The possible role of dental plaque as extra-gastric reservoir of Helicobacter pylori in gastric re-infection: A science-metric study

Document Type: Review Article(s)


1 Kerman Social Determinants on Oral Health Research Center AND Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman

2 Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND AND AIM: Helicobacter pylori (H. pylori) infection is one of the most common infections which still affects individuals worldwide. The main route for transmission of H. pylori infection is the oral route and this microorganism has been detected in dental plaque. In past decades, there have been a number of controversies about the station of dental plaque in the recurrence of gastric H. pylori Infection after eradication by triple therapy. In this study, attempts have been made to illustrate the current body of high quality evidence in this field.
METHODS: All relevant studies published between 2000 and 2017 were included in this review. The creditable databases were searched for relevant key words. The cross-sectional, experimental, and interventional investigations assessing the existence of H. pylori in the plaque, the state of plaque in gastric re-infection, the presence of co-infection between the oral cavity and stomach, the influence of triple therapy on the plaque, and the impression of periodontal treatments on prevention of recurrent gastric H. pylori infection were included.
RESULTS: Science metric review of literature demonstrated considerable disagreement with no definite conclusion. Due to the existing diversity in methodology and population groups, wide variation in results was reported.
CONCLUSION: Further homogenous studies are required to more clarify the “H. pylori in dental plaque” theory.


1. Anand PS, Kamath KP, Anil S. Role of dental plaque, saliva and periodontal disease in Helicobacter pylori infection. World J Gastroenterol 2014; 20(19): 5639-53.
2. Al Sayed A, Anand PS, Kamath KP, Patil S, Preethanath RS, Anil S. Oral cavity as an extragastric reservoir of helicobacter pylori. ISRN Gastroenterol 2014; 2014: 261369.
3. Cheng LH, Webberley M, Evans M, Hanson N, Brown R. Helicobacter pylori in dental plaque and gastric mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81(4): 421-3.
4. Thomas E, Jiang C, Chi DS, Li C, Ferguson DA Jr. The role of the oral cavity in Helicobacter pylori infection. Am J Gastroenterol 1997; 92(12): 2148-54.
5. Gebara EC, Faria CM, Pannuti C, Chehter L, Mayer MP, Lima LA. Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy. J Clin Periodontol 2006; 33(5): 329-33.
6. Gebara EC, Pannuti C, Faria CM, Chehter L, Mayer MP, Lima LA. Prevalence of Helicobacter pylori detected by polymerase chain reaction in the oral cavity of periodontitis patients. Oral Microbiol Immunol 2004; 19(4): 277-80.
7. Umeda M, Kobayashi H, Takeuchi Y, Hayashi J, Morotome-Hayashi Y, Yano K, et al. High prevalence of Helicobacter pylori detected by PCR in the oral cavities of periodontitis patients. J Periodontol 2003; 74(1): 129-34.
8. Anand PS, Nandakumar K, Shenoy KT. Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection? J Periodontol 2006; 77(4): 692-8.
9. Berroteran A, Perrone M, Correnti M, Cavazza ME, Tombazzi C, Goncalvez R, et al. Detection of Helicobacter pylori DNA in the oral cavity and gastroduodenal system of a Venezuelan population. J Med Microbiol 2002; 51(9): 764-70.
10. Ozdemir A, Mas MR, Sahin S, Saglamkaya U, Ateskan U. Detection of Helicobacter pylori colonization in dental plaques and tongue scrapings of patients with chronic gastritis. Quintessence Int 2001; 32(2): 131-4.
11. Avcu N, Avcu F, Beyan C, Ural AU, Kaptan K, Ozyurt M, et al. The relationship between gastric-oral Helicobacter pylori and oral hygiene in patients with vitamin B12-deficiency anemia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92(2): 166-9.
12. Butt AK, Khan AA, Khan AA, Izhar M, Alam A, Shah SW, et al. Correlation of Helicobacter pylori in dental plaque and gastric mucosa of dyspeptic patients. J Pak Med Assoc 2002; 52(5): 196-200.
13. Choudhury CR, Choudhury AD, Alam S, Markus AF, Tanaka A. Presence of H. pylori in the oral cavity of betel-quid ('Paan') chewers with dyspepsia: Relationship with periodontal health. Public Health 2003; 117(5): 346-7.
14. Young KA, Allaker RP, Hardie JM. Morphological analysis of Helicobacter pylori from gastric biopsies and dental plaque by scanning electron microscopy. Oral Microbiol Immunol 2001; 16(3): 178-81.
15. Kim N, Lim SH, Lee KH, You JY, Kim JM, Lee NR, et al. Helicobacter pylori in dental plaque and saliva. Korean J Intern Med 2000; 15(3): 187-94.
