Oral health and liver function in children and adolescents with cirrhosis of the liver

Abstract

IntroductionPeople with cirrhosis of the liver are predisposed to developing oral lesions. The occurrence and type of lesion depend on the degree of liver function impairment and its type, and on the severity and duration of systemic diseases. In children, the age at which the early symptoms of liver disease are experienced is also of great importance.AimTo assess the prevalence of oral pathological lesions in children and adolescents with cirrhosis of the liver, and their correlation with the degree of liver function impairment.Material and methodsClinical and laboratory results of liver function tests (Model of End-Stage Liver Disease/Score of Paediatric End-Stage Liver Disease, Child-Pugh score) were assessed in 35 patients with cirrhosis of the liver. The average age of the patients was 10.7 ±4.74 years. All patients also had their oral cavities examined (mucosa, gingiva – GI, hygiene – PLI, teeth – dmft/dmfs and DMFt/DMFs, DDE Index and Candida spp. presence) and this was then correlated to the degree of liver function impairment.ResultsAccording to the Child-Pugh scale, 16 patients were class A and 19 were class B/C. Jaundice during the first 3 years of life occurred in 9 patients. Mucosal lesions were found in 26 out of 35 patients (74%), including 10 out of 16 (63%) in Child-Pugh group A, and 16 out of 19 (84%) in group B/C (NS – non significant). Oral candidiasis occurred more often in class B/C than in class A (47.4% vs. 12.5%; p < 0.05). The GI index (Gingival Index) and PLI index (Dental Plaque Index) did not differ between the groups (A vs. B/C) but correlated in the whole group (R = 0.58) as well as in subgroups A (R = 0.65) and B/C (R = 0.59). Dmft/dmfs and DMFt/DMFs indexes did not differ between groups A and B/C, and neither did the DMFt/DMFs in patients with/without enamel defects.ConclusionsOral mucosal lesions are commonly found in children with cirrhosis of the liver. Advanced liver disease promotes oral candidiasis. Severity of gingivitis correlates with the presence of dental plaque.

Oral mucosa lesions and gingival bleeding can indicate the progression of liver disease in children and adolescents aged two to 18 years

“…Multiple symptom candidiasis was twice as frequent as in class B than in class A. Its prevalence decreased as albumin levels dropped, which additionally emphasised the impact of malnutrition on infections, mirroring the results of a previous study (11). No oral infections in children and adolescents with CLD were reported.…”

“…Numerous publications have indicated that chronic liver disease predisposes oral mucosa lesions, which was not unlike the current study (9)(10)(11). We also found that systemic disturbances associated with liver failure may have had a greater impact on oral mucosa and periodontal tissue than the actual causes of liver disease.…”

“…exist (11). The aim of the study was to assess the correlation between systemic disturbances of chronic liver disease and oral symptoms in children and adolescents and to examine whether certain oral symptoms indicated the progression of liver failure.…”

“…The most common oral mucosal lesions include oral candidiasis, mucosa and gum discoloration, telangiectasia, petechiae, bald tongue and cracked strawberry lips . Patients suffering from liver disease are also predisposed to gingivitis, and a correlation between liver function and the occurrence of oral lesions may also exist . The aim of the study was to assess the correlation between systemic disturbances of chronic liver disease and oral symptoms in children and adolescents and to examine whether certain oral symptoms indicated the progression of liver failure.…”

Dermatological manifestations of chronic liver disease

“…Study done by Kowalczyk et al showed oral candidiasis in 28.6% of the cirrhotic patients. 20 Cellulitis was seen in 7% of the patients in our study. In a study done by Rongey et al, cellulitis was seen in 19.3% of the patients.…”