Association between recurrent aphthous stomatitis and Helicobacter pylori infection: a meta-analysis

Objectives

Several studies have shown the possible involvement of Helicobacter pylori infection in individuals with recurrent aphthous stomatitis (RAS), but the relationship remains controversial. This meta-analysis was performed to validate the association between RAS and H. pylori infection.

Materials and methods

The PubMed database was searched up to January 25, 2013 to select studies on the prevalence of H. pylori infection between RAS patients and control subjects. Studies were included if they evaluated and clearly defined exposure to RAS, reported the incidence of H. pylori infection, or provided data for their estimation. For subgroup analyses, studies were separated by region, publication year, and source of controls to screen the potential factors against the results. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Summary odds ratio (OR) estimates with 95 % confidence intervals (CIs) were calculated using the fixed-effects model.

Results

Seven case-control studies containing 339 cases and 271 controls were eventually selected for analysis. A total of 100 (29.50 %) RAS patients had H. pylori infection, which was significantly greater than the 54 (19.93 %) non-RAS controls with H. pylori infection (OR?=?1.85, 95 % CI: 1.24–2.74, P?=?0.002). This result persisted in a hospital-based control subgroup (OR?=?2.72, 95 % CI: 1.57–4.72).

Conclusions

Based on our meta-analysis, H. pylori infection is associated with an increased risk of RAS.

Clinical relevance

The eradication of H. pylori in the stomach may promote relief of RAS symptoms and healing of oral ulcers, and even prevent the occurrence of RAS.     

Recurrent aphthous stomatitis and Helicobacter pylori

Background

Recurrent aphthous stomatitis (RAS) is a recurrent painful ulcerative disorder that commonly affects the oral mucosa. Local and systemic factors such as trauma, food sensitivity, nutritional deficiencies, systemic conditions, immunological disorders and genetic polymorphisms are associated with the development of the disease. Helicobacter pylori (H. pylori) is a gram-negative, microaerophile bacteria, that colonizes the gastric mucosa and it was previously suggested to be involved in RAS development. In the present paper we reviewed all previous studies that investigated the association between RAS and H. pylori.

Material and Methods

A search in Pubmed (MEDLINE) databases was made of articles published up until July 2015 using the following keywords: Helicobacter Pylori or H. pylori and RAS or Recurrent aphthous stomatitis.

Results

Fifteen experimental studies that addressed the relationship between infection with H. pylori and the presence of RAS and three reviews, including a systematic review and a meta-analysis were included in this review. The studies reviewed used different methods to assess this relationship, including PCR, nested PCR, culture, ELISA and urea breath test. A large variation in the number of patients included in each study, as well as inclusion criteria and laboratorial methods was observed. H. pylori can be detected in the oral mucosa or ulcerated lesion of some patients with RAS. The quality of the all studies included in this review was assessed using levels of evidence based on the University of Oxford’s Center for Evidence Based Medicine Criteria.

Conclusions

Although the eradication of the infection may affect the clinical course of the oral lesions by undetermined mechanisms, RAS ulcers are not associated with the presence of the bacteria in the oral cavity and there is no evidence that H. pylori infection drives RAS development. Key words:Campylobacter, elisa, h. pylori, Helicobacter Pylori, RAS, recurrent aphthous stomatitis, PCR.     

Periodontal treatment is more effective in gastric Helicobacter pylori eradication in those patients who maintain good oral hygiene

Objectives: This study aimed to investigate the effect of periodontal treatment and oral hygiene on the eradication of gastric Helicobacter pylori. Materials and methods: In this clinical trial, the 98 patients with gastric H. pylori infection that were enrolled received either triple-therapy regimen only or triple-therapy regimen plus periodontal treatment given during triple therapy. Eradication of H. pylori was checked at 3 months, and then after therapy using the urea breath test. Results: The triple-therapy plus periodontal treatment regime resulted in a 64.7% eradication rate, and the triple-therapy regime alone resulted in a 51.1% eradication rate (P = 0.17). Additionally, subgroup analysis indicated that the beneficial effect of periodontal treatment on the gastric H. pylori eradication rate improved if adequate plaque control was maintained (P = 0.02). Multivariate logistic regression analysis showed that post-treatment oral hygiene status [as indicated by the Oral Hygiene Index (OHI)] was associated with H. pylori eradication (P = 0.02), but not with pretreatment oral hygiene status (P = 0.24). Oral hygiene measures without periodontal treatment appear to have a limited impact on H. pylori eradication. Post-treatment oral hygiene level (OHI ≤ 1.25) had a positive effect on H. pylori eradication, increased the gastric eradication rate, with an OR of 3.19, and the oral H. pylori eradication rate, with an OR of 4.57. Furthermore, if periodontal treatment was unsuccessful in eliminating oral H. pylori, as tested using the Campylobacter-like organism test, the OR for the unsuccessful gastric eradication increased 64-fold. Conclusion: This result illustrates that the key factors for achieving successful gastric H. pylori eradication are professional periodontal treatment and the patients’ later adherence to an oral hygiene regimen.     

