Association of Dental Plaque, Poor Oral Hygiene and Periodontal Disease with Helicobacter Pylori Infection

110 patients with dyspeptic symptoms and clinical indications for an upper gastroendoscopy from the outpatient Department of Medical Gastroenterology Government General Hospital Chennai were selected for the study. The study variables age, gender, handling of animals, smoking and alcohol consumption were obtained from the patient’s history. The socio-economic status was arrived, based on Kuppuswamy’s Socioeconomic status 2007. Oral hygiene status was evaluated using the Simplified Oral Hygiene Index of Greene and Vermillion 1964. Probing depth and clinical attachment level were recorded and based on the AAP 1999 classification , patients were classified into periodontitis and healthy patients. Antral biopsy samples (during endoscopy) and dental plaque samples were obtained. H.pylori in dental plaque was detected by RUT and culture, while antral biopsy samples were examined for the presence of H.pylori by RUT, culture, histopathology and ELISA. Patients with clinical symptoms and a positive test on antral biopsy sample by any of the three diagnostic tests – RUT, histology, and serology were cases and those negative were controls. Among the variables, handling of animals was found to be a risk factor for acquiring H.pylori infection. The oral hygiene status of the patients did not influence H.pylori infection. Patients with periodontitis were at a higher risk for developing H.pylori infection and pocket depths ≥5mm could serve as a reservoir for the organism. All these observations are based on the positive results obtained with the rapid urease test in dental plaque. However there was no cultural detection of H.pylori in dental plaque samples in this study. Hence the presence of H.pylori in dental plaque is inconclusive. Dental plaque cannot however be discounted as a possible alternate site for the organism. The present methods may be inadequate to reliably isolate the organism from this site. A more comprehensive search for the organism in this environment and other ecological niches within the gingival crevices ought to be conducted to elucidate the role of dental plaque as a potential reservoir for H.pylori. If the oral cavity is a reservoir for gastric infection, even in a minority of individuals, the control of dental plaque along with standard periodontal procedures should be recommended for patients with chronic gastritis or peptic ulcer