In the 1990s, the bacteria Helicobacter pylori was identified as a cause of many gastric diseases. Since then, there has been a growing amount of research trying to determine if H pylori is also related to oral disease. H. pylori infections of the gut may be as high as 80% in developing countries and 40% in developed countries. Populations studied in the United States indicate a huge difference in the numbers of those testing positive for the bacteria when they are born outside of the United States. H pylori is a Gramnegative bacteria and is a type 1 carcinogen; it has also been found to cause peptic ulcers and gastritis. Since H pylori infection is usually asymptomatic, patients don’t know they are infected. The mode of transmission of H pylori is unclear, though there is an association with infected saliva, contaminated food, eating utensils, and animal handling (mainly domestic cats and sheep). These associations may indicate a possible route of transmission, although these findings are presently controversial. The finding of H pylori in the oral cavity has led to many theories as to whether it is dormant until an imbalance of oral flora occurs or the immune system is compromised. While treatment of chronic gastritis is successful, reinfection does occur, leading some studies to conclude that the oral cavity is a reservoir for the bacteria, that the bacteria is a temporary resident, or that the bacteria is part of normal biofilm. The periodontal pathogens Porphyromonas gingivalis and Fusobacterium nucleatum appear able to bind with H pylori, which may explain its presence in periodontal patients. Studies indicate that patients with pocket depths more than 5 mm had circulating blood containing H pylori. One study concluded that subgingival plaque was the reservoir for H pylori. Other studies concluded that H. pylori was found in the oral cavity due to gastric reflux or vomiting stomach contents through the oral cavity. Eliminating H pylori from the oral cavity through effective plaque control may be the only way to stop reinfection of the stomach. When assessing patients for periodontal disease, it may help to ask them about any gastric issues, ensuring that the patient understands why complete plaque control may be important in the disease process.
(Source: Dimensions of Dental Hygiene, May 2008)
