Table 1.
The main characteristics of the included studies
| Author, year | Country | Study design | Sample size | Mean age | Percentage of males (%) |
Definition of periodontitis | Periodontal measurements | Statistical analysis | Main findings |
|---|---|---|---|---|---|---|---|---|---|
| Movin et al. (1981) [26] | Denmark | Cross-sectional |
N = 73 Cirrhosis: 30 Controls: 43 |
Cirrhosis: 52.3 ± 1.5 Controls: 51.9 ± 1.1 |
Overall: 84 Cirrhosis: 83 Controls: 84 |
NA |
Tooth mobility (TM), number of teeth, PI, GI, retentive calculus (RC), CAL |
Chi-square test, Mann–Whitney- Wilcoxon test, Student's t-test |
Patients suffering from cirrhosis for more than 3 years showed significantly greater loss of attachment, as well as more plaque and calculus compared with those with a disease duration of fewer than 3 years |
| Novacek et al. (1995) [28] | Austria | Cross-sectional |
N = 168 Cirrhosis: 97 Controls: 71 |
Cirrhosis: 31–60 Controls: 21–60 |
Overall: 65 Cirrhosis: 72 Controls: 52 |
NA | Number of teeth, PI, CAL |
Multiple linear regression, chi-squared test, Kruskall Wallis test (chi-squared approximation), Student's t-test |
The presence of cirrhosis is not a predisposing factor for dental and periodontal diseases |
| Barak et al. (2000) [25] | Israel | Cross-sectional |
N = 25 Cirrhosis: 8 Controls: 17 |
Cirrhosis: 49.1 ± 3.90 Controls: 50.16 ± 3.81 |
NA | NA | ABL | ANOVA | Alveolar bone loss in the advanced liver cirrhosis patients (5.68 ± 0.57 mm) was greater than that in the control group (2.47 ± 0.13 mm) |
| Oettinger-Barak et al. (2001) [29] | Isarel | Cross-sectional |
N = 30 Cirrhosis: 13 Controls: 17 |
Cirrhosis: 46.4 ± 13.34 Controls: 48.53 ± 12.41 |
Overall: 53 Cirrhosis: 54 Controls: 53 |
NA | PI, GI, PD, CAL | ANOVA | Liver cirrhosis patients demonstrated greater pocketing and attachment loss compared to healthy controls |
| Oettinger-Barak et al. (2002) [30] | Isarel | Cross-sectional |
N = 30 Cirrhosis: 13 Controls: 17 |
Cirrhosis: 46.4 ± 13.34 Controls: 48.53 ± 12.41 |
Overall: 53 Cirrhosis: 54 Controls: 53 |
NA | ABL | ANOVA | Liver cirrhosis patients demonstrated greater bone loss compared to healthy controls |
| Panov et al. (2011) [31] | Iran | Cross-sectional |
N = 40 Cirrhosis: 20 Controls: 20 |
Cirrhosis: 43 ± 2 Controls: 42 ± 2 |
Overall: 80 Cirrhosis: 85 Controls: 75 |
NA | PD, CAL, GI, BPI, PI | Mann–Whitney test, t-test | No significant differences between cirrhotic and healthy subjects in terms of periodontal disease parameters |
| (Banihashemrad et al. (2012) [24] | Bulgaria | Cross-sectional |
N = 96 Cirrhosis: 25 Controls: 71 |
Cirrhosis: 24–87 Controls: 18–87 |
Overall: 63 Cirrhosis: 52 Controls: 66 |
NA | Number of extracted teeth, debris index (DI), CI, oral hygiene index (OHI), PBI | NA | Patients with chronic hepatitis have poor oral health resulting not only in the large number of extracted teeth, but also and a presence of dental plaque and calculus and gingival bleeding |
| Raghava et al. (2013) [32] | India | Cross-sectional |
N = 150 Cirrhosis: 50 Controls: 100 |
NA | NA | NA | Russell’s periodontal index |
ANOVA, Tukey’s HSD test |
There is very high statistically significant difference on periodontal destruction in alcoholic liver cirrhosis patients when compared to the control group |
| Di Profio et al. (2018) [20] | Brazil | Case–control |
N = 100 Cirrhosis: 50 Controls: 50 |
Cirrhosis: 52.3 ± 9.6 Control: 51.6 ± 9.3 |
Overall: 82 Cirrhosis: 82 Controls: 82 | 30% or more of teeth with proximal CAL ≥ 5 mm | Number of teeth, GR, PD, CAL, BOP, VPI |
Paired t-test, McNemar test |
Patients with cirrhosis had a greater prevalence of periodontitis than healthy controls (p < 0.001). In addition, they had greater mean percentage of sites with CAL ≥ 3 mm (p = 0.008) and CAL ≥ 5 mm (p = 0.023), greater mean CAL (p = 0.003), greater mean gingival recession (p < 0.001), and more missing teeth than in the control group (p = 0.02) |
| Costa et al. (2019) [19] | Brazil | Case–control |
N = 294 Cirrhosis: 98 Controls: 196 |
Cirrhosis: 49.3 ± 6.9 Controls: 47.12 ± 5.15 |
Overall: 76 Cirrhosis: 90 Controls: 44 |
The 2017 World Workshop Classification system for periodontal and peri-implant diseases and conditions [36] | Number of teeth, PD, CAL, PI, BOP | Univariate analysis, multivariate logistic regression | A high prevalence of periodontitis was observed among cases (62.2%) when compared to controls (41.8%). Individuals with cirrhosis presented 2 times greater chances of having periodontitis than controls (OR = 2.28; 95% CI 1.39–3.78; p < .001) |
| Sun et al. (2021) [33] | China | Cross-sectional |
N = 320 Cirrhosis: 163 Controls: 140 |
NA | NA | PD ≥ 5 mm | PD, CAL | ANOVA | The prevalence of periodontitis in cirrhosis patients were 85.3%, which were significantly higher than those in the control group (74.1%, p < 0.05). PD and CAL were higher than those in the control group (p < 0.01) |
| Narwat, D et al., (2021) [27] | India | Case–control |
N = 120 Cirrhosis: 60 Controls: 60 |
Cirrhosis: 46.63 ± 8.34 Controls: 44 ± 8.04 |
100% | NA | PI, GI, PD, CAL | ANOVA, post-hoc test |
The Plaque Index, gingival index, probing depth and clinical attachment loss has shown a statistically significant difference (p = 0.000) when compared between test and control groups. There was no statistically significant difference (p = 0.045) found in the number of missing teeth between test and control group |
Abbreviations: N cases with liver cirrhosis or control, NA Not Applicable, CPI community periodontal index, GI gingival inflammation, OR odds ratios, PD probing depth, CAL clinical attachment level, ABL Alveolar bone loss, CAL clinical attachment level, PBI papillary bleeding index, GI gingival index, PI Periodontal index, ANOVA = analysis of variance, GR gingival recession, VPI visible plaque index, AST aminotransferase, ALT = aminotransferase