16. Lin NC, Ho KY, Tsai CC, Wu DC, Jen CM, Wang WM. Helicobacter pylori in dental plaque: A possible source of gastric re-infection. J Dent Res 2003; 82: 154.
17. Siddiq M, Haseeb UR, Mahmood A. Evidence of Helicobacter pylori infection in dental plaque and gastric mucosa. J Coll Physicians Surg Pak 2004; 14(4): 205-7.
18. Chumpitaz Conde J, Gutierrez Manay J, Cordova Acosta R, Sanchez Medina M, Vasquez Valverde N, Rivadeira Malaga C, et al. Isolation of helicobacter pylori in dental plaque in patients with gastritis at "Angamos" clinic. Rev Gastroenterol Peru 2006; 26(4): 373-6.
19. Navabi N, Darvish Moghadam S, Torabi M. Association between gastric helicobacter pylori infection and periodontal disease. Journal of Dentistry 2010; 10(Suppl): 45-9. [In Persian].
20. Navabi N, Aramon M, Mirzazadeh A. Does the presence of the Helicobacter pylori in the dental plaque associate with its gastric infection? A meta-analysis and systematic review. Dent Res J (Isfahan) 2011; 8(4): 178-82.
21. Czesnikiewicz-Guzik M, Karczewska E, Bielanski W, Guzik TJ, Kapera P, Targosz A, et al. Association of the presence of Helicobacter pylori in the oral cavity and in the stomach. J Physiol Pharmacol 2004; 55(Suppl 2): 105-15.
22. Kignel S, de Almeida Pina F, Andre EA, Alves Mayer MP, Birman EG. Occurrence of Helicobacter pylori in dental plaque and saliva of dyspeptic patients. Oral Dis 2005; 11(1): 17-21.
23. Czesnikiewicz-Guzik M, Bielanski W, Guzik TJ, Loster B, Konturek SJ. Helicobacter pylori in the oral cavity and its implications for gastric infection, periodontal health, immunology and dyspepsia. J Physiol Pharmacol 2005; 56(Suppl 6): 77-89.
24. Chitsazi MT, Fattahi E, Farahani RM, Fattahi S. Helicobacter pylori in the dental plaque: Is it of diagnostic value for gastric infection? Med Oral Patol Oral Cir Bucal 2006; 11(4): E325-E328.
25. Namiot DB, Namiot Z, Kemona A, Bucki R, Gotebiewska M. Oral health status and oral hygiene practices of patients with peptic ulcer and how these affect Helicobacter pylori eradication from the stomach. Helicobacter 2007; 12(1): 63-7.
26. Teoman I, Ozmeric N, Ozcan G, Alaaddinoglu E, Dumlu S, Akyon Y, et al. Comparison of different methods to detect Helicobacter pylori in the dental plaque of dyspeptic patients. Clin Oral Investig 2007; 11(3): 201-5.
27. Song Q, Haller B, Ulrich D, Wichelhaus A, Adler G, Bode G. Quantitation of Helicobacter pylori in dental plaque samples by competitive polymerase chain reaction. J Clin Pathol 2000; 53(3): 218-22.
28. Abdolsamadi HR, Hooshmand B, Mohammad Alizadeh AH. Evaluation the existence of the Helicobacter Pylori in stomach, subgingival plaque and samples taken from periodontal pockets in dyspeptic patients by polymerase chain reaction (PCR). J Dent Mashhad Univ Med Sci 2005; 29: 87-90. [In Persian].
29. Nasrolahei M, Maleki I, Emadian O. Helicobacter pylori colonization in dental plaque and gastric infection. Rom J Gastroenterol 2003; 12(4): 293-6.
30. Goudarzi H, Islami G, Pourmohammad A, Riazi M. Relationship between Helicobacter pylori colonization in the dental plaque and its colonization in the gastric mucosa. J Dent Sch Shahid Beheshti Univ Med Sci 1999; 36(17): 54-9. [In Persian].
31. Kamat AH, Mehta PR, Natu AA, Phadke AY, Vora IM, Desai PD, et al. Dental plaque: An unlikely reservoir of Helicobacter pylori. Indian J Gastroenterol 1998; 17(4): 138-40.
32. Cammarota G, Tursi A, Montalto M, Papa A, Veneto G, Bernardi S, et al. Role of dental plaque in the transmission of Helicobacter pylori infection. J Clin Gastroenterol 1996; 22(3): 174-7.
33. Dore-Davin C, Heitz M, Yang H, Herranz M, Blum AL, Corthesy-Theulaz I. Helicobacter pylori in the oral cavity reflects handling of contaminants but not gastric infection. Digestion 1999; 60(3): 196-202.
