Severe periodontitis as defined by standard periodontology criteria strongly predicts higher all-cause mortality among patients with irreversible scarring of the liver, or cirrhosis, according to an international team of researchers. Presented at the International Liver Congress 2017 in Amsterdam, the study enrolled 184 consecutive patients with cirrhosis who received oral health assessments and were followed for an average of a year.
“Periodontitis may act as a persistent source of oral bacterial translocation, causing inflammation and increasing cirrhosis complications,” said Lea Ladegaard Grønkjaer, PhD, RN, of the Aarhus University Hospital in Denmark and lead author of the study. “As it can be treated successfully, however, we hope that our findings motivate more trials on this subject.”
When the study began, 44% of the patients had severe periodontitis. Nearly half of the included patients died during the follow-up. The association of periodontitis with mortality was adjusted for age, gender, cirrhosis etiology, Child-Pugh score, Model of End-Stage Liver Disease score, smoker status, present alcohol use, co-morbidity, and nutritional risk score. Mortality was mostly attributable to complications of cirrhosis.
In Europe, the researchers noted, cirrhosis is responsible for 1% to 2% of all deaths and is the leading cause of liver transplantation. Meanwhile, more than 35% of the European adult population has periodontitis, with 10% to 15% having severe forms of the disease. Previous studies have suggested that periodontitis is involved in the progression of liver diseases and that it has a negative impact on the clinical course after liver transplantation.
“This study demonstrates the association between gum disease and risk of death in patients with liver disease,” said Philip Newsome, PhD, of the Centre for Liver Research at the University of Birmingham in the United Kingdom and governing board member of the European Association for the Study of the Liver. “Further studies are now required to determine if improving gum care can improve outcomes in patients with liver cirrhosis.”
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