Title Non-Surgical Periodontal Therapy Can Reduce the Reinfection Rate of Helicobacter pylori in Patients Suffering from Peptic Ulcer Disease
Clinical Question In patients diagnosed with peptic ulcer disease, will non-surgical periodontal therapy reduce Helicobacter pylori gastric reinfection rates?
Clinical Bottom Line Patients with peptic ulcer disease experience lower H. pylori reinfection rates when treated with nonsurgical periodontal therapy in addition to anti-H. pylori therapy. This is supported by a systematic review of three included studies showing significantly lower rates of gastric infection over time in patients receiving periodontal therapy.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24701355Arwa/20143 studies- 205 patientsSystematic review of randomized trials
Key resultsThree studies evaluated the effects of periodontal therapy on gastric H. pylori infection. The gastric eradication rate after 1 year for anti-H. pylori + non-surgical periodontal therapy (anti-HP + NSPT) was 62.8% vs. 32.4% for anti-HP alone. In the second study, at 3 months, gastric eradication was 77.3% for anti-HP + NSPT vs. 47.6% for anti-HP alone. In the third study, after 6 months, the gastric mucosa became reinfected in 84.31% of patients who received no plaque control vs. 19.64% of patients who received full-mouth scaling and root planing.
Evidence Search ("helicobacter pylori"[MeSH Terms] OR ("helicobacter"[All Fields] AND "pylori"[All Fields]) OR "helicobacter pylori"[All Fields]) AND reinfection[All Fields]
Comments on
The Evidence
Validity: The systematic review included 23 studies relating to H. pylori and the oral cavity. Three studies specifically evaluated non-surgical periodontal therapy (NSPT) and H. pylori gastric infection. Overall, the studies did conclude that H. pylori can be harbored in the plaque biofilm. The three studies conducted on NSPT and H. pylori gastric infection demonstrate that NSPT can reduce reinfection rates of the bacteria. Sampling method bias is a possibility due to wide variation in sampling methodology for data collection of H. pylori in dental plaque biofilm. Additionally, the systematic review did not address the issue of patient compliance as a variable that could impact outcomes. Perspective: Further studies to establish correlation between the effectiveness of NSPT on H. pylori in plaque biofilm and gastric infection are warranted.
Applicability This information can benefit a patient with recurrent reinfection of peptic ulcer disease caused by Helicobacter pylori. Non-surgical periodontal and antibiotic therapy, as compared to antibiotic therapy alone, can reduce the reinfection rate in these patients. NSPT is ideally performed every 3-6 months, depending on the patient’s treatment needs. The problem with NSPT is that patients tend to have low compliance. It is not always available to all communities and can be costly.
Specialty (Public Health) (General Dentistry) (Periodontics) (Dental Hygiene)
Keywords Helicobacter pylori, peptic ulcer disease, dental plaque, periodontitis, oral hygiene
ID# 2763
Date of submission 09/02/2014
E-mail paladino@livemail.uthscsa.edu
Author Dana Paladino
Co-author(s) Rachel Roberts
Co-author(s) e-mail RobertsRD@livemail.uthscsa.edu
Faculty mentor Carol A. Nguyen, RDH, MPH, MS
Faculty mentor e-mail NguyenC@livemail.uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available