Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3614 - 3621

The Association Of Dental Plaque And Helicobacter Pylori Infection In Dyspeptic Patients Undergoing Endoscopy

DEEPIKA BALI*,JOSEPH ROSAMMA**, AMIT BALI***

*MDS , Reader, Dept Of Periodontology, DAV(C) Dental College, Yamuna Nagar, Haryana, India; ** MDS, Professor And Head, Dept Of Periodontics, Govt Dental College, Kerala, India; *** MDS, Reader, Dept Of Oral & Maxillofacial Surgery, MM College Of Dental Sciences & Research, Mullana, Ambala, Haryana

Correspondence Address :
Dr. Deepika Bali
M.D.S. , Reader, Dept Of Periodontology,
D.A.V.(C) Dental College, Yamuna Nagar-135001
Haryana, India
Phone No. +919466302335
Email- drdeepikab@yahoo.com

Abstract

Objective and Background
The aim of this study was to analyze whether there is any association between dental plaque, oral hygiene and periodontal disease and Helicobacter pylori gastric infection. H.pylori, a spiral shaped microaerophilic bacterium, is responsible for peptic ulcer diseases, gastritis and gastric malignancies. Among various reports on the transmission of H. pylori, the faecal oral and oral-oral routes have been suggested to be the most plausible ones. Although it may be transmitted through the oral cavity, it is unknown whether the dental plaque acts as a permanent reservoir of H. pylori.

Methods
In this case control study, 124 dyspeptic patients with dyspepticsymptoms were categorized into the cases (60) and the controls (64) on the basis of the rapid urease test (RUT) and the histopathological results of the antral biopsy specimens. Patients with either of the tests positive or with both the tests positive were categorized as the cases and those with both the tests negative were taken as the controls.

Results
A high prevalence of H. pylori in dental plaque was found among the cases than in the controls. Among the cases, 52 patients out of the 60 (86.6%), had a positive rapid urease test in the dental plaque and among the controls, 12 out of 64 (18.75%) showed positive results. A highly significant association was found between poor oral hygiene status and periodontal disease (probing pocket depth) with H.pylori infection.

Conclusion
Triple / quadruple therapy has no effect on plaque associated H.pylori and it may continue to act as a reservoir. Plaque control measures and pocket eradication therapy are highly beneficial in eliminating and preventing the colonization of H.pylori in the oral cavity.

Keywords

Helicobacter pylori, Dental plaque, Periodontal disease, Oral hygiene

INTRODUCTION
Periodontal disease comprises a group of inflammatory conditions of the tooth supporting tissues that result from a complex interplay between the host tissues and aetiological agents. Aetiological agents are pertained to specific bacteria which are found in the dental plaque. Dental plaque is a soft deposit forming the biofilm, which is primarily a collection of microorganisms of more than 600 distinct species which is embedded in an intercellular matrix.

One gm of plaque (Wet wt) contains approximately 2x1011 bacteria (1). Dental plaque, a host associated biofilm, provides a protective environment for colonizing organisms and fosters metabolic properties. Microorganisms which are present in the biofilm are resistant to antimicrobials because of the slower rate of growth of the bacterial species in the biofilm, thus making them less susceptible to many, but not all antimicrobials. The biofilm also acts as a barrier to antibiotic diffusion and makes the microorganisms resistant to antibiotics as compared to the planktonic bacteria (2).

