Periodontal Disease and Liver Health: Exploring the Bidirectional Link

Periodontal disease is increasingly recognized as both a contributor to and a consequence of liver disease, indicating a bidirectional oral-liver axis. Patients with liver cirrhosis or non-alcoholic fatty liver disease (NAFLD) frequently exhibit worsened periodontal health, including increased plaque, gingival inflammation, alveolar bone loss, and altered subgingival microbiota, suggesting systemic immune dysregulation (Elhassan & Peeran, 2016; Grønkjær, 2015; Jensen et al., 2018; Duseja et al., 2021). Periodontitis may exacerbate liver injury through systemic inflammation, gut dysbiosis, and elevated pro-inflammatory mediators such as TNF-α, while liver disease can reciprocally impair oral health (Åberg & Helenius-Hietala, 2022; Shin et al., 2022; Storjord et al., 2022). Interventions targeting periodontal health—including scaling and root planing combined with adjunctive local drug delivery systems like metronidazole gels, tetracycline fibers, or chitosan-based carriers—improve clinical outcomes and may reduce systemic inflammatory burden (Mutthineni et al., 2023; Wei et al., 2021; Sah et al., 2019). Nutritional factors, such as diets high in saturated fat and cholesterol, can aggravate periodontal inflammation and further promote liver disease progression (Varela-López et al., 2020; Graziani et al., 2018; Kaur et al., 2019). Overall, evidence supports integrating periodontal care into liver disease management to potentially mitigate hepatic complications, though further longitudinal studies are needed to clarify causality and optimize treatment strategies (Nagao et al., 2014; Grønkjær, 2015; Elhassan & Peeran, 2016).

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