Oral Mucosal Health and Dental Care in Cirrhosis Patients: What the Research Is Saying
Cirrhosis, or late-stage scarring of the liver caused by various diseases and conditions, is a common immunosuppressive disease that often requires transplantation. Most people are aware of how serious and painful cirrhosis of the liver can be, but many don’t realize its effect on patients’ oral health. The immunosuppressive part of the disease can have extreme—and often extremely painful—effects on the mouth.
A group of researchers recently concluded a study focusing on how the oral cavities of cirrhosis patients compared to those of individuals without the disease. The study, which was published in the International Journal of Organ Transplantation Medicine, aims to gain a better understanding of specific dental issues and create a blueprint for dental professionals to better serve these patients.
Researchers found that oral mucosal lesions were far more common in the mouths of cirrhosis patients and that the amount of saliva they produced was well below average. The more severe the liver disease, the more likely the person will have decayed, missing, or filled teeth, according to researchers.
Unfortunately, it becomes harder and harder to treat a patient’s dental health as their disease worsens. It is therefore imperative that physicians try to increase understanding, because in many cases, it may save lives.
Angular cheilitis lesions were the most common type of lesion found in cirrhosis patients. They are identified by their unique tendency to form at the corners of the mouth. They cause temperature sensitivity, pain, dry skin, and open wounds, which can easily become infected. Angular cheilitis lesions are easily identifiable by the following signs:
- Red and purple spots on outside corners of the mouth
- Crusting, swelling, and/or cracking
- Pain and burning sensations
- Dry and chapped lips that worsen along the corners of the mouth
Given all the bacteria found in the human mouth, infections spread easily. Some of them, including candida albicans, are hard to treat and pose a serious threat to the patient. Additionally, researchers found a high preponderance of fissured tongues and gingival overgrowth in cirrhosis patients.
Dental professionals must care for and disinfect these areas in a manner that is both thorough and gentle. Many cirrhosis patients experience severe pain upon opening their mouths, and doing so also raises the likelihood of wounds to open, thus becoming susceptible to infection.
Those suffering from cirrhosis of the liver were found to secrete saliva at much lower levels than the average person. These patients are often prescribed diuretics to help manage their disease, which doesn’t help with dryness. The very medications keeping them stay alive also put them at risk for serious infections that can begin in the mouth. Oral hygiene must be emphasized—especially proper home care techniques—in an effort to prolong patients’ lives. But again, it’s important to be gentle and careful when disinfecting.
Smoking and drinking can significantly worsen lesions, as can taking medications to slow down or treat cirrhosis. Bone loss and other osteoporotic changes are very common in these patients.
In conclusion, dental professionals must remain vigilant with regard to the potential dangers of fungal infections in liver failure patients. They must do what they can to prevent infection during treatment. Transplantation further increases infection risk due to immunosuppressant medications, so scheduling more appointments with those suffering from cirrhosis is a good idea—perhaps four checkups per year rather than the average two.