Helicobacter pylori in the oral cavity and gastric mucosa: a meta‐analysis

J Oral Pathol Med (2011) 40 : 317–324 Background: Helicobacter pylori have been found in the oral cavity and stomach. This study is to establish whether there might be any associations between isolates of H. pylori in the oral cavity and those in the stomach by meta‐analysis. Methods: Studies reporting raw data on the prevalence of H. pylori infection in the oral cavity in gastric H. pylori‐positive and H. pylori‐negative patients, in patients with gastroesophageal diseases, and in healthy individuals and studies reporting data on the eradication rate in the oral cavity or stomach, published in the English language, were identified through MEDLINE and EMBASE up to May 2010. Results: The prevalence of H. pylori infection in the oral cavity in gastric H. pylori‐positive patients was significantly higher (45.0%) than that in gastric H. pylori‐negative patients (23.9%). The pooled odds ration (OR) was 3.61 and the 95% CI was 1.91–6.82 (P < 0.0001). Different diagnostic methods produced different pooled ORs with PCR the highest (OR = 5.11, 95% CI: 2.08–12.54, P = 0.0004) and rapid urease test (RUT) the lowest (OR = 2.00, 95% CI: 0.80–5.00, P = 0.14). The 44.8% (91/203) prevalence of H. pylori infection in the oral cavity in patients with clinical and/or histological gastroesophageal diseases was significantly higher than the 13.2% (21/159) in patients with non‐ulcerous dyspepsia or healthy controls (OR = 5.15, 95% CI: 2.97–8.92, P < 0.00001). The eradication efficiency in stomach is 85.8% (187/218), while in oral cavity it is only 5.7% (9/158). The OR is 55.59, P < 0.00001. Conclusions: There is a close relation between the infection of H. pylori in the oral cavity and stomach. H. pylori in the oral cavity are more difficult to be eradicated than in the stomach. It may be a source of reinfection.     

Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases

Background

Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with peptic ulcer, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of H. pylori in the oral cavity of individuals with periodontal disease and gastric diseases.

Methods

115 individuals, with mean age 49.6 (±5.8) years, were divided in 4 groups: (A) with gastric diseases and periodontal disease; (B) with gastric diseases and no periodontal disease; (C) without gastric diseases and without periodontal disease, (D) without gastric diseases and with periodontal disease. Supra and subgingival plaque samples were collected from posterior teeth of the individuals with sterile paper points, and prepared for Polymerase Chain Reaction analysis. Fisher's exact test was used for detecting statistical differences between groups (p < 0.05).

Results

H. pylori was detected in supragingival plaque of 9/36 (25%) of group A, 1/31 (0.3%) of group B, 0 (0%) of group C and 3/36 (8.3%) of group D. No subgingival samples were positive for H. pylori. There was a statistically higher prevalence of H. pylori in groups A and D when compared to B and C (p < 0.05).

Conclusion

H. pylori was detected in the supragingival plaque, but not in the subgingival plaque, of individuals with periodontal disease and upper gastric diseases. There was an association between the supragingival colonization of H. pylori and oral hygiene parameters such as the presence of plaque and gingival bleeding.     

