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Lauridsen MM, Grønkjær LL, Khraibut S, Patel N, Deeb JG, Bajaj JS. The Multi-dimensional Challenge of Poor Oral Health in Cirrhosis-Disparities and Solutions. Gastroenterology 2024; 166:717-722. [PMID: 38224859 PMCID: PMC11034712 DOI: 10.1053/j.gastro.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Mette M Lauridsen
- University Hospital of Southern Denmark, Department for Regional Health Research, Esbjerg, Denmark
- Virginia Commonwealth University, Department of Medicine, Richmond, Virginia, USA
| | - Lea L Grønkjær
- University Hospital of Southern Denmark, Department for Regional Health Research, Esbjerg, Denmark
| | - Sara Khraibut
- Virginia Commonwealth University, Department of Periodontics, School of Dentistry, Richmond, Virginia, USA
| | - Nilang Patel
- Virginia Commonwealth University, Department of Medicine, Richmond, Virginia, USA
| | - Janina Golob Deeb
- Virginia Commonwealth University, Department of Periodontics, School of Dentistry, Richmond, Virginia, USA
| | - Jasmohan S Bajaj
- Virginia Commonwealth University, Department of Medicine, Richmond, Virginia, USA
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2
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Albuquerque-Souza E, Sahingur SE. Periodontitis, chronic liver diseases, and the emerging oral-gut-liver axis. Periodontol 2000 2022; 89:125-141. [PMID: 35244954 PMCID: PMC9314012 DOI: 10.1111/prd.12427] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The liver carries out a wide range of functions ranging from the control of metabolites, nutrient storage, and detoxification to immunosurveillance. While inflammation is essential for the tissue remodeling and maintenance of homeostasis and normal liver physiology, constant exposure to dietary and microbial products creates a niche for potentially prolonged immune activation and unresolved inflammation in susceptible host. Failure to restrain inflammation can lead to development of chronic liver diseases characterized by fibrosis, cirrhosis and eventually liver failure. The liver maintains close interactions with numerous organs which can influence its metabolism and physiology. It is also known that oral cavity microenvironment can influence the physiological conditions of other organs and emerging evidence implicates that this could be true for the liver as well. Presence of chronic inflammation and dysbiotic microbiota is a common feature leading to clinical pathology both in periodontitis and chronic liver diseases (CLDs). In fact, known CLDs appear to have some relationship with periodontitis, which impacts the onset or progression of these conditions in a bidirectional crosstalk. In this review, we explore the emerging association between oral‐gut‐liver axis focusing on periodontitis and common CLDs including nonalcoholic fatty liver disease, chronic viral hepatitis, liver cirrhosis, and hepatocellular cancer. We highlight the immune pathways and oral microbiome interactions which can link oral cavity and liver health and offer perspectives for future research.
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Affiliation(s)
- Emmanuel Albuquerque-Souza
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sinem E Sahingur
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ezhilarasan D. Deciphering the toxicological role of Porphyromonas gingivalis derived endotoxins in liver diseases. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 88:103755. [PMID: 34662732 DOI: 10.1016/j.etap.2021.103755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
Periodontitis is a most prevalent and infectious multifactorial inflammatory disease and is characterized by the progressive destruction of the tooth-supporting tissues. Porphyromonas gingivalis, a Gram‑negative oral anaerobe, mainly causes periodontitis and it is one of the most important risk factors responsible for aggravation of existing systemic diseases. Several experimental and clinical studies have shown the positive association between periodontitis and different forms of liver disease. Periodontal diseases increase the prevalence of non-alcoholic fatty liver diseases and cirrhosis. Infected periodontium and pathogens in the periodontal microenvironments release pathogen-associated molecular patterns such as peptidoglycan, lipopolysaccharides, gingipain, fimbria, bacterial DNA, etc, and damage-associated molecular patterns such as interleukins-1α, β, - 8, and galectin-3, etc. These virulence factors and cytokines enter the bloodstream, disseminate into the whole body, and induce a variety of systemic pathological effects, including liver diseases (steatosis and fibrosis). Maintaining oral hygiene by scaling and root planning significantly improves liver damage in patients with periodontitis. Dentists and physicians should have more awareness in understanding the bidirectional nature of the relationship between oral and systemic diseases. Importantly, periodontitis condition aggravates simple fatty liver into fibrotic disease and therefore, the aim of this review is to understand the possible link between periodontitis and liver diseases.
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Affiliation(s)
- Devaraj Ezhilarasan
- Department of Pharmacology, The Blue Lab, Molecular Medicine and Toxicology Division, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 600 077, India.
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Wu JH, Lee CY, Chang WT, Wu PH, Chen LA, Huang JW, Su WL, Kuo KK. The association between oral health status and the clinical outcome of cirrhotic patients on the waiting list for liver transplantation. Kaohsiung J Med Sci 2021; 37:910-917. [PMID: 34288387 DOI: 10.1002/kjm2.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation (LT) candidates often present with poor oral hygiene, which could potentially lead to systemic infections and sepsis owing to their cirrhotic state. In this study, we investigated the oral health status of LT candidates and propose guidance for the detection and treatment of encountered oral lesions among these patients. The decayed, missing, and filled teeth (DMFT) index was determined through oral examination. The presence of dental calculus was detected using panoramic radiography and defined by the radiopaque dental calculus (RDC). From January 2011 to August 2018, 56 LT candidates were enrolled with a median follow-up of 39 months. The overall mean numbers of decayed, missing, and filled teeth among these patients were 2.7 ± 2.8, 10.9 ± 8.3, and 5.4 ± 4.5, respectively. Eighteen patients (32.1%) had RDC. The 5-year survival rates of all 56 patients was 57.7%, while that of those who either received LT (23 patients) or not were 82.1% and 39.8%, respectively. A Cox regression model revealed better overall survival of patients after LT (adjusted hazard ratio [aHR] = 0.067, p = 0.001), worse survival among patients with RDC (aHR = 3.468, p = 0.010), at Child-Pugh stages B and C (aHR for stage B = 11.889, p = 0.028; aHR for stage C = 19.257, p = 0.013) compared to patients at Child-Pugh stage A, and those with a model for end-stage liver disease (MELD) score ≥25 (aHR = 13.721, p = 0.018). This study demonstrates that RDC was associated with worse prognosis in LT candidates. We therefore recommend that interprofessional collaboration should be a routine preoperative procedure for the evaluation of oral hygiene among LT candidates.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Tsan Chang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Lin-Ann Chen
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Jian-Wei Huang
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Wen-Lung Su
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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5
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GÜMRÜ B, TARÇIN B. Solid Organ Transplant Candidates and Recipients: Dentists’ Perspective. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.915422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Park SY, Hwang BO, Lim M, Ok SH, Lee SK, Chun KS, Park KK, Hu Y, Chung WY, Song NY. Oral-Gut Microbiome Axis in Gastrointestinal Disease and Cancer. Cancers (Basel) 2021; 13:2124. [PMID: 33924899 PMCID: PMC8125773 DOI: 10.3390/cancers13092124] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
It is well-known that microbiota dysbiosis is closely associated with numerous diseases in the human body. The oral cavity and gut are the two largest microbial habitats, playing a major role in microbiome-associated diseases. Even though the oral cavity and gut are continuous regions connected through the gastrointestinal tract, the oral and gut microbiome profiles are well-segregated due to the oral-gut barrier. However, the oral microbiota can translocate to the intestinal mucosa in conditions of the oral-gut barrier dysfunction. Inversely, the gut-to-oral microbial transmission occurs as well in inter- and intrapersonal manners. Recently, it has been reported that oral and gut microbiomes interdependently regulate physiological functions and pathological processes. Oral-to-gut and gut-to-oral microbial transmissions can shape and/or reshape the microbial ecosystem in both habitats, eventually modulating pathogenesis of disease. However, the oral-gut microbial interaction in pathogenesis has been underappreciated to date. Here, we will highlight the oral-gut microbiome crosstalk and its implications in the pathogenesis of the gastrointestinal disease and cancer. Better understanding the role of the oral-gut microbiome axis in pathogenesis will be advantageous for precise diagnosis/prognosis and effective treatment.
