The association between oral health status and the clinical outcome of cirrhotic patients on the waiting list for liver transplantation

Abstract

Liver transplantation (LT) candidates often present with poor oral hygiene, which could potentially lead to systemic infections and sepsis owing to their cirrhotic state.In this study, we investigated the oral health status of LT candidates and propose guidance for the detection and treatment of encountered oral lesions among these patients. The decayed, missing, and filled teeth (DMFT) index was determined through oral examination. The presence of dental calculus was detected using panoramic radiography and defined by the radiopaque dental calculus (RDC). From January 2011 to August 2018, 56 LT candidates were enrolled with a median followup of 39 months. The overall mean numbers of decayed, missing, and filled teeth among these patients were 2.7 ± 2.8, 10.9 ± 8.3, and 5.4 ± 4.5, respectively. Eighteen patients (32.1%) had RDC. The 5-year survival rates of all 56 patients was 57.7%, while that of those who either received LT (23 patients) or not were 82.1% and 39.8%, respectively. A Cox regression model revealed better overall survival of patients after LT (adjusted hazard ratio [aHR] = 0.067, p = 0.001), worse survival among patients with RDC (aHR = 3.468, p = 0.010), at Child-Pugh stages B and C (aHR for stage B = 11.889, p = 0.028; aHR for stage C = 19.257, p = 0.013) compared to patients at Child-Pugh stage A, and those with a model for end-stage liver disease (MELD) score ≥25 (aHR = 13.721, p = 0.018). This study demonstrates that RDC was associated with worse prognosis in LT candidates. We therefore recommend that interprofessional collaboration should be a routine preoperative procedure for the evaluation of oral hygiene among LT candidates.

Revisão integrativa condição oral e qualidade de vida relacionada à saúde bucal dos pacientes com indicação ao transplante de fígado: uma revisão integrativa

“…Entre os 19 estudos incluídos, 11 avaliaram apenas portadores de cirrose hepática avançada e candidatos a transplante de fígado (Kwak et al, 2020), (Zahed, Ranjbar, et al, 2020), (Grønkjaer et al, 2018), (Lins et al, 2017), (Wu et al, 2021), (Hicks, 2015), (Helenius-Hietala et al, 2012), (Grønkjaer et al, 2021), (Lins et al, 2011), (Pidhorodeckyj et al, 2018), (Ramaglia et al, 2019), seis avaliaram grupo pré transplante e controles sadios (Zahed, Bahador, et al, 2020), (di Profio et al, 2018, (Ghapanchi et al, 2019), (Ghapanchi et al, 2020), (Sérgio et al, 2012, (Castellanos-Cosano et al, 2013), um estudo avaliou participantes no pré e pós transplante em comparação com grupo controle saudável (Schmalz et al, 2018), outro comparou pacientes do prétransplante com os do pós-transplante (Kauffels et al, 2017).…”

“…Vários estudos incluídos desta revisão mostraram que a saúde bucal de pacientes com cirrose avançada e indicação ao transplante não é satisfatória (Kwak et al, 2020), (Grønkjaer et al, 2018), (Lins et al, 2017), (Ghapanchi et al, 2019), (Wu et al, 2021), (Hicks, 2015), (Helenius-Hietala et al, 2012), (Ladegaard Grønkjaer et al, 2021), (Lins et al, 2011), (Pidhorodeckyj et al, 2018), (Ramaglia et al, 2019).…”

“…A higiene bucal (HB) se mostrou mais comprometida nesta população (Kwak et al, 2020), (Wu et al, 2021), (Ramaglia et al, 2019). Foi observado que a HB estava mais comprometida nos pacientes candidatos ao pré transplante de fígado que nos pré transplante de rim.…”

“…Para os autores, a provável razão para esta diferença pode estar relacionada ao pior estado de saúde geral dos receptores ao transplante de fígado. A presença de cálculo dentário estava associada a maior risco de mortalidade (Wu et al, 2021). A informação fornecida pelo paciente em relação a saúde bucal, durante o exame, nem sempre é concordante quando da observação clínica.…”

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

“…In an observational study of liver cirrhosis patients, poor oral health correlated with the progression of liver cirrhosis during the year preceding the dental examination [ 96 ]. Other researchers reported that periapical radiolucency as a sign of periapical inflammation was associated with the prevalence of cirrhosis-related complications such as ascites, hepatic encephalopathy and/or variceal bleeding [ 97 ], and the presence of dental calculus predicted worse survival among liver transplant candidates [ 98 ]. Furthermore, Bajaj et al found higher endotoxin levels in saliva of cirrhosis patients compared to healthy controls [ 99 ], and salivary dysbiosis predicted incident cirrhosis decompensation events [ 99 ].…”