Stomach Ulcer and Bad Breath? This Infamous Mouth Bacteria Can Explain Why You Have Both

 

If you have stomach pain, gastritis (inflammation of the stomach), or ulcers, you may be one of every two people who have the bacteria Helicobacter pylori (H. pylori) living in their gut. H. pylori is a notorious bacterium that can cause a lot of damage in certain people. One of the trickiest problems with H. pylori is getting rid of it. Why? Known as a stomach bacterium, H. pylori also lives on the gums, teeth, and tongue where it can avoid the reach of antibiotics by hiding in protective dental plaque biofilms. Some scientists believe this could explain why so many people can’t get rid of H. pylori. Aside from H. pylori gut symptoms, we will discuss how H. pylori in the mouth could be the cause of mouth sores, bad breath, and tongue inflammation. We will go over ways to get rid of H. pylori in the mouth. With this information, clinicians and consumers can develop a comprehensive oral-gut strategy for resolving tough-to-treat H. pylori stomach infections.

 

H. pylori Can Cause Stomach Cancer, Ulcers, and Reflux

H. pylori affects about half of the world’s population. It is the main cause of chronic gastritis (inflammation of the stomach lining), stomach ulcer, and stomach cancer. H. pylori is a common bacteria that lives in the gastric mucosa. It can burrow into the epithelial lining of the stomach and damage the cells there. This exposes the underlying stomach tissues to very high acid levels, which makes matters worse and can even create sores, or ulcers.

Helicobacter pylori has been evolving with us for well over 50,000 years.¹ Robin Warren and Barry Marshall were awarded the Nobel prize in 2005 for discovering that H. pylori could cause stomach ulcers, gastritis (inflammation of the stomach lining causing pain, nausea, vomiting, or a sense of fullness), and stomach cancer.

Symptoms of H. pylori Stomach Infection:

• Chronic gastritis
• Peptic ulcer
• Mucosa-associated lymphoid tissue lymphoma
• Gastric carcinoma²
• Refractory iron deficiency anemia
• Chronic idiopathic thrombocytopenic purpura²
• Antral gastritis and duodenal ulcer disease in children, which is likely to present as chronic abdominal pain³

H. pylori Lives in the Mouth, Too!

H. pylori isn’t just a bacteria that lives in the stomach causing ulcers or heartburn in some people. H. pylori lives in dental plaques in the mouth! It has been found in saliva,⁴ biofilms living above the gums, on the tongue,⁵ and on denture fittings.⁶ H. pylori has been found in dental plaque in 5% to 83% of people.⁷

Researchers have discovered that when someone has a stomach infection with H. pylori, there’s a good chance that it’s living on their teeth as well.⁵ High levels of H. pylori were found in the mouths of H. pylori-positive children with dyspepsia.⁶

It seems that H. pylori living on the teeth can be a continuous source of H. pylori to the stomach, making it hard to get rid of even with all the appropriate treatments. In one study of people with stomach ulcers, those who had regular dental cleanings were able to get rid of H. pylori infection more effectively. For their counterparts who didn’t get a dental cleaning to remove plaque, nearly 85 percent had a relapse of the H. pylori infection. ^8,9

H. pylori infection is a risk factor for certain oral diseases such as periodontal disease, canker sores, squamous cell carcinoma, burning tongue, and bad breath.⁷ Antibiotic treatment isn’t always successful, which leads some researchers to believe that H. pylori in the mouth could be a source of constant reinfection.

H. pylori may be a perfect example of the oral-gut connection. Bacteria living on our teeth can take the “waterslide” down the esophagus and dive right into the stomach, small intestine, or large intestine. The oral microbiome can influence the gut microbiome and vice versa. Since H. pylori can cause stomach cancer, gastritis, and ulcer, it may be wise to develop a two-pronged approach for successful treatment of H. pylori, including both the mouth and the gut. Indeed, to rid the stomach of H. pylori, some experts recommend especially targeting H. pylori in the mouths of patients with periodontitis.⁷

 

Symptoms of H. pylori in the Mouth

• Bad breath^5,6
• Burning tongue⁷
• Canker sores (recurrent apthous ulcers)^5-7
• Dental cavities⁶
• Glossitis (inflamed, swollen tongue)⁶
• Squamous cell carcinoma (cancer of the middle and outer layers of skin) ⁷

Can H. pylori Live on Your Toothbrush?

 

It’s hard to find clear-cut scientific information about whether H. pylori can live on your toothbrush or not. But we do know a few things, which make your toothbrush highly suspect for carrying H. pylori.

