Periodontal disease–related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral‐liver axis

Kuraji, Ryutaro; Sekino, Satoshi; Kapila, Yvonne; Numabe, Yukihiro

doi:10.1111/prd.12387

Cited by 67 publications

(60 citation statements)

References 274 publications

(764 reference statements)

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“…The impairment of gut wall barrier function promotes the transfer of enterobacteria and hepatotoxins to the liver through the enterohepatic circulation [61], but some bacteria from microbiota can escape the liver firewall and reach the general circulation. Excessive enterohepatic circulation can cause a transient hepatic disease [62], a phenomenon commonly observed in patients with RA, especially following treatments such as methotrexate (which modify gut homeostasis [63], but cannot always restore gut impermeability).…”

Section: Translocation Of Some Oral Bacteria In Blood May Occur Following a First Step Of Migration Of Those Bacteria To Gutmentioning

confidence: 99%

Another Look at the Contribution of Oral Microbiota to the Pathogenesis of Rheumatoid Arthritis: A Narrative Review

Berthelot¹,

Bandiaky

Goff³

et al. 2021

Microorganisms

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Although autoimmunity contributes to rheumatoid arthritis (RA), several lines of evidence challenge the dogma that it is mainly an autoimmune disorder. As RA-associated human leukocyte antigens shape microbiomes and increase the risk of dysbiosis in mucosae, RA might rather be induced by epigenetic changes in long-lived synovial presenting cells, stressed by excessive translocations into joints of bacteria from the poorly cultivable gut, lung, or oral microbiota (in the same way as more pathogenic bacteria can lead to “reactive arthritis”). This narrative review (i) lists evidence supporting this scenario, including the identification of DNA from oral and gut microbiota in the RA synovium (but in also healthy synovia), and the possibility of translocation through blood, from mucosae to joints, of microbiota, either directly from the oral cavity or from the gut, following an increase of gut permeability worsened by migration within the gut of oral bacteria such as Porphyromonas gingivalis; (ii) suggests other methodologies for future works other than cross-sectional studies of periodontal microbiota in cohorts of patients with RA versus controls, namely, longitudinal studies of oral, gut, blood, and synovial microbiota combined with transcriptomic analyses of immune cells in individual patients at risk of RA, and in overt RA, before, during, and following flares of RA.

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Section: Translocation Of Some Oral Bacteria In Blood May Occur Following a First Step Of Migration Of Those Bacteria To Gutmentioning

confidence: 99%

Another Look at the Contribution of Oral Microbiota to the Pathogenesis of Rheumatoid Arthritis: A Narrative Review

Berthelot¹,

Bandiaky

Goff³

et al. 2021

Microorganisms

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“…Associations between oral health and various systemic diseases are well described [ 1 ]. Recent studies have also linked oral diseases specifically with liver disease [ 2 , 3 , 4 ]. Such links can in part be explained by the many shared risk factors between oral disease and liver disease, such as diabetes, smoking and alcohol use [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have also linked oral diseases specifically with liver disease [ 2 , 3 , 4 ]. Such links can in part be explained by the many shared risk factors between oral disease and liver disease, such as diabetes, smoking and alcohol use [ 1 , 2 ]. Moreover, there may be co-existent diseases; for instance, primary biliary cholangitis (PBC) often co-exists with Sjögren’s syndrome, which in turn is related to oral diseases [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there may be co-existent diseases; for instance, primary biliary cholangitis (PBC) often co-exists with Sjögren’s syndrome, which in turn is related to oral diseases [ 5 ]. In addition to this, periodontitis has more recently also been suggested as a cause or co-factor in the onset and progression of liver disease [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent animal studies have demonstrated biologically plausible mechanisms whereby experimental periodontitis can induce liver injury [ 1 , 2 ]. Epidemiological studies have further supported this concept by reporting independent associations between periodontitis and liver disease even after adjusting for multiple confounders [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review

Åberg

Helenius‐Hietala

2022

Dentistry Journal

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Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes.

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Association between nonalcoholic fatty liver disease scores and chronic periodontitis: A retrospective cohort study

Joo,

Kang,

Moon

et al. 2024

Journal of Periodontology

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BackgroundAlthough several studies have demonstrated a bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and chronic periodontitis, few studies have reported that NAFLD causes chronic periodontitis, especially in the Asian population.MethodsThis study was conducted on 129,087 individuals, and the NAFLD score was assessed using the Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and Framingham Steatosis Index (FSI). The incidence of chronic periodontitis was defined as a diagnostic code with dental procedures. Multi‐variable adjusted Cox proportional hazard regression analysis was performed with hazard ratio (HR) and 95% confidence intervals (CIs).ResultsNine thousand one hundred and twenty‐eight chronic periodontitis cases (7.1%) were identified during a mean 7.4 years follow‐up period. Each NAFLD score was related to chronic periodontitis. In the FLI score, HR and 95% CIs for the incidence of chronic periodontitis compared with a low FLI group were as follows: indeterminate FLI: 1.19 (1.12–1.26), high FLI: 1.32 (1.18–1.47). In the HSI and FSI scores, HR and 95% CIs for the incidence of chronic periodontitis were 1.13 (1.05–1.22) and 1.23 (1.05–1.31), respectively.ConclusionsAll NAFLD scores were associated with chronic periodontitis in the Korean population. As chronic periodontitis can aggravate the liver status, patients with NAFLD may need regular dental visits.

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Periodontal disease–related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral‐liver axis

Cited by 67 publications

References 274 publications

Another Look at the Contribution of Oral Microbiota to the Pathogenesis of Rheumatoid Arthritis: A Narrative Review

Another Look at the Contribution of Oral Microbiota to the Pathogenesis of Rheumatoid Arthritis: A Narrative Review

Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review

Association between nonalcoholic fatty liver disease scores and chronic periodontitis: A retrospective cohort study

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