The Association between Oral Hygiene and Gastric Pathology in Patients with Dyspepsia: a Cross-Sectional Study in Southeast Iran

Oral Hygiene With Neutral Electrolyzed Water and Systemic Therapy Increases Gastric Helicobacter pylori Eradication and Reduces Recurrence

OBJECTIVES

Helicobacter pylori gastric infection strongly correlates with gastric diseases such as chronic gastritis, functional dyspepsia, and complications such as peptic ulcers and gastric cancer. In developing countries, systemic therapies are not usually successful due to elevated antibiotic resistance. Additionally, oral H. pylori infection and periodontal disease correlate with gastric treatment failures. This study aimed to explore the effect of an integral therapy, comprising oral hygiene and concomitant systemic treatment, to increase the eradication of gastric infection and recurrences.

MATERIALS AND METHODS

A prospective, randomized, four-arm, parallel-group, open-label clinical trial was conducted to investigate the efficacy of integral therapy to eradicate gastric H. pylori infection and avoid recurrences in double-positive (real-time PCR oral and gastric infection) patients. Oral hygiene involved mouthwash with neutral electrolyzed water (NEW), with or without periodontal treatment. One hundred patients were equally distributed into four groups: NS, NS-PT, NEW, and NEW-PT. All patients had concomitant systemic therapy and additionally, the following oral treatments: mouthwash with normal saline (NS), periodontal treatment and mouthwash with normal saline (NS-PT), mouthwash with NEW (NEW), and periodontal treatment and mouthwash with NEW (NEW-PT). Gastric and oral infection and symptoms were evaluated one and four months after treatments.

RESULTS

Integral therapy with NEW-PT increased gastric eradication rates compared with NS or NS-PT (84%-96% vs. 20%-56%; p < 0.001). Even more, a protective effect of 81.2% (RR = 0.1877; 95% CI: 0.0658-0.5355; p = 0.0018) against recurrences and 76.6% (RR = 0.2439; 95% CI: 0.1380-0.4310; p < 0.001) against treatment failure (eradication of infection and associated symptoms) was observed in patients from the NEW and NEW-PT groups.

CONCLUSIONS

Implementation of oral hygiene and systemic treatment can increase the eradication of gastric infection, associated symptoms, and recurrences. NEW is recommended as an antiseptic mouthwash due to its efficacy and short- and long-term safety.

Possible Association of Periodontal Diseases With Helicobacter pylori Gastric Infection: A Systematic Review and Meta-Analysis

Some research has suggested that dental plaque and saliva could be reservoirs of Helicobacter pylori (H. pylori) and be capable of infecting or re-infecting the gastric mucosa after eradication, with certain studies showing a significant association between PD and gastric infection by this bacterium. An electronic search was performed in PubMed, EMBASE, and Web of Science databases with the terms “Helicobacter pylori AND periodontal diseases”; “Helicobacter pylori AND gingivitis”; “Helicobacter pylori AND chronic periodontitis”; “Helicobacter pylori AND periodontitis”; “Helicobacter pylori AND dental plaque”, to identify articles up to September 2021. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using RevMan 2020 (Cochane Collaboration) software. A total of 1,315 studies were identified and 12 were included, analyzing 226,086 patients with mean age between 10.5 and 63.4 years. The prevalence of H. pylori in the oral cavity ranged from 5.4 to 83.3%. A random-effects model was used to analyze the presence of H. pylori and subgroups were made according to the method of evaluation (PCR or RUT). Statistical significance was found in the overall analysis (p = 0.01). There is no clear evidence that H. pylori present in oral bacterial plaque causes gastric infection and vice versa.

