International Journal of Medical Dentistry 253 Medical Interferences EXTRAGASTRIC AND ORODENTAL MANIFESTATIONS IN PEDIATRIC INFECTION WITH HELICOBACTER PYLORI. A REVIEW Smaranda DIACONESCU 1 , Raluca STANCA 2 , Maria BOLAT 3 1 Lecturer, MD, PhD, Mother and Child Dept., «Gr. T. Popa» University of Medicine and Pharmacy, Iasi 2 Pediatric trainee, «St. Mary» Children’s Emergency Hospital, Iaşi 3 Univ. Assist., MD, PhD student, Cariology Dept., «Gr. T. Popa» University of Medicine and Pharmacy, Iasi Corresponding author: cristina_stanca_raluca@yahoo.com Abstract Helicobacter pylori is a worlwide spread infection mostly manifested in childhood. Many - both invasive and non- invasive diagnostic tests - are now available,. The colonisation effect of gastric mucosa and its consequences are well known and studied. H. pylori can also induce extra-gastric manifestations, like iron-defciency anemia. The role of oral cavity colonisation is not clearly defned, several studies stating that the oral cavity represents a reservoir for H. pyloris. The presence of this rod in the dental plaque may lead to periodontitis, dental caries, dental calculus and tooth loos. Dental treatment associated with eradication therapy decreases the prevalence of oral H. pylori and improves the eradication rate of gastric H. pylori. Dental treatment in H. pylori infection management should be taken into consideration, especially in children and teens. Keywords: children, Helicobacter pylori, orodental diseases 1. INTRODUCTION Helicobacter pylori is a gram-negative microaerophilic rod which colonizes the gastric mucosa in 50% of the population worldwide. The incidence of the infection is associated mostly with childhood, as well as with the socio- economic and sanitary conditions. H. pylori infection plays a major role in antral and corporeal gastritis, peptic ulcer disease; a causal relation between H. pylori infection and the risk of gastric malignancies, including cancer and gastric marginal zone B-cell lymphoma of mucosa- associated lymphoid tissue (MALT) type, has been supported by epidemiological and interventional studies [1]. Although H. pylori– associated gastric cancer has not been reported in children, MALT lymphomas have been described in a few H. pylori–infected pediatric patients. In children, it may also be associated with iron-defciency anemia [2]. In the developed countries, less than 10% of children younger than 12 years are infected; however, seropositivity increases with age at a rate of 0.3-1% per year. Studies of seropositivity in adults in the developed countries revealed prevalences of 30-50%. The annual incidence is of 3-10% in the population of the developing countries, compared with 0.5% in the developed countries.Worldwide, more than one billion people is estimated to be infected with H. pylori [3]. 2. DIAGNOSTIC METHODS In H. pylori, the “gold standard” diagnostic test is considered as a histological examination. Many diagnosis methods are available, each one with its advantages and disadvantages. A reference diagnostic method should fulfll criteria such as sensitivity, specifcity, availability, cost, rapidity of the results and reproducibility. Diagnostic tests can be classifed as invasive (histology, culture, rapid urease test and molecular methods) and non-invasive methods (urea breath test, stool antigen test, antibody- based tests). An invasive test requires a gastric biopsy during endoscopy. In histology, several stains, like hematoxylin-eosin, Giemsa, Warthine- Starry, acridine orange, Genta, Dieterle, toluidine blue or McMullen, are used. A novel method used on histological samples is Fluorescent in situ hybridization (FISH), which detects a specifc bacterial feature (such as antibiotic resistance) and a virulence factor in a short period of time (3 hr), however it is expensive and laborious. The sensitivity and specificity of histology is infuenced by the biopsy samples (site, size, and