Intended for healthcare professionals


Smoking, Helicobacter pylori, and periodontitis

BMJ 2006; 332 doi: (Published 22 June 2006) Cite this as: BMJ 2006;332:1513
  1. Trevor L P Watts, honorary consultant in periodontology (trevor.watts{at}
  1. King's College London Dental Institute at Guy's, King's, and St Thomas' Hospitals, London SE1 9RT

    EDITOR—BMJ Updates summarises a fascinating study.1 2 It gives further support to the view that the reservoir of Helicobacter pylori in dental plaque on teeth cannot be removed by systemic antimicrobials and is an important potential source of reinfection.3 The link between smoking and periodontitis has become well established over the past 20 years. In addition to exacerbating periodontitis, smoking also interferes with the treatment outcome. The magnitude of the problem was assessed in a recent paper based on NHANES III data, in which the authors found that smokers in the 30-75 age group were six times more likely to have advanced periodontitis.4

    In patients who smoke and whose gums have been damaged by periodontitis, a reservoir of dental plaque exists not only above the gums, but also below the gums in periodontal pockets. As plaque is a biofilm, organisms in it are protected from systemic antimicrobials and must be removed mechanically by instrumentation if they are to be removed at all. The potential for reinfection of the stomach by H pylori is obvious. Large clinical trials of the effect of thorough periodontal treatment on this problem are long overdue.


    • Competing interests None declared.


    1. 1.
    2. 2.
    3. 3.
    4. 4.
    View Abstract

    Log in

    Log in through your institution


    * For online subscription