Association among Helicobacter pylori Infection, Tooth Loss, and Heavy Medal Exposure in a Chinese Rural Population

Previous research suggests that heavy metals may be associated with increased susceptibility to Helicobacter pylori infection. This study investigated the effect of heavy metal exposure (Pb and Cd) on tooth loss and H. pylori infection in a Chinese rural population, who live near a mining and smelting area. Blood samples were collected from the study participants to estimate the lead (Pb) and cadmium (Cd) exposure levels. H. pylori infection was analyzed using the 14C-urea breath test, and the number of missing teeth (MT), filled teeth (FT), and missing or filled teeth (MFT) were counted by conducting a physical examination. Regression analysis was used to assess the difference between H. pylori-positive and -negative individuals in the MT, FT, and MFT groups, adjusting for confounders. The H. pylori infection prevalence was higher in individuals in the high Cd or high Pb groups than that in the low Cd or low Pb groups (p < 0.05). In addition, greater numbers of FT and MFT were observed in individuals in the high Pb group than those in the low Pb group (p < 0.05). We further found 8.7% (95% CI, 2.8−23.8%, p = 0.017) of the effect of the high BPb level on H. pylori infection risk could be statistically explained by FT using amediation analyses in adjusted models, and 6.8% (95% CI, 1.6−24.8%, p = 0.066) by MFT. Furthermore, FT and MFT were significantly associated with increased risk for H. pylori infection (odds ratio (OR) = 4.938, 95% confidence interval (CI): 1.125−21.671; OR = 3.602, 95% CI: 1.218−10.648, respectively). Pb and Cd exposure may be associated with tooth loss and increased susceptibility to H. pylori infection, and tooth loss may be an independent risk factor for H. pylori infection.

Determinants of Dental Health Problems Among Adult Patients at Dental Clinic, Debre Berhan Comprehensive Specialized Hospital, Ethiopia: Unmatched Case-Control Study

Purpose

This study was aimed to assess the determinants of dental health problems among adult patients at the dental clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

Methods

A case-control study was conducted to recruit a total of 267 adults (cases = 134, and controls = 133) who received oral health screening service in Debre Berhan Comprehensive Specialized Hospital, 2018. Data were collected by physical examination and pretested semi-structured questionnaire from March 1 to 31, 2018. Collected data were entered in EpiData 3.1 and analyzed by using SPSS version 20. Bivariable and multivariable logistic regressions were done via the forward stepwise method. Variables were declared statistically significant when p-value <0.05.

Results

Of the total study participants, 75 (55%) of cases and 62 (46.6%) of controls were males. The mean age (± SD) of cases was 36.2 (± 14.2) years and that of controls was 31.4 (± 10.3) years. The classification table revealed that the sensitivity of cases was 70.7%, and the specificity of controls was 74.8%. This study showed that 28 (20.89%) of cases and 6 (4.5%) of controls had confirmed gastritis (P < 0.05). Regarding dental health information, 78 (58.2%) of cases and 123 (92.5%) of controls perceived that they had received dental health information from different sources. Access to dental health information and tooth brushing practice reduced dental health problems (adjusted odds ratio (AOR) = 0.28; 95% CI: 0.12, 0.64; and AOR = 0.24; 95% CI: 0.13, 0.45), respectively, whereas study participants who had gastritis were at increased risk of developing dental health problems (AOR = 3.12; 95% CI: 1.14, 8.57).

Interpretation

Study participants who had adequate information on dental health had a reduced risk of developing dental health problems by 72% and participants who practiced tooth brushing were at reduced risk of developing dental health problems by 76%. However, individuals who had gastritis were 3 times more likely to develop dental health problems compared with their counterparts.

Conclusion

In summary, health information, tooth brushing practice, and gastritis infection were the determinants of dental health problems. Thus, health information dissemination on dental health particularly on how to prevent and control dental health problems is very critical. Moreover, strategies to combat gastritis integrated with life course principles should be strengthened to improve dental health.

Periodontitis and Helicobacter pylori Infection: Eradication and Periodontal Therapy Combination

Objectives  This study was aimed to assess (1) the prevalence of salivary and gastric Helicobacter pylori (HP) infection in patients with and without periodontitis, (2) the prevalence of HP infection in patients with periodontitis according to its clinical classification, (3) the effect of periodontitis treatment in patients with or without gastric HP infection, and (4) if gastric HP eradication in combination with periodontitis treatment influences periodontitis clinical outcome.

