Studies On Relationship Between Oral Health Status And Gastric Diseases

PART?SURVEY ON ORAL HEALTH STATUS IN PATIENTS WITH CHRONIC GASTRIC DISEASESObjectiveOral cavity is tightly integrated with the stomach as important organs of ingestive system. The major role of oral cavity is the food intake and its preparation for swallowing and the transport of ingested food into further segments of gastro-intestinal tract (GIT). Data have proved that the oral health status influence gastric function and vice versa. Additionally, oral cavity is inhabited by millions of various microorganisms forming an oral bacteria biofilm. Helicobacter pylori, which causes chronic gastritis and plays important roles in peptic ulcer disease, gastric carcinoma, and gastric lymphoma, resides in the oral cavity which as an extragasric reservior of Helicobacter pylori, is associated with the recurrence of gastric diseases, periodontitis, oral ulcer and dental caries. However, there has little literature on oral health status of a group of patients with chronic gastric diseases can be found up to now. So the aim is to describe the oral health status of a group of patients with chronic gastric diseases, to demonstrate the relationship between oral cavity and gastric diseases, to emphasize the necessity of oral health treatment programs in gastric disease therapy.Material and MethodsRetrospective review of medical records of patients with chronic gastric diseases, of whom 243 were suffering chronic gastritis,89 were suffering gastric ulcer, and 232 were from normal population. Clinical parameters involved in the evaluation of oral health status are gingival index(GI), plaque index(PLI), probing depth(PD), clinical attachment level(CAL), numbers and degrees of teeth mobility, halitosis, pH of saliva, whether accompany with the recurrence of oral ulcer, and surface numbers of decayed, missed and filled teeth(DMFS). Methods of Loe and Silness'gingival index, and Quigley and Hein's plaque index were used in the assements. Periodontal clinical measurements were performed at six sites per tooth with periodtonal probing stylet. The pH values of saliva were measured by pH test paper. Oral malodor was detected by organoleptic assessment. DMFS was recorded in accordance with Henry Klein's method. The severity of gingival inflammation was collapsed into two categories (present or absent) to facilitate comparison. Periodontal inflammation, halitosis, and oral ulcer accompany were similarly assessed and dichotomized. The pH value, dental plaque, and DMFS were analyzed by means.Statistical analysesStatistical analyses were performed using SPSS10.0 for windows statistical software package. Full-mouth clinical measurements were computed for each subject and then averaged across subjects within the groups. Differences in clinical parameters betweens groups were sought using X2 tests or t tests. Any difference of P<0.05 was considered statistically significant.Results Oral health status was considered defective in most patients suffering gastritis and gastric ulcer. Sixty point one percent had halitosis,63% had periodontitis, 75.3% had gingivitis,97.5% had caries and 49.8% were subject to oral ulcer in patients with chronic gastritis. Sixty two point nine percent had halitosis, 64%hadperiodontitis,76.4% hadgingivitis,97.8% had caries, and 50.6% were subject to oral ulcer in patients with gastric ulcer. The mean of dental plaque index were 2.658 and 2.831 in gastritis and gastric ulcer. The DMFS and pH of saliva for the patients with gastric ulcer were 15.436 and 5.796, respectively, which had a significant difference compared with that of healthy individuals and patients with gastritis (10.835 and 6.132), however, there has no significant difference between healthy individuals and patients with gastritis.ConclusionsThis group of patients with chronic gastric diseases presented a poor oral health status. There has a relationship between poor oral health status and gastric diseases. Suggesting that dental treatment programs for these patients should be implemented to promote the treatment of gastric diseases.PART?STUDY ON THE RELATIONSHIP BETWEEN ORAL CAVITY AND GASTRIC HELICOBACTER PYLORI INFECTIONObjective Helicobacter pylori (H.pylori) is a gram-negative bacterium which causes chronic gastritis and plays important roles in peptic ulcer disease, gastric carcinoma, and gastric lymphoma. Researchers have suggested that the primary extragastric reservoir for H.pylori was the oral cavity. However, data on the role of oral plaque in the transmission of H.pylori have varied greatly. Some authors reported strong association between chronic colonization of oral cavity and gastric mucosa infection, while other investigators could not find supporting evidences, which caused from difference of methods of detecting H. pylori and sampling. Therefore, our aims are to provide new evidence on the relationship between oral cavity and gastric H. pylori infection, to clarify the necessity of strategy of plaque controlling on those patients by investigating the detected rate of H. pylori in the stomach following complete plaque control on patients.MethodsNinety three patients suffering from chronic gastritis or peptic ulcer were selected in digestion ward, QiLu Hospital of Shandong University from April 2006 to May 2007.The age ranged from 25 to 72, mean 36. All subjects had been eradicated H. pylori of their gastric mucosa with the following method and assessment standard:omeprazole (2 x 20 mg), amoxicillin (2 x 500 mg), metronidazole (2 x 400 mg) (14-day course), then ranitidine (1 x 300 mg) bismuth subcitrate potassium (4 x 110 mg)(30-day course)?One month later, both symptoms disappearing and H. pylori negative detection certified by 13C-urea breath test was considered to be