Hepatitis C Infection and Periodontal Disease: Is there a Common Immunological Link?

Abstract

Hepatitis C virus (HCV) infections could have an important impact on the oral health status of patients, favoring conditions such as periodontal disease and oral cancer. The review of the existing scientific literature written in English was performed, searching for oral and periodontal manifestations of HCV infection and its impact on the oral fluids. HCV infection can determine direct extrahepatic manifestations at the oral and periodontal level including oral lichen planus, Sjögren-like sialadenitis, and oral cancer. The changes caused by the infection in the subjects' immune system, diet, and lifestyle can facilitate the development of oral conditions such as periodontal disease. Important changes also occur in the composition of the infected patients' saliva and gingival fluid. HCV-infected patients need to be carefully monitored in terms of oral health since the infection with the virus can result in oral complications. The cellular and molecular particularities of the gingival fluid of HCV-infected patients can answer some questions regarding its impact upon periodontium impairment and whether this refers to a possible bidirectional relationship, with hepatic biomarker adjustments being induced by the periodontal patients' inflammatory status.

Periodontal Implications of Hepatitis C Infection

“…As it has been previously suggested [68,75,76], the possible connection between periodontal disease and chronic hepatitis C becomes more than plausible. It seems that, given the holistic perspective on the pathogenic mechanisms of the human body, any disruption of its homeostasis caused by inflammatory processes ongoing even in distant territories like the periodontal and liver tissues has a general impact that reverberates across the entire biological structure and becomes relevant in terms of clinical manifestation.…”

“…This can leave the patient vulnerable to the onset of other infections such as periodontal disease triggered by bacterial biofilm. Recent scientific data show that multiple-layered connections between HCV infection and periodontal disease could be possible, including transmission implications via oral fluids (saliva and gingival fluid), related clinical manifestations of the two conditions [63,[67][68][69], and common pathogenic pathways that may favor their evolution [68].…”

“…This connection could be possible through the HCV-mediated changes upon the patient's homeostasis. As it was recently suggested, one such mechanism could be insulin resistance [68]. Chronic inflammation or infections like hepatitis C have been shown to cause insulin resistance, meaning that cells become insensitive or unresponsive to insulin stimulation and thus with a decreased ability to absorb and metabolize the glucose [70].…”

Periodontal disease as predictor of chronic liver diseases

“…Moreover, some authors suggested that, HCV may lead to the development of SS 47 .The Sjogren's Sydnrome (SS) is associated with marked reduction in saliva flow into the oral cavity leading to, dryness of oral cavity and subsequently, the teeth no longer protected against bacteria by salivary components and the dental plaque are no longer removed by the saliva flow. This dryness of mouth leading to dental caries and fragile oral mucosa which becomes more susceptible to trauma and infection 41 The direct infection and proliferation of HCV in salivary glands together with formation of immune complexes containing HCV may explain the association between the SS and HCV infection 48,49…”

Evaluation of IL-2, IL-10, IL-4 and ɤ-interferon levels in the oral fluids of patients with hepatitis C, B and HIV

“…The periodontal changes for HCV patients occur more frequently and more visible than for healthy control group. Several pathological changes boost proinflammatory cytokines production [19,20]. Periodontal disease occurs when the ecological balance of the oral cavity is disrupted and periodontal bacterial pathogens start triggering an inflammatory reaction.…”