34. Ogunbodede EO, Lawal OO, Lamikanra A, Okeke IN, Rotimi O, Rasheed AA. Helicobacter pylori in the dental plaque and gastric mucosa of dyspeptic Nigerian patients. Trop Gastroenterol 2002; 23(3): 127-33.
35. Suk FM, Chen SH, Ho YS, Pan S, Lou HY, Chang CC, et al. It is difficult to eradicate Helicobacter pylori from dental plaque by triple therapy. Zhonghua Yi Xue Za Zhi (Taipei) 2002; 65(10): 468-73.
36. Chaudhry S, Iqbal HA, Khan AA, Izhar M, Butt AK, Akhter MW, et al. Helicobacter pylori in dental plaque and gastric mucosa: Correlation revisited. J Pak Med Assoc 2008; 58(6): 331-4.
37. Dye BA, Kruszon-Moran D, McQuillan G. The relationship between periodontal disease attributes and Helicobacter pylori infection among adults in the United States. Am J Public Health 2002; 92(11): 1809-15.
38. Bouziane A, Ahid S, Abouqal R, Ennibi O. Effect of periodontal therapy on prevention of gastric Helicobacter pylori recurrence: A systematic review and meta-analysis. J Clin Periodontol 2012; 39(12): 1166-73.
39. Ren Q, Yan X, Zhou Y, Li WX. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection. Cochrane Database Syst Rev 2016; 2: CD009477.
40. Zou QH, Li RQ. Helicobacter pylori in the oral cavity and gastric mucosa: A meta-analysis. J Oral Pathol Med 2011; 40(4): 317-24.
41. Marbaix S, Soueidan A, Romani M, Campard G, Amador G, Badran Z. Helicobacter Pylori and Periodontal diseases: An update and proposal of a multidisciplinary clinical protocol. Open Journal of Stomatology 2013; 3(6): 318-22.
42. Adler I, Muino A, Aguas S, Harada L, Diaz M, Lence A, et al. Helicobacter pylori and oral pathology: Relationship with the gastric infection. World J Gastroenterol 2014; 20(29): 9922-35.
43. Hu W, Cao C, Meng H. Helicobacter pylori in dental plaque of periodontitis and gastric disease patients. Zhonghua Kou Qiang Yi Xue Za Zhi 1999; 34(1): 49-51.
44. Riggio MP, Lennon A. Identification by PCR of Helicobacter pylori in subgingival plaque of adult periodontitis patients. J Med Microbiol 1999; 48(3): 317-22.
45. Patthy A, Rakoczi G, Vegh A. Diagnosis of Helicobacter pylori infection from dental plaque. Fogorv Sz 2002; 95(1): 33-4.
46. Hu W, Cao C, Meng H, Zhang J, Ma D, Zhang L. Detection and analysis of Helicobacter pylori in oral cavity and stomach from chronic gastritis patients. Zhonghua Yi Xue Za Zhi 2002; 82(15): 1037-41.
47. Hardo PG, Tugnait A, Hassan F, Lynch DA, West AP, Mapstone NP, et al. Helicobacter pylori infection and dental care. Gut 1995; 37(1): 44-6.
48. Oshowo A, Gillam D, Botha A, Tunio M, Holton J, Boulos P, et al. Helicobacter pylori: The mouth, stomach, and gut axis. Ann Periodontol 1998; 3(1): 276-80.
49. Savoldi E, Marinone MG, Negrini R, Facchinetti D, Lanzini A, Sapelli PL. Absence of Helicobacter pylori in dental plaque determined by immunoperoxidase. Helicobacter 1998; 3(4): 283-7.
50. Liu Y, Yue H, Li A, Wang J, Jiang B, Zhang Y, et al. An epidemiologic study on the correlation between oral Helicobacter pylori and gastric H. pylori. Curr Microbiol 2009; 58(5): 449-53.
51. Sahin FI, Tinaz AC, Simsek IS, Menevse S, Gorgul A. Detection of Helicobacter pylori in dental plaque and gastric biopsy samples of Turkish patients by PCR-RFLP. Acta Gastroenterol Belg 2001; 64(2): 150-2.
52. Diouf A, Seck-Diallo AM, Faye M, Benoist HM, Sembene M, Diallo PD, et al. [Prevalence of Helicobacter pylori detected by real-time PCR in the subgingival plaque of patients with chronic periodontitis]. Odontostomatol Trop 2011; 34(133): 5-12.
53. Song Q, Lange T, Spahr A, Adler G, Bode G. Characteristic distribution pattern of Helicobacter pylori in dental plaque and saliva detected with nested PCR. J Med Microbiol 2000; 49(4): 349-53.