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Affiliation(s)
- Se-Young Park
- Department of Applied Life Science, The Graduate School, Yonsei University, and BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea; (S.-Y.P.); (B.-O.H.); (S.-H.O.)
| | - Byeong-Oh Hwang
- Department of Applied Life Science, The Graduate School, Yonsei University, and BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea; (S.-Y.P.); (B.-O.H.); (S.-H.O.)
| | - Mihwa Lim
- Department of Oral Biology, Yonsei University College of Dentistry, Seoul 03722, Korea; (M.L.); (S.-K.L.); (K.-K.P.)
| | - Seung-Ho Ok
- Department of Applied Life Science, The Graduate School, Yonsei University, and BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea; (S.-Y.P.); (B.-O.H.); (S.-H.O.)
| | - Sun-Kyoung Lee
- Department of Oral Biology, Yonsei University College of Dentistry, Seoul 03722, Korea; (M.L.); (S.-K.L.); (K.-K.P.)
| | - Kyung-Soo Chun
- College of Pharmacy, Keimyung University, Daegu 42601, Korea;
| | - Kwang-Kyun Park
- Department of Oral Biology, Yonsei University College of Dentistry, Seoul 03722, Korea; (M.L.); (S.-K.L.); (K.-K.P.)
| | - Yinling Hu
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD 21702, USA;
| | - Won-Yoon Chung
- Department of Oral Biology, Oral Cancer Research Institute, and BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea;
| | - Na-Young Song
- Department of Oral Biology, Yonsei University College of Dentistry, Seoul 03722, Korea; (M.L.); (S.-K.L.); (K.-K.P.)
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7
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Oral–Gut Microbiome Axis in Gastrointestinal Disease and Cancer. Cancers (Basel) 2021. [DOI: 10.3390/cancers13071748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is well-known that microbiota dysbiosis is closely associated with numerous diseases in the human body. The oral cavity and gut are the two largest microbial habitats, playing a major role in microbiome-associated diseases. Even though the oral cavity and gut are continuous regions connected through the gastrointestinal tract, the oral and gut microbiome profiles are well-segregated due to the oral–gut barrier. However, the oral microbiota can translocate to the intestinal mucosa in conditions of the oral–gut barrier dysfunction. Inversely, the gut-to-oral microbial transmission occurs as well in inter- and intrapersonal manners. Recently, it has been reported that oral and gut microbiomes interdependently regulate physiological functions and pathological processes. Oral-to-gut and gut-to-oral microbial transmissions can shape and/or reshape the microbial ecosystem in both habitats, eventually modulating pathogenesis of disease. However, the oral–gut microbial interaction in pathogenesis has been underappreciated to date. Here, we will highlight the oral–gut microbiome crosstalk and its implications in the pathogenesis of the gastrointestinal disease and cancer. Better understanding the role of the oral–gut microbiome axis in pathogenesis will be advantageous for precise diagnosis/prognosis and effective treatment.
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Cruz AJSD, Castilho LSD, Contarini LCS, Silva MEDSE, Abreu MHNG. Dental Findings of Kidney and Liver Transplantation Patients from a Brazilian Oral Health Care Service. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cocero N, Caratori E, Martini S, Carossa S. Can Plasma Rich in Growth Factors Expedite Healing of Postextraction Tooth Sockets in Patients Undergoing Urgent Liver Transplantation? J Oral Maxillofac Surg 2020; 79:305-312. [PMID: 33091403 DOI: 10.1016/j.joms.2020.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Infections foster morbidity and mortality after liver transplantation (LT). Pre-LT eradication of oral infectious foci is not always possible for patients needing an urgent LT because postextraction sockets must be healed before the patient is operated, and this requires at least 3 weeks. To accelerate healing, we tested the effect of plasma-rich growth factor (PRGF), a highly concentrated form of autogenous platelets on healing. MATERIALS AND METHODS Prospective case-control split-mouth study for more than 100 candidates for LT needing routine extractions of 2 homologous teeth: a socket was to be treated with PRGF, whereas its match (control [CTRL]) was to undergo natural healing. The outcome of interest was the socket size derived from the measurements on the transversal diameters and deepest level of penetration on the PRGF and CTRL sides after extraction and on day 7, 14, and 21 postextraction. The primary predictor was treatment status (PRGF vs CTRL); secondary predictors, the tooth extracted and patient's features. The statistical analysis used nonparametric tests and best subset regression. RESULTS All measurements evidenced a significantly (P < .0001) more advanced closure on the PRGF side than the CTRL side. One week after extraction, PRGF sockets were reduced to 12% (molars) and 6% (nonmolars) of the original wound versus 32 and 20% for CTRL, respectively. The percentage of PRGF sockets with size less than or equal to 5% was 7% for molars and 44% for nonmolars versus 0 and 12% for CTRL (P < .0001), respectively. The percentages with size less than or equal to 10% were 37% for molars and 81% for nonmolars on the PRGF side versus 2 and 26% on the CTRL side, respectively. These percentages showed a significant decrease for smoking patients. CONCLUSIONS The outcome of our trial showed that PRGF significantly accelerates closure of postextraction sockets. Its use, at least in patients who occupy top positions in the LT waiting list, is recommended.
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Affiliation(s)
- Nadia Cocero
- Senior Consultant, Oral Surgery Section of the Dental School of the University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Turin, Italy.
| | - Eleonora Caratori
- Resident, Oral Surgery Section of the Dental School of the University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Turin, Italy
| | - Silvia Martini
- Resident, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Carossa
- Department Head, Department of Surgical Sciences of the Dental School of the University of Torino, Turin, Italy
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Oliveira CDS, Galdino TM, Limeira FIR, Moreira AN, de Magalhães CS, Abreu LG. Is dental caries associated with liver transplantation? A systematic review and meta-analysis. Oral Dis 2020; 27:1346-1355. [PMID: 32469441 DOI: 10.1111/odi.13439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the experience of dental caries in individuals pre- or postliver transplant. MATERIALS AND METHODS Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases' inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta-analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. RESULTS The search retrieved 1990 references. Twenty-four cross-sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre-liver transplant and healthy individuals (mean difference = 1.65, confidence interval = -0.87 to 4.17). The prevalence of dental caries among pre-liver transplant individuals was 73.82% and in the post-transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. CONCLUSIONS Dental caries may be a relevant issue in pre- and postliver transplant individuals. Oral health counseling should be included in the care of pre- and/or postliver transplant individuals.
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Affiliation(s)
- Carla de Souza Oliveira
- Post-Graduate Program in Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tuélita Marques Galdino
- Post-Graduate Program in Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Allyson Nogueira Moreira
- Department of Restorative Dentistry, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia Silami de Magalhães
- Department of Restorative Dentistry, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
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Clinical periodontal and dental findings in liver transplant patients: a systematic review and meta-analysis. Br Dent J 2020; 228:108-116. [PMID: 31980788 DOI: 10.1038/s41415-020-1196-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives This systematic review aimed to investigate the oral health of post-liver transplant recipients (postLTx), in terms of dental and periodontal clinical results.Data sources Pubmed/MEDLINE and Cochrane Library databases were searched electronically.Data selection Prospective, cross-sectional and case-control studies comparing periodontal and dental health of postLTx patients with healthy and/or pre-liver transplant patients.Data extraction This was performed independently by two authors. Quality assessment was done by using tools from the National Heart, Lung, and Blood Institute.Data synthesis Nine studies were eligible for inclusion in the systematic review. A meta-analysis was performed on gingival inflammation, expressed by scores, on four studies including healthy controls. The gingival index scores were significantly higher in postLTx patients compared with healthy controls (p <0.001). The weighted mean difference was 0.91 (95% confidence interval, 0.44 to 1.38, heterogeneity I2 = 99.5%). Increased tendency of gingival enlargement was noticed in postLTx patients, especially after immunosuppression with Cyclosporine A. Controversial results were reported for the prevalence of caries in postLTx recipients, but there seems to be an increase.Conclusion The results suggest that patients with liver transplants, due to systemic condition and immunosuppressive therapy, exhibit a higher degree of gingival inflammation compared with unexposed patients.Prospero registration number: CRD42019121893.
