Is dental caries associated with liver transplantation? A systematic review and meta‐analysis

Abstract

Objective The aim of this systematic review and meta‐analysis was to evaluate the experience of dental caries in individuals pre‐ or postliver transplant. Materials and Methods Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases’ inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta‐analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. Results The search retrieved 1990 references. Twenty‐four cross‐sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre‐liver transplant and healthy individuals (mean difference = 1.65, confidence interval = −0.87 to 4.17). The prevalence of dental caries among pre‐liver transplant individuals was 73.82% and in the post‐transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. Conclusions Dental caries may be a relevant issue in pre‐ and postliver transplant individuals. Oral health counseling should be included in the care of pre‐ and/or postliver transplant individuals.

Dental Findings of Kidney and Liver Transplantation Patients from a Brazilian Oral Health Care Service

“…Published research regarding dental caries experience in patients under transplantation therapy is controversial. Similar, low, and high DMF-T indices among pre-Tx and post-Tx groups have been reported [7,[10][11][12]25,31]. In the kidney group, our findings showed higher DMF-T scores in post-Tx.…”

“…In a previous study [12] developed with SOT (heart, liver, and kidney) patients, mean DMF-T pre-transplantation (18.1 ± 5.3) and posttransplantation (16.8 ± 8.3) showed similarity with our findings. Several studies reported poor habits of oral hygiene and poor oral health status among adults under transplantation therapy [11,25,[30][31][32]. Factors, such as modifications in lifestyle, usage of medicines that reduce salivary flow, and the high burden of ESKD and chronic liver disease in pre-Tx candidates, seem to reduce dental care priorities in this population, increasing the development of caries lesions [32].…”

The mutual effect of dental caries on NAFLD and liver fibrosis: Results from the NHANES and MR study

“…Though liver transplantation (LTx), the treatment of end-stage liver conditions was found relevant with increased risk for dental caries in both pre-LTx and post-LTx populations, patients at the pre-LTx stage showed no signi cant increase in the total amount of UDC. (39) Together with the increasing knowledge of microbiota emerged the therory of oral-gut-liver axis. Its unbalance is speculated to trigger liver in ammation and dysregulated immune response, though most evidence is based on periodontal diseases.…”

Treatment of bleeding in patients with liver disease

“…Formal dental evaluation (and extractions where necessary) are therefore recommended as part of the liver transplantation work up 39 . The prevalence of periodontal disease in this group is reported to be as high as 75% 40 …”