High prevalence of periodontal disease in patients with NASH- possible association of poor dental health with NASH severity

• Published in: Annals of hepatology Vol. 28; no. 2; p. 100887
• Main Authors: Pischke, Sven, Shiprov, Anita, Peters, Ulrike, Schulze zur Wiesch, Julian, Kluwe, Johannes, Westphal, Tim, Fischer, Frank, Mader, Maria, Fründt, Thorben, Horvatits, Karoline, Horvatits, Thomas, Aarabi, Ghazal, Beikler, Thomas
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01-03-2023; Elsevier
• Subjects: Diet; Humans; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic steatohepatitis; Nutrition; P. gingivalis; Periodontal Diseases - complications; Periodontal Diseases - diagnosis; Periodontal Diseases - epidemiology; Periodontitis; Periodontitis - complications; Periodontitis - diagnosis; Periodontitis - epidemiology; Porphyromonas gingivalis; Prevalence; P. gingivalis; NAFLD; AST; Nutrition; Diet; Periodontitis; A.a; MELD; P.g; ALT; Non-alcoholic steatohepatitis; NASH
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2022.100887

Recent translational research indicated a bidirectional relationship between NASH (non-alcoholic steatohepatitis) and periodontitis; however, few clinical cohorts have studied this in detail. Thus we investigated this assumed association in a well-defined cohort.
Data were generated prospectively for 132 patients (32 patients with NASH and 100 unselected, consecutively collected, anonymized controls from a local dental practice): detailed periodontal parameters, i.e., pocket-probing-depths (PPD), bleeding-on-probing (BOP), plaque-index, and utilization of dental care were assessed and correlated with relevant hepatic parameters (liver stiffness via fibroscan, AST, ALT, bilirubin, and MELD-score). Gingiva samples were tested for Porphyromonas gingvalis (P.g.) and Actinobacillus actinomyctemcomitans (A.a.) by PCR.
87.5% of NASH patients and 47% of controls suffered from moderate to severe periodontitis (p=0.01). Liver stiffness was significantly correlated with elevated PPD (p=0.02) and BOP (p=0.03). 34 % of the NASH patients did not make use of regular dental health care. In these patients, AST (p=0.04), MELD score (p<0.01), and liver stiffness (p=0.01) were significantly elevated compared to those who see a dentist regularly. The severity of NASH was not associated with the intraoral detection of P.g. and A.a.
The present study suggests that NASH might be associated with periodontitis, irrespective of the intraoral presence of P.g. and A.a. Moreover, regular dental care utilization might mitigate the course of NASH, and patients should be reminded by their hepatologists of the importance of regular dental visits. Future studies should investigate the role of regular dental care and additional anti-inflammatory treatments of the oral cavity.