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Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation. J Am Dent Assoc 2019; 149:90-99. [PMID: 29389350 DOI: 10.1016/j.adaj.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Facial transplantation (FT) is a challenging reconstructive endeavor that requires the expertise of a multidisciplinary team. The specific role of maxillofacial prosthodontists has not yet been reported in detail. METHODS This review considers the contributions of prosthodontists throughout the FT process, from patient selection and dental evaluation to long-term dental rehabilitation of the transplant patient postoperatively. Moreover, considerations of dental management are evaluated. RESULTS In the almost 40 FT reported in the literature, the most consistently documented contribution by prosthodontists is the fabrication of a donor mask to maintain donor integrity. Though infrequently reported, prosthodontists have the potential to plan and perform a variety of dental procedures and follow-up plans. CONCLUSIONS When applicable, facial transplant teams are tasked with providing optimal stomatognathic function and dental occlusion to recipients with severe facial disfigurement. The maxillofacial prosthodontist's contribution is crucial to the long-term dental restoration of the edentulous facial transplant candidate, in addition to the fabrication of the donor mask which fulfills the team's ethical responsibilities. PRACTICAL IMPLICATIONS Maxillofacial prosthodontists play a pivotal role in facial transplantation, particularly when jaw segments are intended for transplantation.
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Costa FO, Lages EJP, Lages EMB, Cota LOM. Periodontitis in individuals with liver cirrhosis: A case-control study. J Clin Periodontol 2019; 46:991-998. [PMID: 31336404 DOI: 10.1111/jcpe.13172] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/14/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to evaluate the association between liver cirrhosis and periodontitis. METHODS This case-control study included 294 individuals, 98 cases with liver cirrhosis and 196 controls. A full-mouth periodontal examination was performed and plaque index, probing depth, clinical attachment level and bleeding on probing were recorded. The association of risk variables with periodontitis was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. RESULTS A high prevalence of periodontitis was observed among cases (62.2%) when compared to controls (41.8%). Individuals with cirrhosis presented a chance ~2 higher of having periodontitis than controls (OR = 2.28; 95% CI 1.39-3.78; p < .001). Significant variables associated with periodontitis in the final logistic models were as follows: (a) no/occasional alcohol use model-number of teeth up 14, age ≥45-55 years, male sex and smoking; (b) moderate and intensive alcohol use models-cirrhosis, number of teeth up 14, age ≥45-55 years, male sex and smoking. CONCLUSIONS An important risk association between liver cirrhosis and periodontitis was observed. Additionally, the intensive alcohol use significantly increased the risk for periodontitis.
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Affiliation(s)
- Fernando Oliveira Costa
- Department of Periodontology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eugênio José Pereira Lages
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Elizabeth Maria Bastos Lages
- Department of Periodontology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- Department of Periodontology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Bajaj JS, Matin P, White MB, Fagan A, Deeb JG, Acharya C, Dalmet SS, Sikaroodi M, Gillevet PM, Sahingur SE. Periodontal therapy favorably modulates the oral-gut-hepatic axis in cirrhosis. Am J Physiol Gastrointest Liver Physiol 2018; 315:G824-G837. [PMID: 30118351 PMCID: PMC6293251 DOI: 10.1152/ajpgi.00230.2018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cirrhosis is associated with a systemic proinflammatory milieu, endotoxemia, and gut dysbiosis. The oral cavity could be an additional source of inflammation. We aimed to determine the effect of periodontal therapy in cirrhosis through evaluating endotoxemia, inflammation, cognition, and quality of life (QOL). Age-matched cirrhotic and noncirrhotic subjects exhibiting chronic gingivitis and/or mild or moderate periodontitis underwent periodontal therapy with follow-up at 30 days. Saliva/stool for microbial composition and serum for Model for End-stage Liver Disease (MELD) score, endotoxin and lipopolysaccharide binding protein (LBP) and immune-inflammatory markers (IL-1β; IL-6; histatins 1, 3, 5; and lysozyme) were collected at baseline and day 30. The cognitive function and QOL were also evaluated similarly. A separate group of cirrhotic patients were followed for the same duration without periodontal therapy. Cirrhotics, especially those with hepatic encephalopathy (HE), demonstrated improved dysbiosis in stool and saliva, and improved endotoxin, LBP, and salivary and serum inflammatory mediators following periodontal therapy. These parameters, which were higher in HE at baseline, became statistically similar posttherapy. Pretherapy vs. posttherapy QOL and cognition also improved in HE patients following oral interventions. On the other hand, LBP and endotoxin increased over time in cirrhotic patients not receiving therapy, but the rest of the parameters, including microbiota remained similar over time in the no-therapy group. This proof-of-concept study demonstrates that periodontal therapy in cirrhosis, especially in those with HE, is associated with improved oral and gut dysbiosis, systemic inflammation, MELD score, and cognitive function, which was not observed in those who did not receive therapy over the same time period. NEW & NOTEWORTHY Systematic periodontal therapy in cirrhotic outpatients improved endotoxemia, as well as systemic and local inflammation, and modulated salivary and stool microbial dysbiosis over 30 days. This was associated with improved quality of life and cognition in patients with prior hepatic encephalopathy. In a cirrhotic group that was not provided periodontal therapy, there was an increase in endotoxin and lipopolysaccharide binding protein in the same duration. The oral cavity could be an important underdefined source of inflammation in cirrhosis.
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Affiliation(s)
- Jasmohan S. Bajaj
- 1Department of Internal Medicine, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Payam Matin
- 2Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia
| | - Melanie B. White
- 1Department of Internal Medicine, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Andrew Fagan
- 1Department of Internal Medicine, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Janina Golob Deeb
- 2Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia
| | - Chathur Acharya
- 1Department of Internal Medicine, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Swati S. Dalmet
- 3Microbiome Analysis Center, George Mason University, Manassas, Virginia
| | - Masoumeh Sikaroodi
- 3Microbiome Analysis Center, George Mason University, Manassas, Virginia
| | | | - Sinem E. Sahingur
- 2Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia
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Cao Y, Chen X, Jia Y, Lv Y, Sun Z. Oral health status of adult heart transplant recipients in China: A cross-sectional study. Medicine (Baltimore) 2018; 97:e12508. [PMID: 30235763 PMCID: PMC6160112 DOI: 10.1097/md.0000000000012508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Limited information on the oral health status of adult heart transplant recipients (HTRs) is known, and no available data exist in China. A prerequisite dental evaluation is usually recommended for patients' postorgan transplantation because lifelong immunosuppression may predispose them to infection spread.The aim of this study was to investigate the oral health status of Chinese adult HTRs and determine the association between oral health status and history of heart transplantation (HT).We carried out a cross-sectional study to collect clinical, demographic, socioeconomic, and behavioral data from 81 adult patients who received heart transplantation during 2014 to 2015 in China. Clinical examinations for the presence of dental plaque, dental calculus, dental caries, and periodontal health conditions were performed in a standardized manner by one trained examiner. Sociodemographic, socioeconomic, and behavioral data were self-reported using questionnaires. The prevalence of the above conditions was compared with 63 age- and sex-matched controls. General liner regression analysis was used to assess associations between mean number of decayed, missing, and filled teeth (DMFT) and mean community periodontal index of treatment needs (CPITN) scores and history of heart transplant.Mean age of the HT group was 47.7 ± 12.2 years and men accounted for 69.1% of the sample. The overall median DMFT score in the HT group was 3 (1-5) and caries prevalence was 80.2%, which were similar to the control group (P > .05). The overall mean CPITN score of the HT group was 1.84, which was significantly higher than the control group (1.07, P = .001). Participants in the HT group had worse oral hygiene status and more teeth with probing depth ≥ 4 mm than controls (P = .043). Compared with participants who had no history of heart transplantation, HTRs presented worse periodontal health conditions (mean CPITN score, adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.12-1.71, P = .003) and similar dental caries status (DMFT score, adjusted OR = 0.58, 95% CI = 0.37-0.91, P = .058).Periodontal health status was positively associated with history of heart transplantation in Chinese adult HTRs.
