New liver consensus statements highlight the importance of dental care
International liver experts have added dental care to global guidelines for people with chronic liver disease.
The recommendation is part of the Baveno VIII consensus, a set of standards used by liver specialists and digestive health doctors that are adopted after a rigorous process. The updated consensus statements were published in the Journal of Hepatology in August.
The guidelines say regular dental visits and gum care may lower the risk of serious problems in people with compensated cirrhosis or advanced chronic liver disease.
Compensated cirrhosis means the liver is damaged but still works well enough to prevent major symptoms. Some people later develop liver decompensation, when the liver can no longer work properly. This can cause internal and external bleeding, fluid buildup in the abdomen, or hepatic encephalopathy, which can affect thinking and behavior. Also, advancing cirrhosis can result in development of liver cancer.
The new recommendation is based on growing evidence linking oral health and liver health, sometimes called the “oral-gut-liver axis.” People with advanced liver disease often have gum disease and other mouth problems. Harmful bacteria in the mouth can cause inflammation throughout the body. They may also affect the gut microbiome, the community of bacteria living in the digestive system.
Changes in these bacteria may make it harder for the body to fight infections. They may also increase the risk of liver damage and other serious problems. This suggests that poor oral health may play a role in worsening liver disease, rather than simply occurring at the same time.
Research led by Jasmohan Bajaj, M.D., a gastroenterologist with the Institute at Virginia Commonwealth University and the Richmond Veterans Affairs Medical Center, helped support the recommendation. In a study of more than 47,000 veterans with cirrhosis, regular dental visits were linked to fewer cases of liver decompensation, fewer liver-related hospital stays, and lower rates of liver cancer.
The study team included Nilang Patel, M.D., chief of nephrology at VCU Health; Scott Silvey, Ph.D., from VCU’s Department of Biostatistics; and Janina Golob Deeb, D.D.S., a periodontist from the VCU School of Dentistry.
More research is needed to understand exactly how mouth bacteria affect the liver. Scientists also want to know whether treating gum disease or changing the bacteria in the mouth can improve liver health.
For now, people with chronic liver disease should take oral health seriously. Regular dental visits, cleanings, and treatment for gum disease may become an important part of protecting the liver.