The dental plaque typically adheres to the supra gingival and the subgingival tooth surfaces and it quickly forms in the absence of good oral hygiene measures. Many studies have reported the presence of the gram –ve, spiral shaped, urease +ve bacterium, H. pylori in dental plaque, saliva and the dorsum of the tongue. (3),(4)

H. pylori is a microaerophilic bacterium of about 3 μm in length and a diameter of about 0.5 μm, with 4-6 flagella and it is strongly associated with antral gastritis, duodenal ulcers, gastric adenocarcinoma and MALT lymphoma(5). About half of the world’s population is infected with H. pylori (6) and the oral-oral and the fecal-oral modes of transmission have been postulated(7). Viable H. pylori has been isolated from faeces (8), saliva (7), dental plaque (3),(9) and various oral lesions (10). However, the transmission and the source of this infection are still unclear. The failure of triple therapy or quadruple therapy to clear H. pylori infection from the dental plaque, despite its clearance from the gastric mucosa (11), raised the possibility that dental plaque is the potential source of re-infection of the gastric mucosa. The detection of this microorganism in the oral cavity has been reported by several groups (4),(12),(13), who demonstrated that the oral cavity acts as a potential reservoir for H.pylori or a possible route of transmission. Periodontal treatment in combination with systemic therapy, has exhibited the successful eradication of gastric H.pylori as compared to systemic therapy alone, with the decreased risk of reinfection. (14)

However, other studies have not detected H.pylori from dental plaque samples (15),(16),(17) If the oral cavity is the reservoir for H.pylori, the eradication of this bacterium from the oral cavity is necessary to prevent gastric infection. The aim of our study was to find out the association between the presence of H. pylori in dental plaque and gastric infections and also, whether oral hygiene and periodontal disease were the risk factors for the H. pylori gastric infection.

Material and Methods

STUDY DESIGN
This case control study comprised of 124 patients with dyspeptic symptoms of at least 6 months of duration. These patients were enrolled and subjected to an oesophago gastro duodenoscopy in the Department of Gastroenterology, Govt. Medical College, Calicut, Kerala, India. This study was approved by the Ethical Committee, Medical College, Calicut, Kerala, India. Informed consent was taken from all patients who underwent the oesophago gastro duodenoscopy. The patients were evaluated by using a detailed questionnaire. The patients were classified into 2 groups i.e., cases and controls on the basis of the rapid urease test and the histopathology results of the gastric biopsies.

Subjects with dyspepsia, undergoing endoscopy, who were either rapid urease test positive or histopathological examination positive or both, were categorized as the cases and those who are both rapid urease test and histopathological examination negative were categorized as the controls.

A total of 130 patients were taken for the study. Among these 130 patients, 6 patients did not undergo the endoscopic procedure because of some technical problems. Therefore, a complete set of data was available for these 124 patients. Data from these 124 patients were used for final analysis. Out of these patients, 60 patients were categorized as the cases and 64 were taken as the controls, depending on the above mentioned criteria.

The patients who were included in this study were of the age group ranging from 16-65 years (11), who were partially or fully dentate (>8 teeth excluding 3rd molars). The patients had no systemic conditions modifying periodontal disease manifestations (diabetes, osteoporosis and cellular immunity disorders) and no conditions contraindicating a periodontal examination (increased risk of bacterial endocarditis). There was no history of the intake of antibiotics, H2 receptor antagonists, bismuth compounds or proton pump inhibitors in the past 3 months and no history of any dental treatment in past 6 months, including oral prophylaxis.

A standard proforma was prepared, consisting of variables like name, age, sex, religion, address, occupation, socio demographic status, education status, diet, source of water supply, habits (smoking / alcohol / pet handling), oral hygiene practices and oral examination. Along with these variables, GIT symptoms (diagnostic criteria) were also included. These were recorded for each patient.

ORAL EXAMINATION
Dentition status, oral hygiene status (OHI-S) and probing pocket depth were assessed under proper illumination by using a mouth mirror, an explorer and William’s graduated periodontal probe.

Examination of dental plaque for H.pylori by the rapid urease test:
Supragingival plaque samples were taken from tooth surfaces by using sterile gracey curettes. The plaque sample was squeezed between strips of filter papers to absorb the saliva, which, due to its alkaline pH, can give a false positive result. The dried plaque sample was placed immediately into a capped Eppendorf tube containing 0.5ml of rapid urease solution. A positive result was indicated by the change in colour of the solution from yellow to pink / magenta within the first minute. The urease activity of H.pylori increased the pH to an alkaline value. Few urease positive oral microbes like S. vestibularis and A. viscosus, can give false positive results. But these organisms cannot give positive results within an hour (18)
Gastrointestinal examination
After the oral examination, endoscopic examination was done with the help of a video endoscope. Two gastric biopsy specimens were taken for the detection of H. pylori i.e., one for RUT and the other for histopathological examination (Modified Giemsa staining technique).