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Affiliation(s)
- Ying Cao
- Beijing Stomatological Hospital
- Department of Stomatology, Beijing Anzhen Hospital, Capital Medical University, Beijing City, China
| | - Xi Chen
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City
| | - Yixin Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital
| | - Yalin Lv
- Department of Stomatology, Beijing Anzhen Hospital, Capital Medical University, Beijing City, China
| | - Zheng Sun
- Department of Oral Mucosal Diseases, Beijing Stomatological Hospital, Capital Medical University, Beijing City, China
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Braga Diniz JM, Espaladori MC, Souza E Silva ME, Brito LCN, Vieira LQ, Ribeiro Sobrinho AP. Immunological profile of teeth with inflammatory periapical disease from chronic liver disease patients. Int Endod J 2018; 52:149-157. [PMID: 30091243 DOI: 10.1111/iej.12992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 08/05/2018] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the mRNA expression levels of the cytokines interferon-γ, tumour necrosis factor-α, interleukin (IL)-1β, IL-10, IL-6, VEGF, and AGT and the chemokine CCL2/MCP-1 in periapical interstitial fluid associated with root canal infections before and after the reduction of the bacterial load using a cleaning procedure. METHODOLOGY The case group included 11 patients with chronic liver disease, and the control group included 11 healthy patients. Clinical samples were taken from teeth with pulp necrosis. After cleaning and drying the canal, three paper points were introduced into the root canal and passed through the root apex (2 mm) into the periapical tissues for 1 min. The samples were collected immediately after root canal cleaning and 7 days later to characterize those gene expression levels using real-time PCR. The data were subjected to the Shapiro-Wilk and the Wilcoxon tests. RESULTS In the control group, significantly increased expression of the pro-inflammatory cytokines IFN-γ and TNF-α was observed in teeth with restrained bacterial loads (day 7) (P < 0.05). Similarly, increased TNF-α expression was found on day 7 in the liver group (P < 0.05). No differences were observed in the expression levels of the IL-1β, IL-10 and, IL-6, MCP-1/CCL-2 and VEGF between the first collection (day 0) and second collection (day 7), over time in either group. CONCLUSION Chronic liver disease patients exhibited sufficient immunologic ability showing relatively similar expression levels of cytokines, chemokines and angiogenic factors in periapical samples compared with the responses from no-chronic liver disease patients. The outcomes of this study suggest that liver impairment did not compromise the periapical immune response.
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Affiliation(s)
- J M Braga Diniz
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M C Espaladori
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M E Souza E Silva
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - L C N Brito
- Faculty of Dentistry, University of Itaúna, Itaúna, Brazil
| | - L Q Vieira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - A P Ribeiro Sobrinho
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Di Profio B, Inoue G, Marui VC, de França BN, Romito GA, Ortega KL, Holzhausen M, Pannuti CM. Periodontal status of liver transplant candidates and healthy controls. J Periodontol 2018; 89:1383-1389. [DOI: 10.1002/jper.17-0710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/14/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Bruna Di Profio
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Gislene Inoue
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Vanessa Costa Marui
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Bruno Nunes de França
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | | | - Karem Lopez Ortega
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Marinella Holzhausen
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Claudio Mendes Pannuti
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
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18
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Ghapanchi J, Zahed M, Haghnegahdar A, Niakan N, Sadeghzadeh A. Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4280312. [PMID: 30225253 PMCID: PMC6129325 DOI: 10.1155/2018/4280312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/22/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Patients with chronic liver failure (CLF) are faced with many complications, because this organ is involved in various metabolic activities. Hepatic osteodystrophy is one of the major health issues encountered by this group of patients. The current study evaluated osteoporosis and bone changes in oral panoramic radiographies of cirrhotic patients. MATERIALS AND METHODS In this study, 138 panoramic views of CLF patients, candidates for liver transplant (65 females, 73 males, aged 19-68 years) referred to Shiraz University Dental Clinic (Shiraz, Iran) for pretransplant oral examination, were evaluated. Also 138 healthy individuals (69 females, 69 males, aged 18-70 years) referred to the same clinic were examined. Abnormalities such as osteoporosis, pathologic radiolucencies, pathologic calcifications, tonsilloliths, condylar degeneration, and other findings in the alveolar bones were recorded. RESULTS Osteoporosis was a common finding in CLF patients (p<0.001), and the probability of detecting low bone density in the panoramic view was 20.37 times higher among patients than healthy subjects. The probability of detecting pathologic jaw radiolucencies was 8.92 times higher in the case group than in the controls (p<0.001). Other bone abnormalities such as condylar degeneration and idiopathic osteosclerosis were also more prevalent in CLF patients compared to healthy subjects (p<0.001). CONCLUSION Cirrhotic patients are prone to osteoporosis of the alveolar bones. Also, pathologic jaw radiolucencies as a result of oral infections are more prevalent in this group of patients. Routine oral panoramic views are acceptable and cost-effective radiographies for use in detecting such abnormalities in the alveolar bones as well as overall dental health. These findings also support the importance of dental health examinations prior to liver transplantation to reduce the risk of organ rejection.
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Affiliation(s)
- Janan Ghapanchi
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Zahed
- Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Niakan
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Sadeghzadeh
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
BACKGROUND Liver transplantation has become commonplace for patients with end-stage liver disease. The liver is a bodily organ of great importance, and its dysfunction can cause significant complications throughout the body. Patients with hepatic disease should be able to acquire knowledge of the physiology of the liver via the dental profession, and it is also necessary to modify some aspects of dental treatment even in healthy patients. Problems such as excessive bleeding and hepatotoxicity caused by some of the drugs used in dental treatment can lead to a decrease in systemic health. Otherwise, patients with liver disease will have poorer oral health than the general population. Thus, it is important to have well-established routine dental care in this patient group and offer management of oral health in view of the effects of liver disease. METHODS The objective of this work was to undertake a bibliographic review of the dental approaches to patients with liver disease and liver transplant recipients and to propose a dental care routine for such patients in an outpatient setting. RESULTS A search was carried out on the main scientific databases (PubMed, Medline, and SciELO) for publications related to this subject and, particularly those published after 2010. The articles selected describe poor oral hygiene among patients, independent of the etiology of their liver disease. These patients also had a high index of xerostomia, caries, periodontal disease, apical lesions, and fungical infections. To control bleeding during and after surgery, hemostatic measures must be understood and adopted. CONCLUSION There are no data about routine dental care among liver disease/transplantation patients. Thus, our findings will hopefully encourage other services to structure their approaches and consider enhancing their dental care protocols for patients with liver-related complications.
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Unique subgingival microbiota associated with periodontitis in cirrhosis patients. Sci Rep 2018; 8:10718. [PMID: 30013030 PMCID: PMC6048062 DOI: 10.1038/s41598-018-28905-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/03/2018] [Indexed: 02/08/2023] Open
Abstract
Liver cirrhosis is a severe disease with major impact on the overall health of the patient including poor oral health. Lately, there has been increasing focus on oral diseases as cirrhosis-related complications due to the potential impact on systemic health and ultimately mortality. Periodontitis is one of the most common oral diseases in cirrhosis patients. However, no studies have investigated the composition of the subgingival microbiome in patients suffering from periodontitis and liver cirrhosis. We analysed the subgingival microbiome in 21 patients with periodontitis and cirrhosis using long-reads Illumina sequencing. The subgingival microbiota was dominated by bacteria belonging to the Firmicutes phylum and to a lesser extend the Actinobacteria and Bacteroidetes phyla. Bacteria usually considered periodontal pathogens, like Porhyromonas ginigivalis, Tannerella forsythia, Treponema denticola, generally showed low abundancy. Comparing the microbiota in our patients with that of periodontitis patients and healthy controls of three other studies revealed that the periodontitis-associated subgingival microbiota in cirrhosis patients is composed of a unique microbiota of bacteria not normally associated with periodontitis. We hypothesise that periodontitis in cirrhosis patients is a consequence of dysbiosis due to a compromised immune system that renders commensal bacteria pathogenic.