Comparison of different methods to detect <Emphasis Type="Italic">Helicobacter pylori</Emphasis> in the dental plaque of dyspeptic patients

The aim of this study was to compare different methods of detection of Helicobacter pylori (H. pylori) in the dental plaque of dyspeptic patients. After recording the clinical indices, culture and polymerase chain reaction (PCR) methods were performed on plaque samples, while rapid urease test in addition to these tests was carried on gastric samples from 67 dyspeptic patients who attended for an upper gastrointestinal endoscopy. Forty-seven of 67 patients were H. pylori-positive in gastric biopsy material whereas the microbial dental plaque from 19 patients demonstrated H. pylori positivity detected by PCR. Among the patients, 25.4% harbored H. pylori both in the stomach and in microbial dental plaque. No significant correlations were found among the presence of H. pylori in the stomach, in plaque, and clinical variables (P > 0.05). Although oral hygiene was observed optimal and the mean of pocket depth was not found to be higher, the prevalence of H. pylori was observed to be higher in dental plaque. According to our results, PCR technique gave the highest detection rate both in gastric biopsy and in dental plaque compared to the other methods used.     

Detection of cytotoxin genotypes of Helicobacter pylori in stomach, saliva and dental plaque

Background

The aim of this study was to detect the presence of Helicobacter pylori and its virulent cagA genes in the oral cavity of individuals with upper gastric diseases. Sixty-two individuals (42 ± 2.3 years) with dispepsy symptoms, referred for gastroscopy and who were H. pylori positive in the gastric biopsy, were recruited and separated in two groups: case group—individuals with gastric disease (n = 30); control group—individuals with no gastric disease (n = 32); saliva, dental plaque and biopsy samples were collected from all individuals. Oral and biopsy samples were analyzed by PCR using specific primers for H. pylori 16S ribosomal and cagA genes. PCR products were sequenced for DNA homology confirmation. H. pylori was detected neither in dental plaque nor in saliva in the control group. In the case group H. pylori DNA was detected in 16/30 (53.3%) saliva samples and in 11/30 (36.6%) dental plaque samples. The cagA gene was detected in 13/30 (43.3%) gastric biopsies, in 7/16 (43.8%) saliva samples, and in 3/11 (27.3%) dental plaque samples. Eighteen (60.0%) individuals in the case group were H. pylori positive both in oral and biopsy samples, and 8 (26.6%) of those were positive for cagA-H. pylori DNA. H. pylori and its virulent clone showed a higher prevalence in the oral cavity of individuals in the case group than in the control group (p < 0.05). Our results suggest that dental plaque and saliva may serve as temporary reservoir for H. pylori and its virulent cagA variant in individuals with gastric disease.     

Periodontal Treatment Is Associated With Improvement in Gastric Helicobacter pylori Eradication: An Updated Meta-analysis of Clinical Trials

ObjectivesThe efficacy of conventional systemic antibiotic therapy for eradication of Helicobacter pylori has been seriously challenged by antibiotic resistance. Identification of alternative therapeutic strategies might help to overcome this limitation. The aim of this study was to update previous meta-analyses that investigated the effect of periodontal treatment on gastric H. pylori eradication.MethodsA systematic electronic search of the literature was conducted to identify all published clinical trials that compared the effect of adjunct periodontal treatment on conventional systemic H. pylori eradication therapy.ResultsThe updated analysis (consisting of 541 participants representing six studies) demonstrated that, compared with conventional systemic eradication therapy alone, the addition of periodontal treatment resulted in improvements in gastric H. pylori eradication rates with OR 4.11 (P = 0.01). Moreover, not to lose any data, the previously presented Chinese results that could not be assessed by any available mechanism deduced from previously published meta-analysis and with other records were re-analysed. Similarly, the second meta-analysis adding up to a final cluster of 10 studies (909 participants) gives further credence to periodontal treatment as a useful concomitant therapy in the H. pylori eradication therapy (odds ratio [OR] = 2.65; P = 0.0002). Finally, the meta-analysis of four trials consisting of 177 cases and 161 controls showed that periodontal treatment also improved non-recurrence rates of gastric H. pylori infection, with an OR of 5.36 (P-value = 0.0002).ConclusionAlthough the inclusion of five additional clinical trials in this updated meta-analysis has not changed the result of the previous review, the current meta-analysis is superior for having removed one study involving the use of chlorhexidine, which did not meet appropriate criteria for inclusion. Our results strengthen the value of periodontal treatment as an adjunctive remedy. Consistency of these results suggests that the incorporation of professional periodontal treatment with systemic eradication therapy may be a wise strategy, enhancing the efficacy of H. pylori eradication therapy. Systematic review registration: in PROSPERO ID number: CRD42019119347.     

