Reflex Gastroesophageal Disorders and Functional Dyspepsia: Potential Confounding Variables for the Progression of Chronic Periodontitis: A Clinical Study

Ramanarayana Boyapati, Vijaya K. P. Vudathaneni, Swetha B. Nadella, Appaiah C. Bollepalli, Yamuna Marella, Chaitanya Adurty


Aim: To probe into the possible connection between gastroesophageal reflux disorders (GERDs) and functionally occurring dyspepsia as a factor raising the risk of chronic periodontitis.

Materials and Methods: A cross‑sectional study was carried out on 40 patients with chronic periodontitis with age group between 40–60 years. The test group included 20 people diagnosed with gastroesophageal reflux disease (GERD), according to the Montreal Definition and Classification agreement, and chronic periodontitis. Symptomatic diagnoses were done to confirm functional dyspepsia. The control group comprised 20 systematically healthy people suffering from chronic periodontitis. Indices measured included flow‑rate of saliva, repetitive saliva swallowing test for swallowing function, papillary marginal attachment index of gingiva, oral hygiene index‑simplified and decayed, missing, filled teeth index. Data was analyzed using SPSS version 22 (IBM Inc. Chicago, USA). Descriptive statistics, such as mean and standard deviation (SD) for continuous variables and frequency and percentage for categorical variables were determined. T test was performed for intergroup comparison and Pearson correlation test was done for evaluating correlation between various parameters. P ≤ 0.05 considered as significant.

Results: Statistically significant differences were observed between the test and control groups with regard to all the clinical parameters of interest. Pearson’s correlation test revealed a strong negative correlation between salivary flow rate and OHI‑S and DMFT scores. The RSST swallow function values demonstrated a moderate negative correlation with OHI‑S scores, while OHI‑I scores and DMFT scores were observed to be strongly correlated in a positive direction. A statistically significant difference was present in the probing depth and CAL levels between both the groups with higher levels in test group.

Conclusion: GERD was linked to incremental incidences of chronic periodontitis and was established as an independent risk‑raising factor.


Chronic periodontitis; functional dyspepsia; gastroesophageal reflux; risk factor

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Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global

Consensus Group. The Montreal definition and classification

of gastroesophageal reflux disease: A global evidence‑based

consensus. Am J Gastroenterol 2006;101:1900‑20.

Heidelbaugh JJ, Gill AS, Van Harrison R, Nostrant TT. Atypical

presentations of gastroesophageal reflux disease. Am Fam

Physician 2008;78:483‑8.

Crow HC, Ship JA. Are gingival and periodontal conditions

related to salivary gland flow rates in healthy individuals? J Am

Dent Assoc 1995;126:1514‑20.

Dzhamaldinova TD. Dynamics of inflammatory periodontal

diseases under the influence of gastroesophageal reflux disease

therapy. Eksp Klin Gastroenterol 2010:46‑51.

Dzhamaldinova TD, Maksimovskaia LN, Li ED. Manifestations

of gastroesophageal reflux disease in the oral cavity. Eksp Klin

Gastroenterol 2010;3:23‑7.

Helm JF, Dodds WJ, Hogan WJ. Salivary response to esophageal

acid in normal subjects and patients with reflux esophagitis.

Gastroenterology 1987;93:1393‑7.

Sarosiek J, McCallum RW. What role do salivary inorganic

components play in health and disease of the esophageal

mucosa? Digestion 1995;56:24‑31.

Song JY, Kim HH, Cho EJ, Kim TY. The relationship between

gastroesophageal reflux disease and chronic periodontitis. Gut

Liver 2014;8:35‑40.

Yoshikawa H, Furuta K, Ueno M, Egawa M, Yoshino A, Kondo S,

et al. Oral symptoms including dental erosion in gastroesophageal

reflux disease are associated with decreased salivary flow volume

and swallowing function. J Gastroenterol 2012;47:412‑20.

Gorr SU, Abdolhosseini M. Antimicrobial peptides and

periodontal disease. J Clin Periodontol 2011;38:126‑41.

Watkins HR, Lapp CA, Hanes PJ, Dickinson DP, Volkmann KR,

Newman CL, et al. CCL28 effects on periodontal pathogens.

