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Periodontal treatment may improve symptoms in cirrhosis patients

By Dental Tribune International
September 19, 2018

RICHMOND, Va., U.S.: Oral care is known to be important, not only to protect one’s teeth, but also for overall health. A new study has shown that thorough oral care can also have health benefits for the liver. Researchers at the Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center found that routine oral care to treat periodontitis alters gut bacteria, reduces inflammation and improves cognitive function in patients with liver cirrhosis.

Cirrhosis, which is a growing epidemic in the U.S., is a condition in which liver damage results in the development of scar tissue on the liver. Complications of cirrhosis can include infections throughout the body and hepatic encephalopathy, a buildup of toxins in the brain caused by advanced liver disease. Symptoms of hepatic encephalopathy include confusion, mood changes and impaired cognitive function.

Previous research has found that people with cirrhosis have changed gut and salivary microbiota, which can lead to periodontitis and a higher risk of cirrhosis-related complications. In addition, studies have found that people with cirrhosis have increased levels of inflammation throughout the body, and this is associated with hepatic encephalopathy.

The researchers studied two groups of volunteers with cirrhosis and mild to moderate periodontitis. One group received periodontal care, while the other group was not treated. Each volunteer underwent standardized tests to measure cognitive function before and after treatment.

After periodontal treatment, the participants, especially those with hepatic encephalopathy, had increased levels of beneficial gut bacteria that could reduce inflammation, as well as lower levels of endotoxin-producing bacteria in the saliva. The untreated group demonstrated an increase in endotoxin levels in the blood over the same period. The research team suggested that the improvement in the treated group could be attributed to a reduction in oral inflammation leading to lower systemic inflammation or to a reduced amount of bacteria being swallowed and thereby affecting the gut microbiota.

Cognitive function also improved in the treated group, suggesting that the reduced inflammation levels in the body may minimize some of the symptoms of hepatic encephalopathy in people who are already receiving standard of care therapies for the condition, according to the researchers.

“The epidemic of liver cirrhosis is worsened by the inflammation and microbial alterations that can persist despite current therapies. Given this, we needed to explore sources other than the gut and found the oral cavity as an important but neglected area,” said lead author Dr. Jasmohan Singh Bajaj, associate professor at the university and medical center. “We hope that the results of this study can help encourage more dental evaluations and potentially dental coverage in patients with cirrhosis. Our dental colleagues are an integral part of this study and we continue to aim to treat the entire patient and not just individual parts to achieve the maximum benefit.”

The study, titled “Periodontal therapy favorably modulates the oral-gut-hepatic axis in cirrhosis,” was published online on Aug. 17, 2018, in the American Journal of Physiology—Gastrointestinal and Liver Physiology ahead of inclusion in an issue.

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