The effectiveness of systemic eradication therapy against oral Helicobacter pylori

J Oral Pathol Med (2010) 40 : 428–432 Background: Helicobacter pylori infection is associated with numerous gastroduodenal diseases. The oral cavity could be a potential extragastric reservoir for H. pylori, and oral H. pylori might cause gastric reinfection after the eradication therapy. The aim of the study was to evaluate the presence of H. pylori in oral cavity of patients with gastric H. pylori infection and to examine the effectiveness of the eradication therapy against H. pylori in stomach and in the oral cavity. Methods: Fifty‐six patients with chronic periodontitis and gastric H. pylori were enrolled in the study. Gastric H. pylori infection was determined using ¹³C‐urea breath test before and 3 months after eradication therapy. The presence of the oral H. pylori was assessed using polymerase chain reaction before and 3 months after eradication therapy. The 1‐week eradication therapy consisted of amoxycilin 1 g, clarithromycin 500 mg, and proton pump inhibitor 20 mg twice a day. Results: Of 56 subjects with gastric infection, 23 (41.1%) harbored H. pylori in the oral cavity. Eradication rate in stomach was 78.3%, whereas in the oral cavity, H. pylori was not detected from any sample after the eradication therapy. Conclusion: Almost half of the patients with gastric H. pylori harbored the bacterium in the oral cavity. After the eradication therapy, H. pylori was not detected in the oral cavity, what suggests high effectiveness of the therapy protocol in the oral cavity, or it is possible that oral H. pylori is of a transient character.     

Higher levels of salivary MUC5B and MUC7 in individuals with gastric diseases who harbor Helicobacter pylori

Objective

The aim of the present study was to assess the salivary levels of MUC5B and MUC7 in individuals with dyspeptic disease and Helicobacter pylori (H. pylori) in the stomach, compared to individuals without dyspeptic disease.

Methods

30 individuals with dyspeptic disease, who underwent endoscopy for upper gastrointestinal complaints at Hospital Pedro Ernesto-RJ, Brasil and tested positive for H. pylori, and 23 controls with no dyspeptic disease, with mean age 53.5 ± 4.4 years, were included in the study. Saliva samples and 3 antral biopsy were taken for PCR analysis and histologic examination. In addition, saliva samples were tested by ELISA with F2 monoclonal antibody and EU7A antibody against MUC7, to determine MUC5B and MUC7 levels, prior to endoscopic examination. The expression pattern of the proteins was quantified by comparison to a pooled saliva sample of 19 healthy volunteers.

Results

MUC5B and MUC7 salivary levels were higher in the individuals with dyspeptic disease than in controls (p < 0.0001). 33.3% (9/30) of the dyspeptic individuals and 0% of the controls had H. pylori in the oral cavity.

Conclusions

Individuals with gastric diseases, with H. pylori in the stomach, showed higher levels of salivary H. pylori receptors-MUC5B and MUC7-than individuals without gastric diseases. These results suggest that higher levels of specific salivary mucins could be useful as risk indicators for infection by H. pylori.     

Helicobacter pylori in dental plaque and gastric mucosa

ObjectivesThe aim of this study was to investigate the presence of Helicobacter pylori in both dental plaque and gastricmucus.Study designDental scaling hand instruments were used to collect supragingival and subgingival dental plaque from 81 dentate participants. Denture plaque was obtained from the fitting surfaces of dentures from 41 edentulous patients. Gastric mucus from gastric mucosa of antrum and body of stomach were collected from all 122 participants (92% white) with a soft gastroscopic brush. These samples were dispersed in modified urea broth and normal saline solution before being inoculated onto selective Skirrow's agar and incubated in a microerophilic atmosphere for culturing H. pylori.ResultsDental plaque from all dentate participants was negative for H. pylori culture. Only one 80-year-old edentulous patient had positive H. pylori culture in both gastric mucus and denture plaque.ConclusionsAlthough dental plaque has a mixed flora that may act as a reservior for gastric reinfection, dental plaque could not be implicated as the major reservoir of H. pylori for gastric reinfection.     

