Periodontal disease and liver cirrhosis: A systematic review

Abstract

Objectives:Studies suggest that periodontal disease, a source of subclinical and persistent infection, may be associated with various systemic conditions, including liver cirrhosis. The aim of this study was to examine the literature and determine the relationship between periodontal disease and liver cirrhosis and to identify opportunities and directions for future research in this area.Methods:A systematic review of English articles in the PubMed, EMBASE, and Scopus databases was conducted using search terms including ‘liver cirrhosis’, ‘end-stage liver disease’, ‘liver diseases’, ‘oral health’, ‘periodontal disease’, ‘mouth disease’, ‘gingivitis’, and ‘periodontitis’.Results:Thirteen studies published between 1981 and 2014 were found to include data on oral health and periodontal disease in cirrhotic patients. Studies indicated an increased incidence of periodontal disease in patients with liver cirrhosis, measured with several different periodontal indices. The reported prevalence of periodontal disease in cirrhosis patients ranged from 25.0% to 68.75% in four studies and apical periodontitis was found in 49%–79% of the patients. One study found that mortality was lower among patients who underwent dental treatment versus non-treated patients. Another study suggested an association between periodontal disease and the progression of liver cirrhosis, but data are sparse and conflicting as to whether periodontal disease is correlated to cirrhosis aetiology and severity.Conclusion:Despite the clinical reality of periodontal disease in liver cirrhosis patients, there are few published studies. Before clinical implications can be addressed, more data on the prevalence of and correlation between periodontal disease and liver cirrhosis aetiology, duration, and progression are needed.

Periodontal status of liver transplant candidates and healthy controls

“…Poor oral hygiene might be an explanation for higher prevalence, extent, and severity of periodontitis in cirrhotic patients . Further, other risk factors for periodontal disease, such as sociodemographic characteristics, might also explain the poor periodontal condition of LTCs.…”

“…Considering the limitations of previous studies, the association between cirrhosis and periodontitis still remains controversial. More studies focusing on the influence of smoking and diabetes, with matching or adjustment for these factors are required . Thus, the aim of the study was to compare the periodontal status of LTC with healthy controls.…”

Periodontitis in individuals with liver cirrhosis: A case–control study

“…Sample size calculation for the present case–control study was based on an expected prevalence of periodontitis of 30% among cirrhotic individuals compared to 15% among non‐liver disease control ones (mean values from Grønkjær, ). Calculation was carried out using the Fleiss method through the OpenEpi software (Open Source Epidemiologic Statistics for Public Health, version 3.01, Boston, USA).…”

Microbiota, cirrhosis, and the emerging oral-gut-liver axis

“…Although studies on the interaction between cirrhosis and periodontitis are still too limited to make assumptions regarding a potential cause-and-effect relationship, a higher incidence of periodontitis (ranging from 25%-68%) has been reported in cirrhotic patients compared with healthy controls (81,82), an observation that warrants further investigation. In a retrospective study, Aberg and colleagues showed an association between periodontal disease and progression of chronic liver disease, suggesting that dental disease could play a role in cirrhosis (83).…”