Statistical analysis
The study variables were analysed by using univariate analysis and the variables which were found to be significant in the univariate analysis were further analysed by logistic regression analysis by using the SPSS software version 10*. The statistical significance for the tests was set at <0.05.

In the univariate analysis, Chi square test and the odds ratio test were used to find the association between the dental plaque and H. pylori gastric infection in dyspeptic patients and to find the relationship between the oral hygiene status of the patients with H. pylori infection. ‘t’ test was used to find the correlation between periodontal health status and H. pylori infection in the dyspeptic patients.

Results

Age and Sex distribution
In the cases and the controls, age distribution was comparable with a mean age of 42.82 years for the cases and 42.50 years for the controls, with more number of cases in between the age group of 30-50 years. The results were statistically insignificant.(Table/Fig 1)
(Table/Fig 1): Age distribution

Higher levels of the positivity of H. pylori were observed in the stomach samples from the males as compared to the females. The male to female ratio in the cases and controls was approximately 2:1. (Table/Fig 2)

(Table/Fig 2): Sex distribution

Socio demographic status and Pet handlingThe effect of variables like income, occupation and education (socio demographic factors) was analyzed and it was found to be statistically non significant in this study. The socioeconomic status of the two groups was comparable in terms of the above variables.
In the case group, only 11.7% (7/60) were pet handlers as compared to 9.4% (6/64) in the control group, which showed no statistical significance (Table 3)

Habits (Smoking and alcohol consumption)
No statistically significant association was found between H. pylori infection and smoking / alcohol use in the cases and controls by the Chi square test (Table/Fig 3).

(Table/Fig 3): Prevalence among Smokers, Alcoholics and Pet handlers

Oral hygiene habits
Among the cases, 31.6% (19/60) patients used their fingers for cleaning their teeth, as compared to 14.06% patients (9/64) among the control group. 50% (30/60) of the case group patients used tooth paste as compared to 71.87% (46/60) among the control group. The results showed a relationship between H.pylori infection and oral hygiene habits. (Table/Fig 4)
(Table/Fig 4): Oral hygiene habits
The prevalence of H. pylori infection and the oral hygiene status of the patients:
The results showed more prevalence of H.pylori infection in the patients (90%) with poor oral hygiene, which was statistically highly significant. (Table/Fig 5)

(Table/Fig 5): Prevalence of H. pylori infection and Oral hygiene status of the patients

The Oesophago gastro duodenoscopy findings:
The Oesophago gastro duodenoscopy (OGD) findings were recorded as patients with normal findings, antral gastritis and gastric ulcers / duodenal ulcers or both. These findings were analysed by the Chi square test. The observed difference between the cases and the controls was statistically significant with a p value of <0.05. (Table/Fig 6)

(Table/Fig 6): Oesophago gastro duodenoscopy findings


The prevalence of gastric H.pylori infection and oral colonization by H.pylori:
86.66% of the cases (52 out of 60) showed +ve RUT / presence of H.pylori in the dental plaque. Among the controls, 12 out of 64 (18.75%) showed the presence of H.pylori in the dental plaque. A positive association was found between the presence of H.pylori in the dental plaque and the gastric infection and it was statistically significant. (Table/Fig 7)

(Table/Fig 7): Prevalence of gastric H.pylori infection and oral colonization by H.pylori (RUT Dental plaque)

Correlation of the number of teeth present and H. pylori infection:
The results showed no statistically significant relationship between the number of teeth present and H. pylori infection. (Table/Fig 8)