The association between interleukin polymorphism and recurrent aphthous stomatitis: A meta-analysis

ObjectiveTo assess the association between interleukin gene polymorphism and recurrent aphthous stomatitis (RAS).DesignsTwo electronic databases, PubMed and Embase, were utilized to assemble potentially relevant studies meeting the inclusion criteria. A meta-analysis was conducted using Revman 5.3 software (London, UK), and the pooled odds ratio (OR) and 95% confidence interval (CI) were then used to evaluate the strength of the relationship between the gene polymorphisms of IL-1beta(−511C/T), IL-1beta(+3954C/T), IL-6(−174G/C) and IL-10(−1082G/A) and the risk of RAS.ResultsTen studies were included in the final meta-analysis, with 884 cases and 1104 controls participating. The results demonstrated that the polymorphism of IL-1beta(−511C/T) significantly increased the probability of the development of RAS in Europeans. (T vs. C: OR = 1.35, 95%CI = 1.09–1.67; CC vs. CT + TT: OR = 1.77, 95%CI = 1.24–2.53; CC vs. TT: OR = 1.86, 95%CI = 1.18–2.95). Furthermore, the C allele in IL-1beta(+3954C/T) was determined to be related to the risk of RAS in Americans (C vs. T: OR = 1.52, 95%CI = 1.07–2.17) and the presence of the C gene was considered a risk variant (CC + CT vs. TT: OR = 1.46, 95%CI = 1.01–2.11), but no relationship was found between the polymorphism of IL-10(−1082G/A) and the risk of RAS.ConclusionsThe meta-analysis suggested that the mutation of IL-1beta(−511C/T) in Europe and IL-1beta(+3954C/T) in America tend to increase the risk of RAS, but the polymorphism of IL-10(−1082G/A) appears to have no association with RAS risk in America. Further study is required to confirm the above conclusions.     

The Association of Dental Pulp Stones to Cardiovascular and Renal Diseases: A Systematic Review and Meta-Analysis

BackgroundPulp stone (PS) is a dystrophic calcification in the tooth’s pulp chamber and was suggested in the literature to be associated with other calcifications in the body. This study aimed to investigate the association of PS to cardiovascular diseases (CVD) and renal stones (RS).MethodsThree databases were searched until June 2021 in addition to manual searching of Google Scholar and grey literature. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale. The odds ratio (OR) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to investigate the association of PS with CVD and or RS (P value ? .05).ResultsThe database search identified 4933 studies, and 19 studies were finally included. The risk of bias was low in 13 studies, moderate in 4 studies, and high in 2 studies. The meta-analysis of the moderate and low risk of bias studies revealed a significant association between PS and CVD (OR, 3.35; 95% CI, 1.91–5.89; P < .001, I² = 65%), but no association was found between PS and RS. The results also revealed an association between PS and CVD in patients older than 40 (OR, 8.78; 95% CI, 3.64–21.17; P < .001, I² = 0%).ConclusionsThe current study results showed an association between PS and CVD, but no association was found between PS and RS. PS in patients older than 40 years, compared with younger patients (<40 years), was associated with CVD.     

Association of MTHFR gene C677T mutation with recurrent aphthous stomatitis and number of oral ulcers

Objectives

Recurrent aphthous stomatitis (RAS) is a common ulcerative disease of the oral mucosa. Methylenetetrahydrofolate reductase (MTHFR) gene variants are associated with thrombophilia and vasculopathy that may result in oral ulceration. Oral ulcers are also the most common feature of Behcet’s disease (BD). Association of MTHFR gene C677T mutation with BD has been reported in different populations. The aim of the present study was to investigate the possible association between MTHFR gene C677T mutation and RAS and evaluate if there was an association with clinical features in a relatively large cohort of Turkish patients.

Materials and methods

The study included 188 patients affected by RAS and 200 healthy controls. Genomic DNA was isolated and genotyped using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay for the MTHFR gene C677T mutation.

Results

The genotype and allele frequencies of C677T mutation showed statistically significant differences between RAS patients and controls (p?=?0.002 and p?=?0.0004, respectively). After stratifying RAS patients according to clinical characteristics of oral ulcers, a significant association was observed between C677T mutation and number of oral ulcers of RAS patients (p?=?0.006).

Conclusions

As a result, a high association between MTHFR gene C677T mutation and RAS was observed in the present study. Also number of oral ulcers was found to be associated with MTHFR C677T mutation in RAS patients.