54. Tarullo A, Tattoli M, Cagiano R. Persistent eradication of Helicobacter pylori after systemic politherapy associated with periodontal pockets treatment with metronidazole and calcium sulphate. Eur Rev Med Pharmacol Sci 2001; 5(4): 127-9.
55. Butt AK, Khan AA, Suleman BA, Bedi R. Randomized clinical trial of Helicobacter pylori from dental plaque. Br J Surg 2001; 88(2): 206.
56. Sheu BS, Cheng HC, Yang YJ, Yang HB, Wu JJ. The presence of dental disease can be a risk factor for recurrent Helicobacter pylori infection after eradication therapy: A 3-year follow-up. Endoscopy 2007; 39(11): 942-7.
57. Jia CL, Jiang GS, Li CH, Li CR. Effect of dental plaque control on infection of Helicobacter pylori in gastric mucosa. J Periodontol 2009; 80(10): 1606-9.
58. Jia CL, Jiang GS, Yang XX, Dou HQ, Li CR. Effects on Helicobacter pylori reinfection in gastric mucosa by two oral plaque control methods. Hua Xi Kou Qiang Yi Xue Za Zhi 2009; 27(2): 172-4.
59. Zaric S, Bojic B, Jankovic L, Dapcevic B, Popovic B, Cakic S, et al. Periodontal therapy improves gastric Helicobacter pylori eradication. J Dent Res 2009; 88(10): 946-50.
60. Gao J, Li Y, Wang Q, Qi C, Zhu S. Correlation between distribution of Helicobacter pylori in oral cavity and chronic stomach conditions. J Huazhong Univ Sci Technolog Med Sci 2011; 31(3): 409-12.
61. Paladino D, Roberts R, Nguyen C. Non-surgical periodontal therapy can reduce the gastric reinfection rate of helicobacter pylori in previously infected patients (UT CAT #2763). Tex Dent J 2015; 132(7): 426.
62. Saxena A, Shukla S, Prasad KN, Ghoshal UC. Virulence attributes of Helicobacter pylori isolates & their association with gastroduodenal disease. Indian J Med Res 2011; 133: 514-20.
63. Argent RH, Thomas RJ, Letley DP, Rittig MG, Hardie KR, Atherton JC. Functional association between the Helicobacter pylori virulence factors VacA and CagA. J Med Microbiol 2008; 57(Pt 2): 145-50.
64. Nagiyev T, Yula E, Abayli B, Koksal F. Prevalence and genotypes of Helicobacter pylori in gastric biopsy specimens from patients with gastroduodenal pathologies in the Cukurova Region of Turkey. J Clin Microbiol 2009; 47(12): 4150-3.
65. Yakoob J, Abid S, Abbas Z, Jafri W, Ahmad Z, Ahmed R, et al. Distribution of Helicobacter pylori virulence markers in patients with gastroduodenal diseases in Pakistan. BMC Gastroenterol 2009; 9: 87.
66. Nguyen TL, Uchida T, Tsukamoto Y, Trinh DT, Ta L, Mai BH, et al. Helicobacter pylori infection and gastroduodenal diseases in Vietnam: A cross-sectional, hospital-based study. BMC Gastroenterol 2010; 10: 114.
67. Paniagua GL, Monroy E, Rodriguez R, Arroniz S, Rodriguez C, Cortes JL, et al. Frequency of vacA, cagA and babA2 virulence markers in Helicobacter pylori strains isolated from Mexican patients with chronic gastritis. Ann Clin Microbiol Antimicrob 2009; 8: 14.
68. Assumpcao MB, Martins LC, Melo Barbosa HP, Barile KA, de Almeida SS, Assumpcao PP, et al. Helicobacter pylori in dental plaque and stomach of patients from Northern Brazil. World J Gastroenterol 2010; 16(24): 3033-9.
69. Wang J, Chi DS, Laffan JJ, Li C, Ferguson DA Jr, Litchfield P, et al. Comparison of cytotoxin genotypes of Helicobacter pylori in stomach and saliva. Dig Dis Sci 2002; 47(8): 1850-6.
70. Goosen C, Theron J, Ntsala M, Maree FF, Olckers A, Botha SJ, et al. Evaluation of a novel heminested PCR assay based on the phosphoglucosamine mutase gene for detection of Helicobacter pylori in saliva and dental plaque. J Clin Microbiol 2002; 40(1): 205-9.
71. Momtaz H, Souod N, Dabiri H. Comparison of the virulence factors of Helicobacter pylori isolated in stomach and saliva in Iran. Am J Med Sci 2010; 340(5): 345-9.
72. Azzi L, Carinci F, Gabaglio S, Cura F, Croveri F, Tettamanti L, et al. Helicobacter pylori in periodontal pockets and saliva: A possible role in gastric infection relapses. J Biol Regul Homeost Agents 2017; 31(1): 257-62.