(Table/Fig 8): Correlation of number of teeth present and H. pylori infection

The prevalence of the H. pylori infection and probing depth:
The results showed a statistically significant association between the seroprevalence of H. pylori and the probing depth. (Table/Fig 9)
(Table/Fig 9): Prevalence of H. pylori infection and probing depth

Logistic regression analysis:
Logistic regression analysis showed that pocket depth, RUT dental plaque, OGD findings and the oral hygiene status of the patients were statistically significant. (Table/Fig 10)
(Table/Fig 10): Logistic regression analysis

Discussion

Dental plaque is a host associated biofilm of incredibly complex communities of microorganisms that lead to periodontal disease and also play a role in affecting systemic health (19). Recent studies have shown that the H. pylori bacterium which is associated with chronic gastritis, peptic ulcer disease and gastric malignancies, is also present in the dental plaque biofilm. Thus, the dental plaque biofilm may act as a reservoir for H.pylori (20).

Among the various reports on the transmission of H. pylori (7), the faecal oral and the oral-oral routes have been suggested to be the most plausible ones. Few reports have suggested that H. pylori infections are associated with heart disease (21). The association between H. pylori and oral mucosal lesions and Halitosis also have been reported by recent studies (10),(22)

From the literature, it has been seen that various studies have detected H.pylori in dental plaque and have found the association between dental plaque and H.pylori gastric infection (23),(24),(25).

In contrast to these studies, certain studies have shown that dental plaque may not be a relevant reservoir of H. pylori (17),(26).

Despite the presence of a large number of studies, the role of dental plaque in the transmission of H.pylori induced gastric infections is still controversial.

In the present case control study, we found that the patients were in the age group between 30-50 years. The age distribution of the cases and controls were comparable with the mean age for the cases (42.82 years) and that for the controls (42.50 years). Higher levels of positivity of H. pylori were observed in stomach samples from males as compared to the females (approximately 2:1).

The effect of variables like income, occupation and education (socioeconomic factors) was analyzed and it was found to be statistically non significant in this study. This is in agreement with the observations of a study done by Berroteron et al (27) (2002).

H. pylori infection, smoking and alcohol consumption are risk factors for acid peptic disorders. However, in the present study, no statistically significant association was found between H. pylori infection and smoking / alcohol use in the cases and the controls by the Chi square test.

Similar results have been reported by Hardo et al (28) (1995) who demonstrated that smoking was not associated with a higher rate of infection.

Pet handling by the patients was also evaluated. The patients were divided into two groups; those who handled pets and those who did not. The data were analysed by the Chi square test. In the case group, only 11.7% (7/60) were pet handlers, as compared to 9.4% (6/64) in the control group, which showed no statistical significance.

The Oesophago gastro duodenoscopy (OGD) findings were recorded as patients with normal findings, antral gastritis, andgastric ulcers / duodenal ulcers or both. These findings were analysed by the Chi square test. The observed difference between the cases and the controls was statistically significant, with a p value of <0.05.

The oral hygiene habits in the cases and controls were evaluated by recording the oral hygiene method (finger / brush), frequency (once / twice), timing (morning / night / both) and the material used (paste / powder / charcoal). The data were analysed by the Chi square test. Among the cases, 31.6% (19/60) patients used their fingers for cleaning teeth as compared to 14.06% patients (9/64) among the control group. 50% (30/60) of case group patients used tooth paste as compared to 71.87% (46/60) in the control group. The frequency of tooth brushing and timing had no statistical significance. But the results showed that a positive relationship existed between the prevalence of H. pylori infection and the oral hygiene technique and the material used. Evidently, the oral hygiene status of the patients was found to be influenced by the brushing technique and the material which was used for tooth brushing.

The oral hygiene status of the patients was examined by using a simplified Greene and Vermillion oral hygiene index. The patients were categorized into good, fair and poor oral hygiene, based on their oral hygiene score. 90% of the cases had poor oral hygiene. The statistical analysis showed a significant relationship between poor oral hygiene and H. pylori infection. H. pylori positivity in the dental plaque was related to the oral hygiene index score. Similar results have been shown by studies done by Avcu et al (29) (2001) and Bruce A Dye et al (30) (2002).