Clinical Relevance

If our observation can be substantiated with further studies, evaluation for MTHFR mutations and perhaps folate supplementation may become necessary in selected patients.     

Evaluation of serum zinc levels in patients with recurrent aphthous stomatitis (RAS)

Background

Recurrent aphthous stomatitis (RAS) is an ulcerative disease of the oral mucosa without a clearly defined etiology. The aim of the study was to evaluate the serum zinc levels in patients with RAS in comparison to healthy controls and to validate the association between zinc levels and the course of RAS.

Methods

Seventy-five patients with RAS and 72 controls underwent full dental examination. Serum zinc levels were determined by flame atomic absorption spectroscopy (F AAS). The results were statistically analyzed with Kruskal-Wallis, Mann-Whitney, chi-square tests and the test of difference between the two rates of structure with p?<?0.05 as a significance level (Statistica 10, StatSoft®).

Results

No statistically significant differences were detected in serum zinc levels between RAS patients and healthy controls. The mean serum zinc concentration was found to be 84.2 μg/dL in RAS group and 83.9 μd/dL in controls, within the accepted norms. Zinc deficiency was observed in 10.7% patients from the RAS group and in 6.9% controls. No significant differences in serum zinc levels were found between patients when the course of the disease was considered.

Conclusions

Serum zinc concentrations did not differ significantly in RAS patients and in healthy controls and it did not influence the course of the disease. Therefore, zinc does not appear to be an important modifying factor in the development of RAS.

     

Bacterial and Dye Penetration through Interim Restorations Used During Endodontic Treatment of Molar Teeth

IntroductionThe purpose of this study was to investigate the association between dye and bacterial penetration through interim restorations used during endodontic treatment.MethodsSixty-four extracted human teeth were used, with 2 teeth each as positive and negative controls. Endodontic access with a mesio–occluso–distal cavity was prepared. Palatal cusps of maxillary molars and buccal cusps of mandibular molars were removed. Cotton was placed over the canals and covered with Cavit. Thirty teeth were restored with Ketac Silver (KS) and 30 with KS reinforced with a stainless steel band (KSSB). Samples were submersed in India ink mixed with brain heart infusion broth containing Streptococcus gordonii. After 3 months of simulated chewing, structural integrity and dye and bacterial penetration were assessed.ResultsPositive controls had both dye and bacterial penetration. Negative controls had no dye or bacterial penetration. All KS restorations debonded, whereas 18 KSSB restorations (60%) debonded. KS restorations were 1.67 times more likely to debond than KSSB restorations (Fisher exact test). KS was 1.3 times more likely to have dye penetration than KSSB (Fisher exact test) and 3 times more likely to have bacterial penetration, although not statistically significant (χ² test). Overall, 88.3% of specimens had dye penetration, and 20% had bacterial penetration. This 68.3% difference indicated no association between dye and bacterial penetration (exact McNemar test).ConclusionsStainless steel bands helped maintain structural integrity of KS restorations under masticatory function. Bands helped prevent dye penetration but not bacterial penetration. There was no association between dye and bacterial penetration.     

Levels of salivary IgA in patients with minor recurrent aphthous stomatitis: a matched case–control study

Objectives

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease. Despite plenty of studies on aetiopathogenesis of RAS, a definite cause is not clear. The objective of this study was to determine the potential changes of salivary IgA and salivary flow rate in patients affected with minor form of RAS.

Materials and methods

Levels of salivary IgA in 33 patients with acute RAS (minor form) and 33 matched healthy controls were determined using enzyme-linked immunosorbent assay. Resting salivary flow rates were determined too. Both measurements, levels of salivary IgA and resting salivary flow rate, were performed again for each RAS patient in remission phase.

Results

Levels of salivary IgA were significantly increased in acute phase of RAS [median (interquartile range)—124.94 μg/mL (106.22–136.31)] in comparison with the levels in healthy controls [88.92 μg/mL (76.85–93.91; P?<?0.001)] and with the levels in remission phase [102.4 μg/mL (84.6–120.16; P?=?0.01)]. Even in the disease-free period (remission phase), levels of salivary IgA remained significantly higher in comparison with the levels in healthy controls (P?=?0.01). Salivary flow rates, on the other side, were not influenced by the disease state (RAS vs. healthy), phase (acute vs. remission) or even gender (males vs. females).