Materials and Methods  Thirty-three adults with periodontitis treated by quadrant scaling and root planning (QSRP). The simplified plaque index (PI), bleeding on probing index (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed pretreatment and 3 months of posttreatment. The patients were tested for oral and gastric HP. Gastric HP (+) patients received eradication therapy. A control group of 32 periodontically healthy volunteers was tested for oral and gastric HP. Saliva samples were evaluated by real-time polymerase chain reaction (rtPCR); gastric HP was detected by urea breath test (UBT).

Statistical Analysis  Normality of variables assessed by the Kolmogorov–Smirnov test, while the differences of pre- and post-treatment were analyzed by paired samples t -test. Differences between subgroups were compared by a Student’s t -test or a Mann–Whitney U -test. Comparisons of nominal variables were made by Pearson’s Chi-square test.

Results  No saliva samples were positive for HP. Gastric HP was detected in six patients with periodontitis and seven controls ( p > 0.05). HP infection affected patients with higher disease stages and grades. All HP (+) patients underwent successful eradication treatment. All clinical periodontitis indices improved following QSRP. HP (+) patients who received QSRP as adjunctive to eradication treatment showed improvement in BOP ( p < 0.001), PI ( p < 0.013), and CAL ( p < 0.004) compared with HP (−) patients who received QSRP alone.

Conclusion  Periodontitis was not associated with gastric HP infection. Saliva was not a gastric HP supply reservoir. Gastric HP infection was associated with advanced stages and grades of periodontitis. Although all periodontal clinical markers improved after QSRP, BOP, PI, and CAL, they were further improved when combined with eradication treatment. Periodontal evaluation and treatment combined with HP eradication are recommended in patients with HP gastric infection.

Relationship of delta over baseline with serum levels of gastrin 17, interleukin-32, and soluble interleukin 2 receptor and gastroscopic pathological changes in patients with chronic atrophic gastritis and Helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is a recognized causative factor of gastric cancer. The diagnosis and treatment of chronic atrophic gastritis (CAG) and H. pylori infection have always been the focus of clinical research.

AIM

To investigate the relationship of the delta over baseline (DOB) and serum gastrin 17 (G-17), interleukin-32 (IL-32), soluble interleukin 2 receptor (sIL-2R) levels and gastroscopic pathological changes in patients with CAG and H. pylori infection.

METHODS

A total of 224 CAG patients at the Physical Examination Center of Wenzhou Central Hospital from January 2017 to December 2019 were selected as the research subjects, including 124 patients with H. pylori infection as an observation group, and 100 patients without H. pylori infection as a control group. The clinical data, DOB, and serum levels of G-17, IL-32, and sIL-2R in the two groups were compared. Logistic regression analysis was used to identify the influencing factors of CAG and H. pylori infection, and the correlation of DOB with serum G-17, IL-32, and sIL-2R was analyzed. The levels of DOB and serum G-17, IL-32, and sIL-2R in patients with different gastroscopic pathological changes were compared, and ROC curves were drawn to evaluate the value of DOB, G-17, IL-32, and sIL-2R in assessing CAG and H. pylori infection.