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Schmalz G, Wendorff H, Berisha L, Meisel A, Widmer F, Marcinkowski A, Teschler H, Sommerwerck U, Haak R, Kollmar O, Ziebolz D. Association between the time after transplantation and different immunosuppressive medications with dental and periodontal treatment need in patients after solid organ transplantation. Transpl Infect Dis 2018; 20:e12832. [PMID: 29359871 DOI: 10.1111/tid.12832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/10/2017] [Accepted: 10/07/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Horst Wendorff
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Lisa Berisha
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Anja Meisel
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Florian Widmer
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Anna Marcinkowski
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Helmut Teschler
- Department of Pneumology; West German Lung Center; Ruhrlandklinik; University Hospital Essen; University Duisburg-Essen; Essen Germany
| | - Urte Sommerwerck
- Department of Pneumology; West German Lung Center; Ruhrlandklinik; University Hospital Essen; University Duisburg-Essen; Essen Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Otto Kollmar
- Department of General and Visceral Surgery; HELIOS Dr. Horst Schmidt-Kliniken; Wiesbaden Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
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Grønkjær LL, Holmstrup P, Schou S, Kongstad J, Jepsen P, Vilstrup H. Periodontitis in patients with cirrhosis: a cross-sectional study. BMC Oral Health 2018; 18:22. [PMID: 29439734 PMCID: PMC5811961 DOI: 10.1186/s12903-018-0487-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many patients with cirrhosis have poor oral health but little is known on periodontitis, and its clinical significance is largely unknown. This study aimed to examine the prevalence and predictors of periodontitis, and evaluate the association of periodontitis with nutritional and systemic inflammation status. METHODS 145 patients with cirrhosis were consecutively enrolled. Clinical, oral examination of plaque, pocket depth, clinical attachment level, and bleeding on probing was performed. Patients were categorized as having no-or-mild, moderate, or severe periodontitis. Predictors of severe periodontitis and the association with nutritional and systemic inflammation status were analyzed using univariable and multivariable logistic regression analyses. RESULTS The large majority of patients had periodontitis, 46% of them severely and 39% moderately. Predictors of severe periodontitis included smoking (odds ratio (OR) 2.93, 95% confidence interval (CI) 1.29-6.63), brushing teeth twice daily (OR 0.30, 95% CI 0.11-0.79), and visiting the dentist annually (OR 3.51, 95% CI 1.22-10.81). Cirrhosis etiology or severity was not predictors of severe periodontitis. The patients with severe periodontitis had a higher nutritional risk score than patients with moderate, mild, or no periodontitis (3, interquartile range (IQR) 3-5 vs. 3, IQR 2-4, P = 0.02). CONCLUSIONS Most cirrhosis patients had significant periodontitis, the severity of which was related to life style factors and was associated with higher nutrition risk score. Our results emphasize the need for further research to establish the effect of periodontitis on cirrhosis.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Palle Holmstrup
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schou
- Section for Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanne Kongstad
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
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Abstract
BACKGROUND There is a gap in the scientific literature about the association between oral health and the health-related quality of life of patients on the liver transplantation waiting list. The aim of this work was to describe aspects of oral health and quality of life of patients on a liver transplantation waiting list. METHODS This was a cross-sectional study among 116 patients with chronic hepatic disease: 29 on a liver transplantation waiting list (Model for End-Stage Liver Disease score ≥15) and 87 under monitoring in a gastroenterology service in a Brazilian university hospital. Oral health was evaluated according to criteria recommended by the World Health Organization and by the European Association of Dental Public Health. Health-related quality of life was evaluated by means of the 36-Item Short-Form Health Survey (SF-36). RESULTS Patients on the liver transplantation waiting list presented poorer health-related quality of life than those who were not on the list in the domains physical functioning, role physical, bodily pain, general health perceptions, and social functioning and in the physical component summary. Periodontitis affected 72.4% of the patients on the liver transplantation waiting list, but only 27.6% of the patients not on that list. Reduced salivary flow was associated with poorer mental health component summary in hepatitis C patients. CONCLUSIONS Patients on the liver transplantation waiting list presented poorer health-related quality of life than those who were not on the list, mainly in the indicators concerning physical health, as well as higher frequencies of decayed teeth and periodontitis. The mental health component summary was associated with reduced salivary flow in hepatitis C patients.
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Oral health-related quality of life depending on dental and periodontal health in different patients before and after liver transplantation. Clin Oral Investig 2017; 22:2039-2045. [DOI: 10.1007/s00784-017-2298-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022]
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Alazawi W, Bernabe E, Tai D, Janicki T, Kemos P, Samsuddin S, Syn WK, Gillam D, Turner W. Periodontitis is associated with significant hepatic fibrosis in patients with non-alcoholic fatty liver disease. PLoS One 2017; 12:e0185902. [PMID: 29220367 PMCID: PMC5722374 DOI: 10.1371/journal.pone.0185902] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/21/2017] [Indexed: 01/01/2023] Open
Abstract
Background and aims Non-alcoholic fatty liver disease (NAFLD) has a bidirectional association with metabolic syndrome. It affects up to 30% of the general population, 70% of individuals with diabetes and 90% with obesity. The main histological hallmark of progressive NAFLD is fibrosis. There is a bidirectional epidemiological link between periodontitis and metabolic syndrome. NAFLD, periodontitis and diabetes share common risk factors, are characterised by inflammation and associated with changes in commensal bacteria. Therefore we tested the hypothesis that periodontitis is associated with NAFLD and with significant fibrosis in two study groups. Methods We analyzed data from a population-based survey and a patient-based study. NHANES III participants with abdominal ultrasound and sociodemographic, clinical, and oral examination data were extracted and appropriate weighting applied. In a separate patient-based study, consenting patients with biopsy-proved NAFLD (or with liver indices too mild to justify biopsy) underwent dental examination. Basic Periodontal Examination score was recorded. Results In NHANES, periodontitis was significantly associated with steatosis in 8172 adults even after adjusting for sociodemographic factors. However, associations were fully explained after accounting for features of metabolic syndrome. In the patient-based study, periodontitis was significantly more common in patients with biopsy-proven NASH and any fibrosis (F0-F4) than without NASH (p = 0.009). Periodontitis was more common in patients with NASH and significant fibrosis (F2-4) than mild or no fibrosis (F0-1, p = 0.04). Conclusions Complementary evidence from an epidemiological survey and a clinical study show that NAFLD is associated with periodontitis and that the association is stronger with significant liver fibrosis.
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Affiliation(s)
- William Alazawi
- Blizard institute, Queen Mary, University of London, London, United Kingdom
- * E-mail:
| | - Eduardo Bernabe
- Institute of Dentistry, King’s College London, London, United Kingdom
| | - David Tai
- Blizard institute, Queen Mary, University of London, London, United Kingdom
| | - Tomasz Janicki
- Dental Institute, Queen Mary, University of London, London, United Kingdom
| | - Polychronis Kemos
- Blizard institute, Queen Mary, University of London, London, United Kingdom
| | - Salma Samsuddin
- Blizard institute, Queen Mary, University of London, London, United Kingdom
| | - Wing-Kin Syn
- Blizard institute, Queen Mary, University of London, London, United Kingdom
- Section of Gastroenterology, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States of America
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, United States of America
| | - David Gillam
- Dental Institute, Queen Mary, University of London, London, United Kingdom
| | - Wendy Turner
- Dental Institute, Queen Mary, University of London, London, United Kingdom
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Sandoval MJ, Zekeridou A, Spyropoulou V, Courvoisier D, Mombelli A, McLin V, Giannopoulou C. Oral health of pediatric liver transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28670817 DOI: 10.1111/petr.13019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 01/25/2023]
Abstract
To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.
