy specimens collected from patients with a history of recurrent peptic ulcer disease. Fourteen stomach specimens were positive for Helicobacter pylori when tested with the PCR method, while the respective figures with culture, histological examination and the urease test were 11, 12 and 9. No positive dental plaque samples were observed.
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Affiliation(s)
- J Wahlfors
- Department of Biochemistry and Biotechnology, A.I. Virtanen Institute, Kuopio, Finland
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29
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Nguyen AM, el-Zaatari FA, Graham DY. Helicobacter pylori in the oral cavity. A critical review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:705-9. [PMID: 7621027 DOI: 10.1016/s1079-2104(05)80304-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Helicobacter pylori is now generally accepted as a key etiologic agent in peptic ulcer disease as well as in gastric cancer. Dental plaque has been implicated as a possible source of H. pylori by studies that used culture, biochemical, nucleic acid, and immunologic analyses. Variation in the sensitivities of detection by these different reported assays may reflect the methods used, technical difficulties, microbiota complexes, geographic distribution, and host response. The finding of H. pylori in dental plaque also suggested that dental workers may be at increased risk of acquiring H. pylori infection from occupational exposure. We review the available data concerning the presence of this important pathogen in the oral cavity and its potential to be acquired by dental workers. Knowledge of this organism's route of transmission may aid in the development of therapeutic procedures to stop its potential spread.
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Affiliation(s)
- A M Nguyen
- Department of Periodontics, University of Texas Health Science Center, Houston, USA
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30
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Lambert JR, Lin SK, Aranda-Michel J. Helicobacter pylori. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1995; 208:33-46. [PMID: 7777803 DOI: 10.3109/00365529509107760] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Helicobacter pylori is an important cause of chronic active gastritis and is strongly associated with peptic ulcer disease and gastric cancer. H. pylori colonizes the surface of the gastric epithelium with production of a number of factors, resulting in inflammation and an altered mucosa. H. pylori infection occurs world-wide and the mode of transmission most likely is from human to human via the fecal-oral and/or the oral-oral route. Treatment and, in the future, prevention of this infection may result in a marked diminution of upper gastrointestinal tract disease.
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Affiliation(s)
- J R Lambert
- Gastroenterology Research Group, Mornington Peninsula Hospital, Frankston, Victoria, Australia
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31
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Direct DNA fingerprinting of Helicobacter pylori in dental plaque by PCR amplification and restriction analysis of urease a gene sequences. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/0888-0786(94)90032-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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