Ioana Martu, Liliana Pasarin, Diana Tatarciuc, Maria-Alexandra Martu, Ionut Luchian, Sorina-Mihaela Solomon, Irina-Georgeta Sufaru
Abstract
Background: Periodontitis is a chronic, dysbiosis-driven inflammatory disease with systemic immune and inflammatory footprints. Major gastric diseases—including Helicobacter pylori–associated gastritis, peptic ulcer disease, and gastric cancer—also evolve within an inflammation-shaped mucosal ecosystem. Objective: To summarize current evidence connecting periodontal inflammation with gastric outcomes and to identify clinically actionable signals and research gaps. Results: Observational studies and meta-analyses generally report higher odds of gastric H. pylori infection in individuals with periodontitis, while oral detection of H. pylori (especially in dental plaque) is frequent but method-dependent and does not prove viable colonization. Systematic reviews of randomized trials suggest that adjunctive non-surgical periodontal therapy delivered alongside eradication regimens can increase eradication success and may reduce recurrence, supporting (but not confirming) an oral reservoir contribution in selected patients. Periodontal assessment should complement, not replace, guideline-based eradication and test-of-cure, and may be prioritized in practice after repeated treatment failure episodes. Evidence linking periodontitis with chronic gastritis, atrophic changes, or peptic ulcer disease is less robust and is dominated by cross-sectional designs with incomplete control of NSAID exposure, smoking, socioeconomic position, and metabolic comorbidity. For gastric cancer, pooled observational data indicate small risk elevations with substantial heterogeneity and potential reverse causality; emerging genetic approaches have reported null or inconclusive causal signals. Conclusions: The oral–gastric connection is biologically plausible and most consistently supported for H. pylori–related endpoints, whereas causality for broader gastric outcomes remains unproven. Standardized periodontal phenotyping, guideline-consistent gastric endpoints, and contemporary multicenter trials are needed to define which high-risk subgroups benefit from integrated dental–gastroenterology management.
DOI : 10.62610/RJOR.2025.4.17.4
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