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Affiliation(s)
- Marίa José Sandoval
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Alkisti Zekeridou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vasiliki Spyropoulou
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | | | - Andrea Mombelli
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Valérie McLin
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
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Abstract
Cirrhosis is a prevalent cause of morbidity and mortality, especially for those at an advanced decompensated stage. Cirrhosis development and progression involves several important interorgan communications, and recently, the gut microbiome has been implicated in pathophysiology of the disease. Dysbiosis, defined as a pathological change in the microbiome, has a variable effect on the compensated versus decompensated stage of cirrhosis. Adverse microbial changes, both in composition and function, can act at several levels within the gut (stool and mucosal) and have also been described in the blood and oral cavity. While dysbiosis in the oral cavity could be a source of systemic inflammation, current cirrhosis treatment modalities are targeted toward the gut-liver axis and do not address the oral microbiome. As interventions designed to modulate oral dysbiosis may delay progression of cirrhosis, a better understanding of this process is of the utmost importance. The concept of oral microbiota dysbiosis in cirrhosis is relatively new; therefore, this review will highlight the emerging role of the oral-gut-liver axis and introduce perspectives for future research.
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Affiliation(s)
- Chathur Acharya
- Department of Gastroenterology and Hepatology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - Sinem Esra Sahingur
- Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jasmohan S. Bajaj
- Department of Gastroenterology and Hepatology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
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Kauffels A, Schmalz G, Kollmar O, Slotta JE, Weig M, Groß U, Bader O, Ziebolz D. Oral findings and dental behaviour before and after liver transplantation – a single-centre cross-sectional study. Int Dent J 2017; 67:244-251. [DOI: 10.1111/idj.12290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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29
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Ladegaard Grønkjær L, Holmstrup P, Schou S, Jepsen P, Vilstrup H. Severe periodontitis and higher cirrhosis mortality. United European Gastroenterol J 2017; 6:73-80. [PMID: 29435316 DOI: 10.1177/2050640617715846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/15/2017] [Indexed: 12/28/2022] Open
Abstract
Background Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown. Objective The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis. Methods A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan-Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis etiology, Child-Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score. Results The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty-four percent of the patients died during follow-up. Severe periodontitis was associated with higher all-cause mortality in the crude analysis (HR 1.56, 95% CI 1.06-2.54), but not in the adjusted analysis (HR 1.45, 95% CI 0.79-2.45). Severe periodontitis was even more strongly associated with higher cirrhosis-related mortality (crude HR 2.19, 95% CI 1.07-4.50 and adjusted HR 2.29, 95% CI 1.04-4.99). No association was found between edentulism and mortality. Conclusion The presence of severe periodontitis predicted a more than double one-year cirrhosis mortality. These findings may motivate intervention trials on the effect of periodontitis treatment in patients with cirrhosis.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Palle Holmstrup
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schou
- Section for Oral and Maxillofacial Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Schmalz G, Wendorff H, Marcinkowski A, Weinreich G, Teschler H, Haak R, Sommerwerck U, Ziebolz D. Oral health related quality of life depending on oral health and specific factors in patients after lung transplantation. CLINICAL RESPIRATORY JOURNAL 2017; 12:731-737. [PMID: 28294545 DOI: 10.1111/crj.12625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig, Leipzig, Germany
| | - Horst Wendorff
- Department of Cariology, Endodontology and Periodontology; University of Leipzig, Leipzig, Germany
| | - Anna Marcinkowski
- Department of Cariology, Endodontology and Periodontology; University of Leipzig, Leipzig, Germany
| | - Gerhard Weinreich
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen, Essen; Germany
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen, Essen; Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology; University of Leipzig, Leipzig, Germany
| | - Urte Sommerwerck
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen, Essen; Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig, Leipzig, Germany
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Marcinkowski A, Ziebolz D, Kleibrink BE, Weinreich G, Kamler M, Teschler H, Sommerwerck U. Deficits in oral health behavior and oral health status in patients after lung transplantation. CLINICAL RESPIRATORY JOURNAL 2016; 12:721-730. [PMID: 27860358 DOI: 10.1111/crj.12585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Marcinkowski
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Bjoern E. Kleibrink
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen; Essen Germany
| | - Gerhard Weinreich
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen; Essen Germany
| | - Markus Kamler
- Department of Thoracic Transplantation; University Hospital Essen, University Duisburg-Essen; Essen Germany
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen; Essen Germany
| | - Urte Sommerwerck
- Department of Pneumology, Ruhrlandklinik, West German Lung Center; University Hospital Essen, University Duisburg-Essen; Essen Germany
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Cocero N, Bezzi M, Martini S, Carossa S. Oral Surgical Treatment of Patients With Chronic Liver Disease: Assessments of Bleeding and Its Relationship With Thrombocytopenia and Blood Coagulation Parameters. J Oral Maxillofac Surg 2016; 75:28-34. [PMID: 27677683 DOI: 10.1016/j.joms.2016.08.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Cirrhotic patients awaiting liver transplantation require eradication of infectious oral foci to prevent septic episodes after transplantation; however, cirrhosis can hinder hemostasis and can result in severe bleeding. The present study assessed the bleeding risk factors connected with the clinical history of these patients and the characteristics of the extractions. MATERIALS AND METHODS We retrospectively analyzed 1183 extractions in 318 patients, including 47 with severe end-stage liver disease who were outside of our intention-to-treat bracket (ie, platelet count [PLT] >40 × 103/μL and international normalized ratio [INR] <2.5). Follow-up examinations included inspection of the oral cavity on the first, third, and seventh days, with reparatory surgery in the case of severe bleeding. Continuous variables were compared using the Mann-Whitney U and Kruskal-Wallis tests, and categorical variables were compared using Fisher's exact test. Binary logistic regression analysis was also performed. RESULTS Within the intention-to-treat bracket, 1 of the 271 patients (0.4%) required surgical repair. The bleeding rate for an INR of 2.5 or more was significantly greater than that for a PLT of 40 × 103/μL or less (4 of 10 [40%] versus 2 of 34 [6%]; P = .02]. All 3 patients with both an INR of 2.5 or more and a PLT of 40 × 103/μL or less exhibited severe bleeding. No significant association between the occurrence of bleeding with either liver disease etiology or the number of molars extracted was found. No patient required hospitalization. CONCLUSIONS Patients with a PLT greater than 40 × 103/μL and an INR of less than 2.5 can be considered relatively low-risk patients. However, an INR of 2.5 or more and, to a minor degree, a PLT of 40 × 103/μL or less represent significant risk factors.
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Affiliation(s)
- Nadia Cocero
- Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy.
| | - Marta Bezzi
- Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy
| | - Silvia Martini
- Resident, Gastrohepatology, Molinette Hospital, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano Carossa
- Department Head, Department of Surgical Sciences, Dental School, University of Torino, Torino, Italy
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Yoon DL, Kim YG, Cho JH, Lee SK, Lee JM. Long-term evaluation of teeth and implants during the periodic maintenance in patients with viral liver disease. J Adv Prosthodont 2016; 8:321-8. [PMID: 27555902 PMCID: PMC4993846 DOI: 10.4047/jap.2016.8.4.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/22/2016] [Accepted: 08/08/2016] [Indexed: 01/30/2023] Open
Abstract
PURPOSE This study was designed to investigate the maintenance of teeth and implants in patients with viral liver disease. MATERIALS AND METHODS 316 patients without any significant systemic disease were selected as a control group. Liver disease group was consisted of 230 patients. Necessary data were collected using clinical records and panoramic radiographs. Then, the patients were subdivided into 2 groups based on the type of active dental therapy received before maintenance period (Pre-Tx). Analysis for finding statistically significant difference was performed based on the need for re-treatment of active dental therapy (Re-Tx) and change in the number of teeth (N-teeth) and implants (N-implants). RESULTS Comparing to control group, the patients with liver disease showed higher value on N-teeth, N-implants, and Re-Tx. Statistically significant differences were found on N-teeth (P=.000) and Re-Tx (P=.000) in patients with non-surgical Pre-Tx. Analysis based on severity of liver disease showed that N-teeth and Re-Tx were directly related to severity of liver disease regardless of received type of Pre-Tx. Significant differences were found on N-teeth (P=.003) and Re-Tx (P=.044) in patients with non-surgical Pre-Tx. CONCLUSION In this study, it was concluded that liver disease might influence the loss of teeth and cause the relapse of dental disease during maintenance period in patients. A significant positive relationship between tooth and implant loss and severity of liver disease seems to exist.
