One of the questions on your office’s health history form should ask whether the patient has had any gastric or duodenal ulcers. When a patient responds yes to this question, what follow-up questions do you ask? What concerns you about the patient’s response? Many times, we do not delve as deeply into patients’ medical histories as we should.
One 24-year research study of more than 51,000 male participants found a relationship between gastric and duodenal ulcers and periodontal disease: “In this prospective cohort of men, [the study’s authors] found that periodontal disease with bone loss was associated with an increased risk of gastric and duodenal [ulcers]. The association appeared largely consistent for gastric and duodenal ulcers as well as H. pylori–positive and H. pylori–negative ulcers. These observed associations persisted even after adjusting for putative risk factors, including smoking, alcohol intake, and regular use of aspirin and NSAIDs.”1
The study authors hypothesized that the oral microbiota changes that keep periodontal tissue from healing can also keep ulcers from healing in the GI tract.1
Another study found a possible association between poor periodontal health and H. pylori infection.2 Helicobacter pylori is a gram-negative bacterium that causes duodenal and gastric ulcerative disease. The study authors discovered that this bacteria can be found in deeper pockets of those with periodontal disease and that it can be found in those patients’ saliva and plaque biofilm.2 About 41% of the individuals who had pockets measuring 5 mm or more also tested positive for H. pylori.2 This, of course, does not mean that one causes the other, but it does suggest a link we need to study further.
If one of your patients presents with ulcers, a consultation with his or her medical doctor may be necessary to see if a combination of treatments can be planned to help get rid of the H. pylori bacteria in the mouth and thus decrease the amount of bacteria that may be transferred to the gut. Antibiotic treatments, along with deep scaling or periodontal surgery, may be needed. Another study found that “periodontal therapy as an added treatment had some benefits on eradication of gastric H. pylori for short-term and long-term follow-up.”3 It is important that the treatment of your patient is complete with specific oral home-care instructions, tooth brushing, plaque and calculus removal, and use of antimicrobial mouthwashes.
It is important that you discuss any treatment that your patient may have already received for his or her ulcer(s). Many treatments aim to eradicate H. pylori with a series of antibiotics, which can also affect the bacteria in the oral cavity.
This is another example of how salivary diagnostic testing can help our patients. For a patient with ulcerative disease and periodontal disease, periodontal disease treatment may help decrease ulcers in the gut. We can use our knowledge to help our patients with more issues than just their mouths.
Jannette Whisenhunt, RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at [email protected].
1. Boylan MR, Khalili H, Huang ES, et al. A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals. Clin Transl Gastroenterol. 2014;5(2):e49. doi:10.1038/ctg.2013.14.
2. 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):1809-1815.
3. Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol. 2014;20(36):12781-12808. doi:10.3748/wjg.v20.i36.12781.