J Periodontol 2007;78:2356‑63.

Watanabe M, Nakatani E, Yoshikawa H, Kanno T, Nariai Y,

Yoshino A, et al. Oral soft tissue disorders are associated with

gastroesophageal reflux disease: Retrospective study. BMC

Gastroenterology 2017;17:92.

Sujatha S, Jalihal U, Devi Y, Rakesh N, Chauhan P, Sharma S.

Oral pH in gastroesophageal reflux disease. Indian J

Gastroenterol 2016;35:186‑9.

Zahedi L, Jafari E, Torabi PM, Shafieipour S, Abbasi MH,

Moghadam SD, et al. The association between oral

hygiene and gastric pathology in patients with dyspepsia:

A cross‑sectional study in southeast Iran. Middle East J Dig

Dis 2017;9:33‑8.

Tonetti MS, Greenwell H, Kornman KS. Staging and grading of

periodontitis: Framework and proposal of a new classification

and case definition. J Periodontol 2018;89:s159‑72.

Klein HT, Palmer CE, Knutson JW. Studies on dental caries I.

Dental status and dental needs of elementary school children.

Pub Health Rep 1938;53:751.

Massler M. The P‑M‑A index for the assessment of gingivitis.

J Periodontol 1967;38:592‑601.

Greene JC, Vermillion JR. The simplified oral hygiene index.

J Am Dent Assoc 1964;68:7‑13.

Coussens LM, Werb Z. Inflammation and cancer. Nature


Van Winkelhoff AJ, Slots J. Actinobacillus

actinomycetemcomitans and Porphyromonas gingivalis in

nonoral infections. Periodontol 2000;1999:122‑35.

Shapiro KB, Hotchkiss JH, Roe DA. Quantitative relationship

between oral nitrate‑reducing activity and the endogenous

formation of nnitrosoamino acids in humans. Food Chem Toxicol


Song Q, Lange T, Spahr A, Adler G, Bode G. Characteristic

distribution pattern of helicobacter pylori in dental plaque

and saliva detected with nested PCR. J Med Microbiol


Gebara EC, Pannuti C, Faria CM, Chehter L, Mayer MP,

Lima LA. Prevalence of Helicobacter pylori detected by

polymerase chain reaction in the oral cavity of periodontitis

patients. Oral Microbiol Immunol 2004;19:277‑80.

Umeda M, Kobayashi H, Takeuchi Y, Hayashi J,

Morotome‑Hayashi Y, Yano K, et al. High prevalence of

helicobacter pylori detected by PCR in the oral cavities of

periodontitis patients. J Periodontol 2003;74:129‑34.

Dye BA, Kruszon‑Moran D, McQuillan G. The relationship

between periodontal disease attributes and helicobacter pylori

infection among adults in the United States. Am J Public Health


Anand PS, Nandakumar K, Shenoy KT. Are dental plaque,

poor oral hygiene, and periodontal disease associated with

Helicobacter pylori infection? J Periodontol 2006;77:692‑8.

Crew KD, Neugut AI. Epidemiology ofgastric cancer. World J

Gastroenterol 2006;12:354‑62.

Hosseini E, Poursina F, Van de Wiele T, Ghasemian Safaei H,

Adibi P. Helicobacter pylori in Iran: A systematic review on the

association of genotypes and gastroduodenal diseases. J Res Med

Sci 2012;17:280‑92.

Shakeri R, Malekzadeh R, Etemadi A, Nasrollahzadeh D,

AbediArdekani B, Khoshnia M, et al. Association of tooth loss

and oral hygiene with risk of gastric adenocarcinoma. Cancer

Prev Res (Phila) 2013;6:477‑82.

Namiot DB, Namiot Z, Kemona A, Bucki R, Gotębiewska M.

Oral health status and oral hygiene practices of patients with

peptic ulcer and how these affect Helicobacter pylori eradication

from the stomach. Helicobacter 2007;12:63‑7.

Sun J, Yin J, Hou B. The periodontal infection may be a

contributing factor to the development of gastric cancer. Dental

Hypotheses 2017;8:27‑9.

Petersen PE. World Health Organization global policy for

improvement of oral health‑World Health Assembly 2007. Int

Dent J 2008;58:115‑21.