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Affiliation(s)
- Da-Le Yoon
- Department of Periodontology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Gun Kim
- Department of Periodontology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-Hyun Cho
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Sang-Kyu Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Mok Lee
- Department of Periodontology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Han P, Sun D, Yang J. Interaction between periodontitis and liver diseases. Biomed Rep 2016; 5:267-276. [PMID: 27588170 PMCID: PMC4998044 DOI: 10.3892/br.2016.718] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023] Open
Abstract
Periodontitis is an oral disease that is highly prevalent worldwide, with a prevalence of 30–50% of the population in developed countries, but only ~10% present with severe forms. It is also estimated that periodontitis results in worldwide productivity losses amounting to ~54 billion USD yearly. In addition to the damage it causes to oral health, periodontitis also affects other types of disease. Numerous studies have confirmed the association between periodontitis and systemic diseases, such as diabetes, respiratory disease, osteoporosis and cardiovascular disease. Increasing evidence also indicated that periodontitis may participate in the progression of liver diseases, such as non-alcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma, as well as affecting liver transplantation. However, to the best of our knowledge, there are currently no reviews elaborating upon the possible links between periodontitis and liver diseases. Therefore, the current review summarizes the human trials and animal experiments that have been conducted to investigate the correlation between periodontitis and liver diseases. Furthermore, in the present review, certain mechanisms that have been postulated to be responsible for the role of periodontitis in liver diseases (such as bacteria, pro-inflammatory mediators and oxidative stress) are considered. The aim of the review is to introduce the hypothesis that periodontitis may be important in the progression of liver disease, thus providing dentists and physicians with an improved understanding of this issue.
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Affiliation(s)
- Pengyu Han
- The Liver Disease Diagnosis and Treatment Center of PLA, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, P.R. China
| | - Dianxing Sun
- The Liver Disease Diagnosis and Treatment Center of PLA, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, P.R. China
| | - Jie Yang
- Department of Public Healthcare, Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
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Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Huiping Zhou
- Department of Microbiology and Immunology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Dae Joong Kang
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Phillip B Hylemon
- Department of Microbiology and Immunology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
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Periodontal pathogenic bacteria and aMMP-8 findings depending on periodontal conditions of patients before and after liver transplantation. Clin Oral Investig 2016; 21:745-752. [DOI: 10.1007/s00784-016-1821-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/03/2016] [Indexed: 12/28/2022]
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Rodríguez Martínez S, Talaván Serna J, Silvestre FJ. [Dental management in patients with cirrhosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:224-32. [PMID: 26541210 DOI: 10.1016/j.gastrohep.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/14/2015] [Accepted: 07/27/2015] [Indexed: 01/03/2023]
Abstract
The present article makes a brief review about dental management of the patients with cirrhosis. It focus on problems related with infections, haemorrhagic events and treatment with drugs of common use in odontology.
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Affiliation(s)
| | - Julio Talaván Serna
- Servicio de Anestesiología y Reanimación, Hospital General d́Ontinyent, Valencia, España
| | - Francisco-Javier Silvestre
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
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Bajaj JS, Betrapally NS, Hylemon PB, Heuman DM, Daita K, White MB, Unser A, Thacker LR, Sanyal AJ, Kang DJ, Sikaroodi M, Gillevet PM. Salivary microbiota reflects changes in gut microbiota in cirrhosis with hepatic encephalopathy. Hepatology 2015; 62:1260-71. [PMID: 25820757 PMCID: PMC4587995 DOI: 10.1002/hep.27819] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/19/2015] [Accepted: 03/26/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED Altered gut microbiome is associated with systemic inflammation and cirrhosis decompensation. However, the correlation of the oral microbiome with inflammation in cirrhosis is unclear. Our aim was to evaluate the oral microbiome in cirrhosis and compare with stool microbiome. Outpatients with cirrhosis (with/without hepatic encephalopathy [HE]) and controls underwent stool/saliva microbiome analysis (for composition and function) and also systemic inflammatory evaluation. Ninety-day liver-related hospitalizations were recorded. Salivary inflammation was studied using T helper 1 cytokines/secretory immunoglobulin A (IgA), histatins and lysozyme in a subsequent group. A total of 102 patients with cirrhosis (43 previous HE) and 32 age-matched controls were included. On principal component analysis (PCA), stool and saliva microbiome clustered far apart, showing differences between sites as a whole. In salivary microbiome, with previous HE, relative abundance of autochthonous families decreased whereas potentially pathogenic ones (Enterobacteriaceae, Enterococcaceae) increased in saliva. Endotoxin-related predicted functions were significantly higher in cirrhotic saliva. In stool microbiome, relative autochthonous taxa abundance reduced in previous HE, along with increased Enterobacteriaceae and Enterococcaceae. Cirrhotic stool microbiota demonstrated a significantly higher correlation with systemic inflammation, compared to saliva microbiota, on correlation networks. Thirty-eight patients were hospitalized within 90 days. Their salivary dysbiosis was significantly worse and predicted this outcome independent of cirrhosis severity. Salivary inflammation was studied in an additional 86 age-matched subjects (43 controls/43 patients with cirrhosis); significantly higher interleukin (IL)-6/IL-1β, secretory IgA, and lower lysozyme, and histatins 1 and 5 were found in patients with cirrhosis, compared to controls. CONCLUSIONS Dysbiosis, represented by reduction in autochthonous bacteria, is present in both saliva and stool in patients with cirrhosis, compared to controls. Patients with cirrhosis have impaired salivary defenses and worse inflammation. Salivary dysbiosis was greater in patients with cirrhosis who developed 90-day hospitalizations. These findings could represent a global mucosal-immune interface change in cirrhosis.
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Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Naga S Betrapally
- Microbiome Analysis Center, George Mason University, Manassas, Virginia
| | - Phillip B Hylemon
- Department of Microbiology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Douglas M Heuman
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Kalyani Daita
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Melanie B White
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Ariel Unser
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Leroy R Thacker
- Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
| | - Dae Joong Kang
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia
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Grønkjær LL. Periodontal disease and liver cirrhosis: A systematic review. SAGE Open Med 2015; 3:2050312115601122. [PMID: 26770799 PMCID: PMC4679327 DOI: 10.1177/2050312115601122] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/19/2015] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
OBJECTIVE The aim of this study was to describe the oral care habits and self-perceived oral health in patients with liver cirrhosis, as well as to evaluate the impact of oral health on well-being and the relation to nutritional status. PARTICIPANTS AND METHODS From October 2012 to May 2013, we carried out a prospective study on patients with liver cirrhosis. Questions on oral care habits and self-perceived oral health were answered, and the Oral Health Impact Profile questionnaire (OHIP-14) provided information on oral conditions. The findings were compared with The Danish Institute for Health Services Research report on the Danish population's dental status. RESULTS One hundred and seven patients participated. Their oral care habits and self-perceived oral health were poorer than the Danish population; the patients had fewer teeth (on average 19 vs. 26, P = 0.0001), attended the dentist less frequently (P = 0.001), more rarely brushed teeth (P = 0.001) and had problems with oral dryness (68 vs. 14%, P = 0.0001). The patients' mean OHIP score was 5.21 ± 7.2, with the most commonly reported problems being related to taste and food intake. An association was observed between the OHIP score and the patients' nutritional risk score (P = 0.01). CONCLUSION Our results showed that cirrhosis patients cared less for oral health than the background population. Their resulting problems may be contributing factors to their nutritional risk and decreased well-being. Oral health problems may thus have adverse prognostic importance. Our results emphasize the need for measures to protect and improve the oral health of cirrhosis patients.
