Oral changes associated with end-stage liver disease and liver transplantation: implications for dental management

In children, chronic liver disease has a variety of causes; its effects include malnutrition, bleeding tendencies, osteopenia, and rachitic changes in the skeleton. Chronic liver disease in children may have many oral manifestations, such as green staining of the teeth and gingiva, as well as enamel hypoplasia. Dental management may be complicated by many factors, like bleeding tendencies and inability to metabolize routine anesthetics. Patients who undergo increasingly successful liver transplantation require life-long immunosuppressive therapy, which has side-effects. Results of this study of nine patients, seven females and two males, show that the effects of end-stage liver disease are permanently recorded on the teeth. Six were examined both before and after liver transplantation; the other three, only afterwards. This study confirms and extends the findings of three previous reports describing the oral manifestations of congenital biliary atresia in childhood.