Conclusion

Marked increase of salivary IgA in acute and remission phases of the minor RAS may suggest a potential role for this immunoglobulin in pathogenesis of the disease.

Clinical relevance

Salivary IgA may be an important aetiological agent in the pathogenesis of RAS, and hence, its immunomodulation may help prevent the disease.     

Absence of Helicobacter pylori in the oral cavity of 10 non‐dyspeptic subjects demonstrated by real‐time polymerase chain reaction

Helicobacter pylori plays a significant role in gastric disease. However, the presence of this bacterium in the oral cavity remains controversial. The aim of the present study was to detect and quantify H. pylori in 29 different sites of the oral cavity in non‐dyspeptic subjects by means of real‐time polymerase chain reactions (PCR). Ten subjects without gastric symptoms were studied. Samples from unstimulated saliva, three sites of the tongue, oral mucosa, and 12 sites of both supragingival and subgingival plaque were collected from each subject. DNA was extracted from the oral samples and analysed for the presence of H. pylori by real‐time PCR (LightCycler^®) using JW23/22 primers which targeted the 16S rRNA gene. DNA from H. pylori DSM 4867 was used as a positive control. Amplification efficiency for the LightCycler^® 2.0 runs ranged from 1.8 to 2.4. Melting curve analysis identified all the positive control capillaries, which contained H. pylori reference DNA, as a single and narrow peak at a melting temperature between 84.5 and 84.9°C. All the negative control capillaries with no template control and the 29 oral samples from each subject showed either no melting peaks or broad melting peaks below 80°C, which were considered as primer dimers. Therefore, H. pylori was not detected from any of the 290 oral samples. As a conclusion, H. pylori seems not to be permanently present in the oral cavity of a non‐dyspeptic population.     

Serum IgG antibodies to Helicobacter pylori in patients with recurrent aphthous stomatitis and other oral disorders

Objectives. To compare the frequency of serum anti-Helicobacter pylori IgG antibodies in patients with recurrent aphthous stomatitis with patients with other oral ulcerative and nonulcerative disorders.Study design. Prospective study of serum IgG antibodies to H. pylori in 75 patients with recurrent aphthous ulcers, 15 patients with other oral ulcerative disorders, 41 patients with other oral mucosal lesions, 27 patients with oral dysaesthesia, and 25 healthy control patients without oral lesions.Results. The frequency of anti-H. pylori seropositivity was not significantly greater in patients with recurrent aphthous stomatitis (30.6%) compared with patients with other ulcerated oral mucosal lesions (33.0%) and controls (24%).Conclusions.Helicobacter pylori does not appear to be of etiologic significance in the development of recurrent aphthous stomatitis.     

Outcome following treatment for Helicobacter pylori in patients with recurrent aphthous stomatitis

Objective: The aim of the current study was to investigate any association of Helicobacter Pylori (HP) in recurrent aphthous stomatitis (RAS) and the effect of eradication of the microorganism in the clinical course of the disease. Study design: Forty‐eight patients with RAS were included in the study. Twenty‐six were women and 22 men, of average age 41.3 ± 2.44. Thirty‐four out of these 48 patients were HP positive and the rest 14 who were negative were used as a control group. The diagnosis of HP infection was based on the detection of specific immunoglobulin G (IgG), and immunoglubulin A (IgA) antibodies using the enzyme‐linked immunoabsorbent assay technique in the serum and the saliva of the patients. In all HP carriers an eradication therapy was administered. After a 2‐month period the patients were checked for HP status, using ¹³ C‐UBT. The follow up period was 6–12 months following the eradication therapy. Results: At entry patients with HP infection suffered from more severe symptoms compared with HP negative patients (P < 0.05). After the administration of HP eradication therapy, patients who had become negative showed a remarkable improvement (62.5%) with reference to recurrence of RAS as well as to symptom intensity. In 29.2% of patients symptoms had disappeared and in 33.3% of patients there was a decrease in both the frequency of recurrence and the intensity of symptoms. After the eradication treatment, the periods between recurrence of RAS in patients who had become negative were statistically significantly longer compared with those before treatment (P < 0.001). Another important observation was that patients who became negative after eradication therapy were of comparable clinical status with those who were HP negative from the beginning of the study (P > 0.05). Conclusions: These findings support the concept of a potential association between RAS and HP.