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Squires RH, Ng V, Romero R, Ekong U, Hardikar W, Emre S, Mazariegos GV. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology 2014; 60:362-98. [PMID: 24782219 DOI: 10.1002/hep.27191] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Robert H Squires
- Department of Pediatrics, University of Pittsburgh School of Medicine; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Hicks JL. Oral care of the patient with liver failure, pretransplant-a retrospective study. SPECIAL CARE IN DENTISTRY 2014; 35:8-14. [DOI: 10.1111/scd.12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jeffery L. Hicks
- Professor, University of Texas Health Science Center at San Antonio; San Antonio Texas
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Castellanos-Cosano L, Machuca-Portillo G, Segura-Sampedro JJ, Torres-Lagares D, López-López J, Velasco-Ortega E, Segura-Egea JJ. Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates. Med Oral Patol Oral Cir Bucal 2013; 18:e773-9. [PMID: 23722148 PMCID: PMC3790651 DOI: 10.4317/medoral.19148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022] Open
Abstract
Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects.
Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression.
Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects.
Key words:Apical periodontitis, endodontics, hepatic cirrhosis, liver disease, liver transplant, oral health, root-canal treatment.
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Helenius-Hietala J, Ruokonen H, Grönroos L, Rissanen H, Suominen L, Isoniemi H, Meurman JH. Self-reported oral symptoms and signs in liver transplant recipients and a control population. Liver Transpl 2013; 19:155-63. [PMID: 23172817 DOI: 10.1002/lt.23573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/06/2012] [Indexed: 12/15/2022]
Abstract
Recipients of liver transplantation (LT) receive lifelong immunosuppression, which causes side effects. We investigated self-reported oral symptoms and associated risk factors with the following hypothesis: symptoms and signs would differ between LT recipients of different etiology groups and also between LT recipients and a control population. Eighty-four LT recipients (64 with chronic liver disease and 20 with acute liver disease) were recruited for clinical oral and salivary examinations (median follow-up = 5.7 years). A structured questionnaire was used to record subjective oral symptoms. Matched controls (n = 252) came from the National Finnish Health 2000 survey. The prevalence of symptoms was compared between the groups, and the risk factors for oral symptoms were analyzed. Xerostomia was prevalent in 48.4% of the chronic LT recipients and in 42.1% of the acute LT recipients. This subjective feeling of dry mouth was only partly linked to objectively measured hyposalivation. The chronic transplant recipients had significantly lower unstimulated salivary flow rates than the acute transplant recipients (0.34 ± 0.31 versus 0.61 ± 0.49 mL/minute, P = 0.005). Among the chronic transplant recipients, hyposalivation with unstimulated salivary flow was associated with fewer teeth (17.7 ± 8.2 versus 21.9 ± 8.4, P = 0.047) and more dentures (33.3% versus 12.2%, P = not significant). The chronic patients reported significantly more dysphagia than their controls (23.4% versus 11.5%, P = 0.02). Increases in the number of medications increased the symptoms in all groups. In conclusion, dysphagia was significantly more prevalent among the chronic LT recipients versus the controls. The number of medications was a risk factor for dry mouth-related symptoms for both the LT recipients and the controls. The chronic transplant recipients presented with lower salivary flow rates than the acute transplant recipients. Hyposalivation correlated with generally worse oral health among the chronic transplant recipients. These differences between the chronic and acute LT recipients may have been due to differences in their medical conditions due to the different etiologies.
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Silva Santos PSD, Fernandes KS, Gallottini MHC. Assessment and management of oral health in liver transplant candidates. J Appl Oral Sci 2012; 20:241-5. [PMID: 22666844 PMCID: PMC3894770 DOI: 10.1590/s1678-77572012000200020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 07/08/2011] [Indexed: 12/16/2022] Open
Abstract
Liver transplantation has become a standard treatment for end-stage liver disease and
the number of recipients has grown rapidly in the last few years. Dental care during
pre-transplant workup is important to reduce potential sources of infection in the
drug-induced immunosuppression phase of liver transplantation.
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Helenius-Hietala J, Åberg F, Meurman JH, Isoniemi H. Increased infection risk postliver transplant without pretransplant dental treatment. Oral Dis 2012; 19:271-8. [DOI: 10.1111/j.1601-0825.2012.01974.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/25/2012] [Accepted: 07/09/2012] [Indexed: 12/18/2022]
Affiliation(s)
- J Helenius-Hietala
- Department of Oral Infectious Diseases; Institute of Dentistry; University of Helsinki; Helsinki Finland
- Department of Oral and Maxillofacial Diseases; Helsinki University Central Hospital; Helsinki Finland
| | - F Åberg
- Transplantation and Liver Surgery Clinic; Helsinki University Central Hospital; Helsinki Finland
| | - JH Meurman
- Department of Oral Infectious Diseases; Institute of Dentistry; University of Helsinki; Helsinki Finland
- Department of Oral and Maxillofacial Diseases; Helsinki University Central Hospital; Helsinki Finland
| | - H Isoniemi
- Transplantation and Liver Surgery Clinic; Helsinki University Central Hospital; Helsinki Finland
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Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:52-60. [PMID: 22727092 DOI: 10.1016/j.oooo.2011.11.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this article is to review existing research on the prevalence and etiology of dry mouth in the vulnerable elders and identify knowledge gaps. STUDY DESIGN Vulnerable elders (VE) are persons aged >65 years who have any or all of the following: limited mobility, limited resources, or complex health status. A systematic search was conducted of PubMed sources from 1989 to May 2010. Evidence was evaluated on the prevalence and etiology of xerostomia and salivary gland hypofunction (SGH) in VE. RESULTS The search identified 1,422 publications. The inclusion/exclusion criteria yielded 348 articles, 80 of which are cited herein. CONCLUSIONS Research has showed a high prevalence of xerostomia and SGH in VE. Common etiologies include medications, poor general health, female gender, and age. Gaps still exist in the evaluation of dry mouth in VE. Nonetheless, oral dryness will remain an important health issue as life expectancy increases.
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Affiliation(s)
- Bing Liu
- Department of General Dentistry, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts 02118, USA.
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Helenius-Hietala J, Meurman JH, Höckerstedt K, Lindqvist C, Isoniemi H. Effect of the aetiology and severity of liver disease on oral health and dental treatment prior to transplantation. Transpl Int 2011; 25:158-65. [PMID: 22054477 DOI: 10.1111/j.1432-2277.2011.01381.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Elimination of dental infection foci has been recommended before liver transplantation (LT) because lifelong immunosuppression may predispose to infection spread. Association between pre-LT oral health and the aetiology and severity of chronic liver disease (CLD) was investigated retrospectively. A total of 212 adult patients (median age 51.1) who had received LT during 2000-2006 in Finland were included. Their oral health had been pre-operatively examined. Patients were divided into seven different CLD groups. Common indications for LT were primary sclerosing cholangitis (PSC 25.5%), alcohol cirrhosis (ALCI 17.5%) and primary biliary cirrhosis (PBC 14.6%). Patients were also categorized by the Model for End stage Liver Disease (MELD) scoring system. Medical, dental and panoramic jaw x-ray data were analysed between groups. PBC patients had the lowest number of teeth with significant difference to PSC patients (19.7 vs. 25.6, P < 0.005, anova, t-test). ALCI patients had the highest number of tooth extractions with significant difference in comparison to PSC patients (5.6 vs. 2.5, P < 0.005). Lower MELD score resulted in fewer tooth extractions but after adjusting for several confounding factors, age was the most important factor associated with extractions (P < 0.005). The aetiology of CLD associated with the oral health status and there was a tendency towards worse dental health with higher MELD scores.
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