What Is the Relationship Between Oral Cavity and Liver Cirrhosis?
Research indicates that oral mucosal lesions and periodontal disease are more pronounced in liver cirrhosis patients, correlating with a decreased salivary flow in the oral cavity. Several periodontal indices and traditional medical literature combined with modern research methods over the recent decades have established a link between liver disease and periodontal disease. Specifically, liver cirrhosis or scarring, also known as liver fibrosis, is mainly associated with hepatitis and chronic or long-term alcoholism. As this disease progresses, it impairs the quality of life, and liver functions are severely impacted and often irreversible, which can be life-threatening in serious cases.
What Are the Oral Manifestations of Liver Cirrhosis?
The presence of oral manifestations in patients with cirrhosis is mainly associated with the occurrence of bleeding, petechiae, hematomas, yellowish-colored or jaundice-type mucosa, gum bleeding, tongue inflammation or blastos, and inflammatory swelling of the salivary glands (sialadenosis). All of these symptoms are mainly attributed to liver dysfunctionalities.
The use of diuretic drugs in liver dysfunction patients or cirrhosis is also linked to reduced salivary flow (hyposalivation). Hence, the prevalence of these people developing additional dental complications or conditions like deep dental caries, gingival or gum inflammation, and oral candidiasis (fungal infection) is more. Differential diagnosis of oral neoplasms is the oral squamous cell carcinoma or OSCC, another major disease or cancer linked to alcoholic cirrhosis.
Angular cheilitis lesions are the other most common lesions usually identified in cirrhotic patients. In this condition, lesions or ulcers form at the corners of the mouth. They can cause patient discomfort, including temperature sensitivity or intolerance to hot and cold foods, pain, dry skin, and delayed wound healing. Patients may often observe reddish or purple spots on outside corners of the mouth that may or may not be accompanied by crusting, swelling, or cracking of the lips (are other common clinical features of angular cheilitis). If the patient has increased pain or often burning sensation in the mouth, that further aggravates their inability to eat, drink or talk.
What Is the Pathophysiology of Dental Disease and Liver Cirrhosis?
Alcohol, apart from being an addictive substance to regular consumers, is also detrimental to the protein-energy metabolism in the human body. Its interference with protein metabolism results in delayed tissue or wound healing (both metabolic cycles interlinked with periodontal disease). Evidence as per research about the presence of serum cytokines in periodontal inflammation and destruction is more in patients with cirrhosis (especially alcoholic cirrhosis), which could increase the prevalence and severity of periodontitis in these patients.
Dental disease is an immune defensive breach in the microorganisms or toxic and pathogenic bacterium invading through the "port of entry" (breaching the line of defense). Then they enter the host's bloodstream and provoke inflammation mediators responsible for mild, moderate, or severe systemic inflammation. In a healthy individual, these bacterial loads of increased accumulation are eventually neutralized or defeated by our immune system components. The altered pathology in liver cirrhosis is due to the non-clearance of circulating endotoxins released by these pathogens, immunity is severely compromised due to hepatic dysfunction. The effect of oral infections on the progression of cirrhosis has been researched by scientists and clinicians extensively over the recent decades that establish this crucial documentation that dental treatment is mandatory or pivotal to the overall health of the individual already suffering from liver disease and vice versa.
Periodontal disease is loss of alveolar bone with periodontal pockets larger than 6 mm may be seen clinically upon routine dental examination in these patients. Case reports of root fragments or bone loss (either increased horizontally or vertically, that is horizontal or vertical bone loss) have been positively correlated to patients with the more advanced stages of liver cirrhosis.
What Are the Management Methods by Physicians and Dental Surgeons?
The likelihood of infections is higher in cirrhotic patients because the immunosuppressed conditions in these patients mainly vary depending on the stage of the disease. This increases their further susceptibility to systemic or toxic infections. Dental treatment in cirrhotic patients is mainly straightforward and conservative. Surgical interventions cannot be made without the physician's consent, routine blood examination, and neurologic factors. This is because the condition may involve bleeding, and caution should be undertaken before considering the stage of the disease and the need for antibiotic prophylaxis for these patients.
To reduce the complications derived from the spread of dental infection, half-yearly to yearly oral prophylaxis with restorative modalities will not cause any harm. It is very beneficial in preventing the aggravation of various lesions of gingiva and periodontal disease, especially in patients with advanced stages of liver cirrhosis. Research also indicates that patients with liver cirrhosis, particularly those with valvular prosthesis or heart-related defects, people with a history of drug abuse, and patients suffering from chronic renal failure, are at the highest risk for developing bacterial endocarditis. Research about preoperative antibiotic prophylaxis being effective before dental treatment remains elusive; however, some dentists recommend that this may lead to effective infection control prior to a surgical or a prophylactic dental procedure. Due to reduced salivary secretion, the dentist must emphasize oral hygiene, especially proper home care techniques like brushing techniques, chemical or mechanical plaque control measures. The physician or dentist's most important suggestion is to advise against both smoking and drinking alcohol as it can significantly impair the oral and systemic quality of life, aggravating both oral and hepatic lesions.
Conclusion:
In conclusion, dental professionals must not only remain cautious and identify the potential complications of dental infections in liver cirrhosis patients but also adopt an elaborate treatment strategy (upon physician consent) for preventing further oral infections during cirrhosis treatment. Frequent dental checkups and routine follow-ups may be more advisable in the individual suffering from liver cirrhosis than the average healthy individual. The physician should also stress the strict practice of non-alcoholism with healthy lifestyle modifications for long-term recovery from cirrhosis.
