Study liver inflammation (NASH) and periodontitis

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New clinical study confirms link between liver inflammation and periodontitis

Obesity, fatty diet, dyslipidemia and diabetes are known risk factors for non-alcoholic steatohepatitis. New research has suggested that periodontitis is also associated with the disease. (Image: Explode/Shutterstock)
Dental Tribune UK & Ireland

Dental Tribune UK & Ireland

Wed. 1 February 2023


HAMBURG, Germany: Periodontal health can contribute to systemic conditions; recent research has found evidence about the links between gum disease and chronic diseases such as diabetes and heart disease. A pilot study now suggests that non-alcoholic steatohepatitis (NASH) might be associated with periodontitis. The study also suggests regular dental care might mitigate the course of NASH.

Researchers from the departments of medicine, periodontics, preventative and restorative dentistry at University Medical Center Hamburg-Eppendor and the German Center for Infection Research investigated the association in a well-defined cohort.

Amongst the findings, liver stiffness was found to be increased with the severity of periodontitis. This finding, also positively correlated with key increasing periodontitis markers such as bleeding on probing and probing pocket depth. Researchers suggest the findings indicate patients need to be reminded of the importance of regular dental visits.

Data of 132 patients (including 32 patients with NASH) were examined for detailed periodontal parameters, and were correlated with relevant hepatic parameters, such as liver stiffness. Researchers found that 87.5% of NASH patients, compared with 47% of the control group, suffered from moderate and severe periodontitis. Liver stiffness was significantly correlated with elevated pocket probing depths and bleeding on probing.

Furthermore, 34% of the NASH patients examined did not make use of regular dental care. In these patients, alanine transaminase (ALT), model of endstage liver disease and liver stiffness were significantly elevated compared with those who see a dentist regularly.

Dr Sulaman Anwar, a UK specialist periodontist and implant surgeon, spoke with Dental Tribune UK about the study: “The link between periodontitis and systemic health has been thoroughly researched and is constantly being updated. There is already a confirmed link between a patient’s diabetic status and their periodontal health. Strong evidence linking obesity and periodontitis also exists. This recently published pilot study focuses on the liver and highlights an association between non-alcoholic steatohepatitis (NASH) and periodontitis.”

Dr Anwar continued: “It should be noted that the study does not determine with certainty whether there is a causal relationship between periodontitis and NASH or whether the common variable linking the presence of periodontitis and NASH is simply an overall reduced health awareness in these patients. The authors agree do agree that these are preliminary findings and large scale follow up research is required to further prove and validate the association that untreated periodontitis could worsen the course of NASH. However, this medical study once again highlights the need for proactive monitoring and treatment of a hepatic patient’s periodontal health but potentially also for a periodontitis patient’s referral for further investigation and testing of their liver status.”

The study, titled “High prevalence of periodontal disease in patients with NASH-possible association of poor dental health with NASH severity" was published online on 23 January 2023 in the Annals of Hepatology. 

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