title: Association between dental infections and the clinical course of chronic liver disease.
abstract: OBJECTIVE
  Dental infections are implicated in several systemic diseases due to bacteremia and pro-inflammatory effects, but their possible role in liver disease is unclear.
  
  
  METHODS
  We retrospectively analyzed the clinical course of liver disease in relation to dental health among 116 patients with liver cirrhosis who underwent dental examination before liver transplantation.
  
  
  RESULTS
  The need for multiple tooth extractions, a surrogate marker of dental infections, was associated with reduced time from diagnosis of liver disease to the need for liver transplantation (P = 0.02). The association was independent of age, sex, liver disease etiology and Model for End-Stage Liver Disease (MELD) score (P = 0.04). Among 38 patients with accurate laboratory follow-up data, the number of tooth extractions correlated with the change in MELD score during the year preceding dental examination (r = 0.43, P = 0.03). Spontaneous bacterial peritonitis caused by Streptococcus viridans occurred only among patients with multiple dental infections.
  
  
  CONCLUSIONS
  Dental infections may influence the clinical course of liver disease, but prospective studies are needed.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Aberg
authors.forename: Jaana
authors.initials: J
authors.lastname: Helenius-Hietala
authors.forename: Jukka
authors.initials: J
authors.lastname: Meurman
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
keywords: endotoxemia; liver fibrosis; oral health; periodontitis