RESULTS

There were statistically significant differences in the course of disease and gastroscopic pathological changes (chronic inflammation, atrophy, intestinal metaplasia, and intraepithelial neoplasia) between the two groups (P < 0.05). The DOB and serum levels of IL-32 and sIL-2R were significantly higher and serum G-17 level was significantly lower in the observation group than in the control group (P < 0.05). Logistic regression analysis showed that the course of disease, chronic inflammation, atrophy, intestinal metaplasia, intraepithelial neoplasia, DOB, and serum G-17, IL-32, and sIL-2R levels were all influencing factors of CAG and H. pylori infection (P < 0.05). Pearson correlation analysis showed that the DOB of patients with CAG and H. pylori infection was negatively correlated with G-17, and positively correlated with IL-32 and sIL-2R (P < 0.05). Spearman correlation analysis showed that the DOB and serum levels of G-17, IL-32, and sIL-2R in patients with CAG and H. pylori infection were significantly related to chronic inflammation, atrophy, intestinal metaplasia, and intraepithelial neoplasia (P < 0.05). ROC curve analysis showed that the area under the curve of combined DOB, G-17, IL-32, and sIL-2R was the largest (0.975), and the best sensitivity and specificity were 85.48% and 98.00%, respectively.

CONCLUSION

Serum levels of G-17, IL-32, and sIL-2R in patients with CAG and H. pylori infection are related to DOB. H. pylori infection may be involved in the occurrence and progression of gastric mucosal pathological changes in CAG patients by affecting the expression of G-17, IL-32, and sIL-2R. Combined detection of all the above indicators can effectively predict H. pylori infection, which is of great significance for clinical diagnosis and treatment.

Reflex Gastroesophageal Disorders and Functional Dyspepsia: Potential Confounding Variables for the Progression of Chronic Periodontitis: A Clinical Study

Aim:

To probe into the possible connection between gastroesophageal reflux disorders (GERDs) and functionally occurring dyspepsia as a factor raising the risk of chronic periodontitis.

Materials and Methods:

A cross-sectional study was carried out on 40 patients with chronic periodontitis with age group between 40–60 years. The test group included 20 people diagnosed with gastroesophageal reflux disease (GERD), according to the Montreal Definition and Classification agreement, and chronic periodontitis. Symptomatic diagnoses were done to confirm functional dyspepsia. The control group comprised 20 systematically healthy people suffering from chronic periodontitis. Indices measured included flow-rate of saliva, repetitive saliva swallowing test for swallowing function, papillary marginal attachment index of gingiva, oral hygiene index-simplified and decayed, missing, filled teeth index. Data was analyzed using SPSS version 22 (IBM Inc. Chicago, USA). Descriptive statistics, such as mean and standard deviation (SD) for continuous variables and frequency and percentage for categorical variables were determined. T test was performed for intergroup comparison and Pearson correlation test was done for evaluating correlation between various parameters. P ≤ 0.05 considered as significant.

Results:

Statistically significant differences were observed between the test and control groups with regard to all the clinical parameters of interest. Pearson's correlation test revealed a strong negative correlation between salivary flow rate and OHI-S and DMFT scores. The RSST swallow function values demonstrated a moderate negative correlation with OHI-S scores, while OHI-I scores and DMFT scores were observed to be strongly correlated in a positive direction. A statistically significant difference was present in the probing depth and CAL levels between both the groups with higher levels in test group.

Conclusion:

GERD was linked to incremental incidences of chronic periodontitis and was established as an independent risk-raising factor.

Periodontal disease and Helicobacter pylori infection in oral cavity: a meta-analysis of 2727 participants mainly based on Asian studies

OBJECTIVES

To assess the association between periodontal disease and Helicobacter pylori (H. pylori) infection in oral cavity.

MATERIALS AND METHODS

We searched PubMed, Embase, Web of Science, Cochrane library, Gray literature, and clinicaltrials.gov for eligible studies up to September 25, 2019. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The random-effects model was used with the software STATA 13.0. The Newcastle-Ottawa-Scale was used for quality evaluation.

RESULTS

Twelve observational studies (eight from Asia, one from Europe, and three from the South America) involving 2727 participants were included in the meta-analysis. The overall pooled results showed that H. pylori infection in oral cavity was associated with periodontal disease (OR 2.53, 95% CI 1.86-3.44, P < 0.05). No significant heterogeneity among the articles was observed (I² = 44.3%, P < 0.05). The sensitivity analysis indicated that the result of our meta-analysis was generally stable. The Begg test and the Egger test both showed no publication bias was observed (P = 0.45 and P = 0.18 respectively).