• Toothbrushes can harbor oral pathogens and food particles.¹⁰
• H. pylori colonizes the mouth in 5% – 83% of people.⁷
• You can reduce H. pylori in the mouth by brushing your teeth.⁴
• Sharing toothbrushes increases the risk of getting H. pylori.¹¹
• Dental cleanings help prevent H. pylori stomach infections from coming back after antibiotic treatment.^8,9

A word-of-mouth clinical tidbit from my colleague Dr. Natalie Groenewoud, ND, is that in Germany, clinicians have their patients boil their toothbrushes if they are being treated for H. pylori.

 

Some bacteria- anaerobic bacteria- die when they are exposed to oxygen. So, if the toothbrush head dries out completely in the air (which is recommended), those bacteria would die. However, H. pylori is a facultative anaerobe, meaning that this bacterium can live both in the presence and in the absence of oxygen. That means H. pylori could live on the head of a toothbrush, even if it is all dried out.

Given this, I would look at your toothbrush as a potential source of H. pylori. Many experts recommend getting a new toothbrush at the beginning of and after an infection or disinfecting your toothbrush on a routine basis.

If you are struggling with a difficult-to-treat H. pylori infection, then don’t forget that H. pylori could be living on your toothbrush and it needs to be changed frequently, especially after antibiotic treatment.

Where Do You Get H. pylori From?

H. pylori gets into the mouth through saliva, vomit, feces, contaminated food or water, or touching H. pylori and putting your fingers into your mouth. Even pets can carry H. pylori-like organisms.⁵

You can get H. pylori from: ⁶

• Your mother, especially if she chewed up her food and fed it to you as a baby
• Your father
• Household members
• Contaminated food
• Contaminated water
• Domestic animals
• Captive animals
• Birds

Consider that H. pylori can be shared with romantic partners, household members, and others through kissing or sharing utensils. Fecal material can spread H. pylori, making frequent hand-washing important for getting rid of H. pylori.

 

H. pylori Living in the Mouth Can Promote Drug Resistance

Reinfection with H. pylori is common. One in five people who get antibiotic therapy will be infected again.^12,13 H. pylori is more likely to recur if a person has poor oral hygiene.⁶ Many researchers hypothesize that H. pylori in dental biofilms, saliva, and periodontal disease may hold the key to difficult-to-treat H. pylori infections.⁶

Treating stomach H. pylori with systemic antibiotics may completely miss oral H. pylori and even make it stronger.⁶ Antibiotic concentrations are low in saliva while dental biofilms protect oral H. pylori from systemic antibiotic treatments. For these reasons, some suggest that H. pylori in the mouth may be harder to eradicate than even in the stomach.⁷ If H. pylori from dental plaque recolonizes the stomach lining after antibiotic treatment, it could have enhanced drug resistance.⁷

For these reasons, periodontal therapies that directly remove H. pylori from dental plaque may be important for truly removing H. pylori from the mouth and from the gut.⁷ Dental cleanings have been shown to dramatically reduce the risk of reinfection with H. pylori after antibiotic treatments.^8,9

 

Tests for H. pylori Stomach Infection

There is no “gold standard” for diagnosing H. pylori. Each test for H. pylori has advantages and disadvantages, which means there is no single best test. Rather, multiple tests are necessary to pinpoint whether a person truly has an H. pylori infection or not.¹⁴

H. pylori diagnostic tests can be broken down into two categories: invasive testing (endoscopy with biopsy, histology, culture, and rapid urease test) and non-invasive testing (serology, I3C urea breath test, and H. pylori stool antigen).¹⁵ Endoscopy with biopsy, histology, culture, and rapid urease test was for a long time considered the “gold standard” for diagnosing H. pylori.¹⁶ This involved putting a tube down the esophagus and looking at the stomach lining as well as taking samples of the stomach lining and testing it for H. pylori.

Non-invasive H. pylori tests look for H. pylori in blood, stool or breath. Urea breath test (UBT) and H. pylori stool antigen (HpSA) are recommended by the American Gastroenterological Association for optimal noninvasive H. pylori testing.¹⁷ Urea breath testing involves taking a urea substance and measuring what gases are exhaled by the lungs after taking the substance. H. pylori uses an enzyme called urease to neutralize stomach acid. If someone has H. pylori, then the urease will break down the urea substance that is given, creating carbon dioxide and ammonia. The amount of carbon dioxide found in the breath can diagnose an H. pylori infection.⁴

Blood testing for H. pylori detects antibodies to H. pylori. H. pylori can also be detected in the stool. It can be measured as H. pylori stool antigen, which is a widely available test. It can also be measured in stool using quantitative PCR, which is available by companies such as Diagnostic Solutions Laboratory.

