Detection of Salivary Helicobacter pylori in Pediatric Patients and Its Association With Gastrointestinal and Oral Health

Background <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection is one of the most common bacterial infections worldwide and is recognized as a major cause of gastritis. The oral cavity has been suggested as a potential reservoir for this bacterium. Yet, the relationship between its presence in the mouth and stomach, as well as its possible role in dental caries, remains unclear. This study aimed to investigate the prevalence of <i>H. pylori</i> contamination in the saliva of patients aged four to 18 years undergoing endoscopy. Materials and methods This cross-sectional study included 100 children aged four to 18 years who underwent endoscopy due to gastrointestinal symptoms. Saliva samples were collected before endoscopy, and gastric biopsies were analyzed for <i>H. pylori</i> using standard histopathological methods, specifically the Giemsa stain. The presence of <i>H. pylori</i> was confirmed through pathology results. In addition, polymerase chain reaction (PCR) targeting the 23S rRNA gene was used to detect the <i>H. pylori</i> in saliva, and the virulence genes sabA and cagA were also examined. Dental status was assessed using the Decayed/decayed, Missing/missing, and Filled/filled Teeth/teeth (DMFT/dmft) score according to World Health Organization (WHO) criteria. Data were analyzed using descriptive and inferential statistics, including t-tests, correlation analyses, and logistic regression; p<0.05 was considered significant. Results Overall, 61 patients (61%) tested positive for <i>H. pylori</i> in gastric biopsy specimens. In saliva samples, 53 patients (53%) were positive for <i>H. pylori</i>. Notably, all saliva-positive patients were also positive in biopsy specimens, indicating complete overlap. Among the saliva-positive samples, the virulence gene cagA was detected in eight samples (8%). In contrast, the sabA gene wasn't detected in any sample. Notably, children with <i>H. pylori</i>-positive saliva had a significantly higher mean number of dental caries than saliva-negative children (4.10 vs. 2.05, p<0.001). Conclusion Saliva can serve as a reservoir for <i>H. pylori</i> in Iranian children and could be associated with dental caries severity. Saliva testing may provide a simple, non-invasive method for early detection of <i>H. pylori</i>, while promoting oral hygiene and regular dental care can help prevent recurrent gastric infections and improve overall health of the children.