CONCLUSIONS

Based on current available evidence, it seemed there was a correlation between oral H. pylori infection and the occurrence of periodontal disease. However, since most of the data comes from Asia, more large-scale investigations with high quality from all over the world are needed to confirm the association.

CLINICAL RELEVANCE

H. pylori infection in oral may have a positive association with the prevalence of periodontal disease mainly in Asian populations.

Chronic atrophic gastritis aggravate chronic periodontitis with Helicobacter pylori infection and CD4+Th cytokines infiltration

OBJECTIVE

To investigate the potential effect of chronic atrophic gastritis on chronic periodontitis and further explore the possible mechanism.

METHODS

Local periodontal lesions were collected from periodontitis tissues of 30 CAG patients and 35 control adults without CAG (non-CAG). Clinical periodontal parameters were recorded, and the expression levels of distinct CD4+ Th specific cytokines at local periodontitis lesions were evaluated by real time PCR (RT-PCR). Helicobacter pylori (H. pylori) detection was carried out in both gastric and periodontitis lesions of CAG and non CAG patients.

RESULTS

Clinical parameters analysis showed that the level of clinical attachment loss in periodontitis lesions of CAG group was significantly higher than non-CAG group. It was observed that the infection rate of H. pylori in the CAG group was higher than non-CAG group. Further cytokine analysis showed that Th17 associated cytokines IL-17, IL-21 and IL-23 were increased in periodontal lesions of CAG patients when compared with non-CAG patients. However, Th1, Th2, Th9 and Treg cells specific cytokines were not significantly increased in CAG group when compared with non-CAG group.

CONCLUSIONS

Patients with CAG demonstrated that significant elevated attachment loss in periodontitis lesions, while elevated Th17 cytokines IL-17, IL-21 and IL-23 participate in immunopathogenesis of both diseases.

Association between Helicobacter pylori gastritis and dental diseases: A cross-sectional, hospital-based study in Eastern Saudi Arabia

BACKGROUND

There is inconsistent evidence about the association between Helicobacter pylori (H. pylori) and dental diseases with possible effect of environmental factors. The aims of the study were to assess (1) the association between gastric and oral H. pylori colonization and (2) the association between oral colonization of H. pylori and dental diseases.

METHODS

A cross-sectional study was conducted in King Fahad University hospital in Khobar, Eastern Saudi Arabia in 2017. Patients admitted to the Endoscopy Unit were recruited and clinically examined for plaque, decayed teeth (D), filled teeth (F), missing teeth (M), periodontal pocket depth (PPD), attachment loss (AL), and gingival bleeding in addition to assessing their age, gender, education, tooth brushing, flossing, and tobacco use with a questionnaire. Pooled dental plaque samples were collected and analyzed using nested polymerase chain reaction PCR to detect oral H. pylori. Gastroscopy was used to extract biopsies to assess gastritis and the presence of gastric H. pylori using Giemsa stain. Regression analysis was used to assess differences between patients with and without gastritis, oral H. pylori and gastric H. pylori in the percentage of sites with gingival bleeding, PPD, CAL, D, M, and F with adjustment for confounders.

RESULTS

One hundred twenty patients were included. Most of them brushed daily (82.6%) and had university education (45.7%). Of these, 34.2% had gastric H. pylori and 5% had oral H. pylori. No significant association was observed between the percentage of sites with gingival bleeding, mean PPD, AL, F, and either gastritis, the presence of oral or gastric H. pylori. Patients with gastritis had significantly higher number of D and M than patients without gastritis (P = 0.03).

CONCLUSIONS

In this study, the presence of gastric and oral H. pylori in patients with good oral hygiene and moderate socioeconomic status is not significantly associated with periodontal diseases. Patients with gastritis tend to have a higher number of decayed and missing teeth.