H. pylori and the Oral Microbiome

H. pylori colonization of the mouth is more common in periodontal disease, which suggests it thrives in a dysbiotic environment. It does not appear to be causally related to periodontal disease, however.^5,7 H. pylori likes to co-exist in the mouth with other “bad bugs,” or oral pathogens, such as Porphyromonas gingivalis, Treponema denticola, and Prevotella intermedia. However, one study showed that it didn’t disturb other commensal (normal bacteria) or opportunistic bacteria. H. pylori in the mouth (whether high or low) did not significantly affect Streptococcus mutans or Lactobacilli species in the mouth.⁶

 

H. pylori: Not Always a Bad Guy

Researchers have suggested that H. pylori may not be a bad guy all the time. Many people have H. pylori, don’t have any symptoms, and never will. Since 50 percent of people have H. pylori and most have no symptoms, they say it may be a commensal organism and that it might even protect against developing certain allergies, esophageal cancer, heartburn, and obesity.^18,19

Similarly, H. pylori is so common in the mouth that some may consider it a commensal bacteria. Having H. pylori in the mouth doesn’t mean it will lead to a stomach infection.^1,5 In a study of children with dyspepsia compared to healthy children, only very low levels of H. pylori were found in the mouths of healthy children. This suggests that low levels of H. pylori in the mouth are not a health threat as long as they are kept in check with regular dental hygiene.⁶

This is often the confusion around microbes. They can be bad in certain situations and good in others. Labeling a microbe as “good” or “bad” is not cut and dry. It often depends on the other microbes in the mix and the person’s immune system and environment.

 

Treatments to Remove H. pylori from the Mouth and the Stomach

A comprehensive strategy to remove H. pylori should consider both the mouth and the stomach as reservoirs for H. pylori. Consider H. pylori gastric symptoms such as a family history of stomach cancer, heartburn, ulcers, nausea, vomiting, fullness, poor digestion, or even excessive burping. Patients complaining of bad breath, tongue inflammation, canker sores, or periodontal disease are at higher risk of having H. pylori in the mouth. In patients that have recurrent H. pylori infection after treatment, revisit the oral cavity in case it is a source of antibiotic-resistant H. pylori.

 

Take These Steps to Get Rid of H. pylori Once and for All:

 

• Brush, floss, and get your dental cleanings frequently
• Change your toothbrush during and after treating H. pylori infections and follow tips to keep your toothbrush clean
• Test the oral microbiome to find out if you have low good bacteria or excessive pathogens in the mouth
• Address dysbiosis in the mouth
• Build good bacteria in the mouth to crowd out H. pylori
• Look for and address H. pylori infections in romantic partners or family members
• Break the oral-fecal contamination cycle with frequent hand-washing and special precautions when changing diapers or toilet training
• Test for H. pylori stomach infection
• These probiotics are believed to help remove H. pylori from the stomach:
  • Lactobacillus reuteri DSM17648
  • A proprietary Pylopass strain of Lactobacillus reuteri
  • They are used for stomach infections but could be used to swish in the mouth, especially after brushing, when biofilms are more unstable.
• Consider natural treatments for H. pylori to use in the mouth and to take orally:
  • Mastic gum
  • Bismuth
  • Zinc carnosine
  • Ginger root extract
  • Deglycyrrhizinated licorice
  • Methylmethioninesulfonium (vitamin U)
  • Pistacia leiscus
  • Berberine
  • Goldenseal
  • Oregano oil
  • Barberry
  • Oregon grape root extract
  • Coptis chinensis extract
  • Five gram doses of vitamin C²⁰
  • Probiotics (before, during, and after treatment)
• An anti-inflammatory diet, stress reduction, and gut-healing formulas have also been used in comprehensive programs to effectively eradicate gastric H. pylori
• Triple or quadruple pharmaceutical therapy¹⁷

 

 