In contrast, fewer studies have found that there is no significant association between H.pylori colonization in the dental plaque and gastric infection (27),(31).

The presence of H. pylori in the dental plaque was examined by the rapid urease test and the results were scored as positive (H. pylori present) or negative (H. pylori absent). Out of the 124 dyspeptic patients, 64 patients (51.6%) showed a positive rapid urease test, thus indicating the presence of H.pylori in the dental plaque. Statistical analyses have shown that there is a positive association between the presence of H. pylori in the dental plaque and gastric infection. From the literature, it has been seen that many studies have evaluated the association between the H.pylori gastric infection and the dental plaque. Our results are in accordance with the results of these studies (11),(23),(32). The CLO test to detect H. pylori in the dental plaque would thus be a reliable first line diagnostic approach for the gastric H. pylori infection (23).

On the other hand, there are also reports suggesting the absence or lower prevalence of H. pylori in the dental plaque of dyspeptic patients with gastric H. pylori infections (15),(16),(33).

In the present study, we also compared the association of the number of teeth present and H. pylori infection by using the non parametric Mann-Whitney test. The results showed no significant association with respect to the number of natural teeth present and H. pylori gastric infection. These results were in accordance with the studies done by other authors (34),(35).

The probing pocket depth in patients was examined by using William’s graduated periodontal probe on 4 sites of the teeth (buccal / labial, lingual / palatal, mesial and distal) and the results were analysed by univariate analysis (‘t’ test) and logistic regression analysis. The mean probing depth in the cases was 3.20mm, as compared to 2.72mm among the controls and the results showed a statistical significant relationship, with p value of <0.05 by using ‘t’ test. This was further analysed by logistic regression analysis and it was found that the variables had p value of <0.05 and that this was statistically significant. This difference in probing pocket depth among the cases and the controls may be due to the poor oral hygiene status in the cases.

Previous studies also have reported that poor periodontal health characterized by advanced periodontal pockets may be associated with H. pylori infections (30),(36),(37).

But few studies have found no association between periodontal pocket depth and the H.pylori infection (12),(27)

In the present study, we observed that the results shown by the RUT dental plaque examination were comparable with the results shown by the histopathological examination of the gastric biopsies. The clinical implication is that the detection of H.pylori in the dental plaque can be a reliable first line diagnostic approach to screen the patients with gastric complaints before going ahead with endoscopic biopsies.

Regarding the limitation of the rapid urease test to detect the presence of H. pylori in the dental plaque, it has been noted that there is a chance for false positive results. This may be due to other urease positive oral microbial species like S. vestibularis and A. viscosus. Even though these organisms cannot give positive results within an hour as given by H. pylori, further evaluation is required for the confirmation of this finding. To rectify this limitation, more specific and sensitive diagnostic tests like PCR and culture methods are needed.

Conclusion

In our study, we found that there is a statistically significant association between Helicobacter pylori in the dental plaque and Helicobacter pylori associated gastric diseases. Dental plaque, the biofilm may act as a reservoir of Helicobacter pylori reinfection after successful antibiotic therapy. The maintenance of good oral hygiene, plaque control measures and pocket eradication therapy may play effective roles in the successful management of Helicobacter pylori associated gastric diseases.

Long term studies with a larger sample size are required to assess the efficacy of the plaque control programme on Helicobacter pylori associated gastric diseases.

Key Message

1. The detection of H.pylori in dental plaque can be a reliable first line diagnostic approach to screen the patients with gastric complaints.
2. Poor oral hygiene and periodontal disease can be the risk factors for H.pylori associated gastric diseases.
3. Plaque control measures and periodontal therapy can be useful adjunctives to systemic antimicrobial therapy for H. pylori eradication.

Acknowledgement

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