Presence and consequence of tooth periapical radiolucency in patients with cirrhosis.
BACKGROUND
Periapical radiolucency is the radiographic sign of inflammatory bone lesions around the apex of the tooth. We determined the prevalence and predictors of periapical radiolucency in patients with cirrhosis and the association with systemic inflammation status and cirrhosis-related complications.


METHODS
A total of 110 cirrhosis patients were consecutively enrolled. Periapical radiolucency was defined as the presence of radiolucency or widening of the periapical periodontal ligament space to more than twice the normal width. Predictors of periapical radiolucency and the association with systemic inflammation markers and cirrhosis-related complications were explored by univariable and multivariable logistic regression analyses.


RESULTS
Periapical radiolucency was present in one or more teeth in 46% of the patients. Strong predictors were gross caries (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.43-6.79) and severe periodontitis (OR 3.98, 95% CI 1.04-15.20). Also old age (OR 1.10, 95% CI 1.01-1.19) and smoking (OR 3.24, 95% CI 1.02-17.62) were predictors. However, cirrhosis etiology (alcoholic vs nonalcoholic) or severity (Model of End-Stage Liver Disease score) were not predictors. The patients with periapical radiolucency had higher C-reactive protein (15.8 mg/L vs 8.1 mg/L,P=0.02) and lower albumin contents (25 g/L vs 28 g/L,P=0.04) than those without. Furthermore, the patients with periapical radiolucency had a higher prevalence of cirrhosis-related complications such as ascites, hepatic encephalopathy, and/or variceal bleeding (46% vs 27%,P=0.05).


CONCLUSIONS
Periapical radiolucency is often present as an element of poor oral health status and likely has an adverse clinical significance, which should motivate diagnostic and clinical attention to the findings.
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus.
Lea Ladegaard
LL
Grønkjær
Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences.
Palle
P
Holmstrup
Section for Oral and Maxillofacial Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
Søren
S
Schou
Department of Oral and Maxillofacial Surgery.
Kristoffer
K
Schwartz
Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences.
Johanne
J
Kongstad
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Peter
P
Jepsen
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus.
Hendrik
H
Vilstrup
C-reactive protein; MELD score; apical periodontitis; cirrhosis; inflammation status; periapical radiolucency
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