References

1. Yamaoka Y. Mechanisms of disease: Helicobacter pylori virulence factors. Nature reviews Gastroenterology & hepatology. Nov 2010;7(11):629-41. doi:10.1038/nrgastro.2010.154
2. Booka M, Okuda M, Shin K, et al. Polymerase chain reaction–restriction fragment length polymorphism analysis of clarithromycin-resistant Helicobacter pylori infection in children using stool sample. Helicobacter. Jun 2005;10(3):205-13. doi:10.1111/j.1523-5378.2005.00312.x
3. Allaker RP, Young KA, Hardie JM, Domizio P, Meadows NJ. Prevalence of helicobacter pylori at oral and gastrointestinal sites in children: evidence for possible oral-to-oral transmission. J Med Microbiol. Apr 2002;51(4):312-7.
4. Higazy E, Al-Saeedi F, Loutfi I, et al. The impact of brushing teeth on carbon-14 urea breath test results. J Nucl Med Technol. Sep 2000;28(3):162-4.
5. Bicak DA, Akyuz S. Oral Signs of Helicobacter Pylori- Review of Clinical Outcomes. Biomedical Journal of Scientific & Technical Research. 2018;8(2)
6. Aksit Bicak D, Akyuz S, Kiratli B, et al. The investigation of Helicobacter pylori in the dental biofilm and saliva samples of children with dyspeptic complaints. BMC Oral Health. Mar 21 2017;17(1):67. doi:10.1186/s12903-017-0361-x
7. Lopez-Valverde N, Macedo de Sousa B, Lopez-Valverde A, Suarez A, Rodriguez C, Aragoneses JM. Possible Association of Periodontal Diseases With Helicobacter pylori Gastric Infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022;9:822194. doi:10.3389/fmed.2022.822194
8. Anand PS, Nandakumar K, Shenoy KT. Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection? J Periodontol. Apr 2006;77(4):692-8. doi:10.1902/jop.2006.050163
9. Jia CL, Jiang GS, Li CH, Li CR. Effect of dental plaque control on infection of Helicobacter pylori in gastric mucosa. Texas dental journal. Oct 2012;129(10):1069-73.
10. Shang Q, Gao Y, Qin T, Wang S, Shi Y, Chen T. Interaction of Oral and Toothbrush Microbiota Affects Oral Cavity Health. Front Cell Infect Microbiol. 2020;10:17. doi:10.3389/fcimb.2020.00017
11. Yu X, Feng D, Wang G, Dong Z, Zhou Q, Zhang Y. Correlation Analysis of Helicobacter pylori Infection and Digestive Tract Symptoms in Children and Related Factors of Infection. Iranian journal of public health. Oct 2020;49(10):1912-1920. doi:10.18502/ijph.v49i10.4694
12. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. Feb 2017;112(2):212-239. doi:10.1038/ajg.2016.563
13. Alsamman MA, Vecchio EC, Shawwa K, Acosta-Gonzales G, Resnick MB, Moss SF. Retrospective Analysis Confirms Tetracycline Quadruple as Best Helicobacter pylori Regimen in the USA. Dig Dis Sci. Oct 2019;64(10):2893-2898. doi:10.1007/s10620-019-05694-4
14. Patel SK, Pratap CB, Jain AK, Gulati AK, Nath G. Diagnosis of Helicobacter pylori: what should be the gold standard? World J Gastroenterol. Sep 28 2014;20(36):12847-59. doi:10.3748/wjg.v20.i36.12847
15. De Korwin JD. [Advantages and limitations of diagnostic methods for H. pylori infection]. Gastroenterologie clinique et biologique. Mar 2003;27(3 Pt 2):380-90. Avantages et inconvenients des differentes methodes diagnostiques de l’infection a H. pylori.
16. Schabereiter-Gurtner C, Hirschl AM, Dragosics B, et al. Novel real-time PCR assay for detection of Helicobacter pylori infection and simultaneous clarithromycin susceptibility testing of stool and biopsy specimens. J Clin Microbiol. Oct 2004;42(10):4512-8. doi:10.1128/JCM.42.10.4512-4518.2004
17. Ables AZ, Simon I, Melson ER. Update on Helicobacter pylori Treatment. American Family Physician. 2007;75(3):351-358.
18. Walker MM, Talley NJ. Review article: bacteria and pathogenesis of disease in the upper gastrointestinal tract–beyond the era of Helicobacter pylori. Aliment Pharmacol Ther. Apr 2014;39(8):767-79. doi:10.1111/apt.12666
19. Thrift AP, Pandeya N, Smith KJ, et al. Helicobacter pylori infection and the risks of Barrett’s oesophagus: a population-based case-control study. Int J Cancer. May 15 2012;130(10):2407-16. doi:10.1002/ijc.26242
20. Jarosz M, Dzieniszewski J, Dabrowska-Ufniarz E, Wartanowicz M, Ziemlanski S, Reed PI. Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice. Eur J Cancer Prev. Dec 1998;7(6):449-54.