H. pylori eradication on gastric mucosa.56 patients in the test group underwent complete plaque controlling procedure (education of oral health knowledge, teethbrushing, mouthrinsing, teeth clearing and root planing),37 patients without plaque control were assigned into control group.13C-urea breath test were conducted in all patients again after half a year to determine the detect rate of H. pylori of their gastric mucosa.Statistical analyses Statistical analyses were performed using SPSS10.0 for windows statistical software package. The prevalence of H. pylori in gastric mucosa was evaluated by theX2test. Any difference of P<0.05 was considered statistically significant.ResultsAmong 56 patients in the test group,13 individuals were excluded because they had once stopped mouthrising for more than 3 days(7), poor plaque controlling(4), and missing(2). Finally, there were 43 patients avaliable in the test group. Haif a year later, the 13C-urea breath test demonstrated that there were 9 patients in the test group with positive H. pylori on gastric mucosa; 28 in the control group with positive gastric H. pylori. The detected rate of H. pylori in the stomach of patients following dental plaque control (test group) was 20.9%, which was lower significantly than that in control group (75.7%, x2=23.97, P<0.05)ConclusionsThere was strong association between oral plaque and gastric H. pylori infection. Suggesting that dental plaque may be as a reservoir of H. pylori in oral cavity and does play major role in gastric H. pylori infection. Dental plaque control procedures should be performed in the treatment of gastritis and peptic ulcerPART?EFFECTS OF DIFFERENT DENTAL PLQUE CONTROLLING MEASUREMENTS ON GASTRIC HELICOBACTET PYLORI REINFECTIONObjectiveHelicobacter pylori (H. pylori) is considered to be responsible for gastritis and peptic ulcers and is a risk factor for gastric cancer. There was a significant correlationship between oral cavity and gastric H. pylori infection. The H. pylori persistence in oral cavity is an important source of reinfection after its successful eradication therapy in patients with gastritis and peptic ulcer. Data of effects on gastric H. pylori reinfection following oral plaque control have been rare. Therefore, the aims are to detect the reinfection rate of H. pylori in the stomach by three different measures of dental plaque control on patients, to demonstrate the necessity and better measure of strategy of plaque control on those patients.Methods191 patients with no H. pylori in their gastric mucosa were selected in digestive ward in QiLu Hospital Shandong University from 2005 to 2007. They were assigned into 4 groups according to their desires as the following:test group 1 (total 54:males 31, females 23; age ranged 25-72, mean 44.6), test group 2 (47), test group 3 (43) and control group (39). Therapy and eradication standard on H. pylori of gastric mucosa:omeprazole (2 x 20 mg), amoxicillin (2 x 500 mg), metronidazole (2 x 400 mg) (14-day course), then ranitidine (1 x 300 mg) bismuth subcitrate potassium (4 x 110 mg) (30-day course). One month later, both clinical symptoms disappearing and H. pylori negative delection certified by 13C-urea breath test was considered to be H. pylori eradication on gastric mucosa. Methods of plaque control used in the study:teeth brushing; mouthrinsing with Chlorhexidine and professionalplaque control. Methods of plaque control used in groups:teeth brushing+mouthrinsing in test group 1; teeth brushing +mouthrinsing + professional plaque control in test group 2; teeth brushing in test group 3; none of methods mentioned above was used in control group. Dental plaque were removed and cared by the same dentist in test group 2.13C-urea breath was conducted in all patients test again after half a year to determine the reinfection of H. pylori of their gastric mucosa.Statistical analysesStatistical analyses were performed using SPSS 10.0 for windows statistical software package. The prevalence of H, pylori in gastric mucosa was evaluated by the x2 test. Any difference of P<0.05 was considered statistically significant.Results191 patients suffering from gastritis or peptic ulcer started to control oral plaque with their own methods designed in the study from the day before their gastric H. pylori was certified eradicative day. In test groups,5 patients in group 1 were excluded because of once stopping mouthrinsing for more than 3 days; 8 patients in group 2 were excluded duing to poor plaque control; and also 1 missing and 2 failing to brush their teeth with Bass method in group 3. All avaliable subjects in the study comprised 49 in test group 1,47 in test group 2, 40 in test group 3 and 39 in the control group. Half a year later, they underwent 13C-urea breath test. There were 33 patients with positive H. pylori in the test group 1 (67.3%),9 in the test group 2 (19.1%),29 in the test group 3 (72.5%) and 32 in the control group (82.1%). The reinfection rate of H. pylori in test group 2 was lower significantly (P<0.05) than that in other three groups. Although test group 1, test group 3 and control group were higher sequently on the positive H. pylori of gastric mucosa, there were no significant difference among them (P>0.05)Conclusions There was significant association between oral H. pylori and gastric infection. Dental plaque was an important source of gastric H. pylori reinfection. Oral plaque control procedures should be performed in the treatment of gastric diseases correlated with H. pylori. Effects on reinfection rate of gastric H. pylori were higher sequently among teeth brushing, teeth brushing + mouthrinsing andteeth brushing + mouthrinsing + professional plaque control. The measure of teeth brushing + mouthrinsing + professional plaque control was better.