Introduction:
According to current dental literature and research, severe periodontal disease has been the link to a broad spectrum of systemic infections and diseases ranging from head and neck infections, respiratory infections, liver disease, pre-term birth or low birth weight infants (in periodontally diseased maternal infection cases), in salivary gland diseases and also implicated in bone diseases.
Periodontal disease is the disease of the periodontium or the supporting structure of the teeth that anchor them in the underlying jaw bone. The liver is one of the main organs of the human body. The liver secretes different enzymes that are associated with metabolic functions. As a result, the liver is the main functional organ responsible for body metabolism. Among the various liver diseases, liver cirrhosis stands out as the most prevalent condition, with numerous oral manifestations. For example, patients with liver cirrhosis often exhibit clinical signs such as tongue inflammation, yellowish oral mucosa or gingival mucosa, bleeding, and swollen salivary glands due to inflammation. Dental and maxillofacial surgeons frequently encounter angular cheilitis of the lips and oral cancers, particularly oral squamous cell carcinomas, in severe cases of liver cirrhosis due to liver dysfunction.
What Is the Significance of Raised Liver Enzyme Levels?
When the protective barrier of dental immunity, typically responsible for warding off bacterial endotoxins, is compromised, the mouth can serve as a gateway for harmful pathogens or endotoxins to enter the bloodstream. Consequently, this can lead to inflammation of the periodontal tissue, particularly in individuals with liver disease.
According to modern-day dental research - periodontal tissues inflamed in afflicted patients with liver disease is one of the major factors that alter the immune and protein metabolism in the body. The common example that would be seen in liver disease patients is often an elevated serum cytokine level and AST (aspartate transaminase) liver enzymes in the salivary markers. In medical terms, the enzyme AST is a particularly significant hepatic marker that indicates liver functioning.
The level of this enzyme determines whether a patient is afflicted with liver dysfunction or not. This also goes by the name of glutamate oxaloacetate transaminase (GOT) or also called as SGOT (serum glutamic oxaloacetate transaminase). Not only are these hepatic biomarkers important metabolic components of the amino acid or protein metabolism in the body, but they also mainly indicate liver functions in terms of the assessment of inflammation, infection, or injury to the liver tissues.
Serum AST level is a commonly assessed enzyme marker by physicians investigating patients' liver functions. Though in several other systemic disease conditions, AST would be increased, such as in hepatitis, myocardial infarction, certain genetic or metabolic disorders in extrahepatic trauma or injuries, in coagulopathies, or even in acute liver failure - the surprising part of modern dental research that now implicated periodontal disease in liver functions has to do with the elevated enzymatic levels of AST in the saliva. Patients with liver disease frequently experience oral complications, including gingival bleeding and periodontal infections. Research has indicated that salivary markers such as aspartate aminotransferase (AST), along with elevated levels of oral biomarkers like elastase, collagenase, alkaline phosphatase, and beta-glucuronidase, correlate with periodontal pathogenic processes. This observation serves as a foundational hypothesis proposed by dental researchers. The evaluation of oral biomarkers is advantageous as it enables dental and maxillofacial surgeons to identify potential underlying systemic disease mechanisms.
What Are the Periodontal Implications of Liver Diseases?
Upon clinical examination of the periodontal and gingival tissues in patients with liver disease or dysfunction, dentists and oral and maxillofacial surgeons may observe common pathological changes, including heightened pocket probing depth of the tissue and horizontal or vertical bone attachment loss in the affected teeth. In severe periodontal disease, the dentist can detect either grade 1, grade 2, or grade 3 mobility of the impacted tooth based on attachment loss.
Liver cirrhosis, a severe manifestation of liver disease, is increasingly recognized as a significant cause of mortality even in developed nations, often stemming from chronic alcohol consumption. This condition has been the subject of extensive research within modern medical studies. The medical literature provides substantial evidence linking the degree of horizontal or vertical bone loss in patients with periodontal disease to those suffering from liver cirrhosis. Additionally, it is noteworthy that periodontal health may significantly influence the systemic immunity of these patients, as dental researchers indicate that the level of jaw or alveolar bone loss correlates with the progressive stages of liver cirrhosis.
Through dental radiographic methods either by 2D (two dimensional) imaging like intraoral periapical radiography or through oral pentagram or OPG imaging or through 3D (three dimensional) advanced radiographic imaging like Computed cone beam tomography (CBCT) or CT (computed tomography) scan. The extent of alveolar or jaw bone loss can be visualized by the dentist or oral surgeon. However, it is important to note that these traditional diagnostic methods, like oral radiography and measurement of clinical probing depth or attachment loss levels, can still not give any quantifiable result in the assessment of periodontal disease in afflicted patients with liver disease. Hence, the possible detection of serum AST that is elevated in salivary biomarkers can be one of the keys to detecting underlying systemic disease in patients.
Conclusion:
The oral cavity reflects the overall health of the body. When periodontal disease leads to horizontal or vertical loss of the jaw bone in individuals with hepatic disease or liver cirrhosis, it can result in an oral immune breach that significantly contributes to systemic infection and elevated biomarkers of liver inflammation.
Increased levels of serum cytokines and elevated AST levels or salivary biomarkers indicate the importance of regular dental examinations and oral prophylaxis, as well as the management of periodontal infections through surgical or non-surgical interventions by dental or maxillofacial professionals for individuals with liver disease or dysfunction. Additionally, it is crucial to prioritize proper oral hygiene habits, routine dental appointments, and avoidance of alcohol consumption as recommended by healthcare providers.
