Dental prophylactic interventions are associated with lower decompensation-related hospitalizations over 2 years in...

Poor oral health is associated with systemic inflammation and unfavorable outcomes in chronic diseases, including cirrhosis. Data on whether regular dental prophylaxis and periodontal maintenance services (DPS) prevent liver-related complications in cirrhosis are lacking. The aim was to investigate the impact of regular DPS on decompensation, hepatocellular carcinoma (HCC), and hospitalizations in Veterans with compensated cirrhosis.

We evaluated a National Veterans compensated cirrhosis cohort (2005-2023) eligible for comprehensive Veterans Administration dental care. Regular DPS was defined as ≥1 dental prophylaxis or periodontal maintenance visit/year starting 2 years before cirrhosis diagnosis. Patients were divided into two groups: regular DPS (≥1 visit/year) vs. non-regular DPS(<1 visit/year). Propensity score matching and multivariable logistic regression were performed. Outcomes were hospitalizations because of ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or HCC, all-cause and liver-related hospitalizations within 2 years. A separate intervention (colonoscopy screening) was studied to determine the impact of greater engagement/adherence on liver-related outcomes.

Among 47,809 eligible Veterans, 8,359 (17.5%) received regular DPS. After matching, regular DPS was associated with lower odds of ascites (OR 0.85 [0.77-0.93], p <0.001), HE (OR 0.81 [0.71-0.91], p <0.001), HCC (OR 0.73 [0.63-0.94], p <0.001), all-cause hospitalizations (OR 0.85 [0.80-0.90], p <0.001), and liver-related hospitalizations (OR: 0.80 [0.75-0.87], p <0.001) over 2 years. No significant differences were seen in variceal bleeding or spontaneous bacterial peritonitis. A dose-response effect plateaued at one DPS visit/year. Subgroup analysis of patients undergoing screening colonoscopy did not show a similar protective impact. Local chart review validated cirrhosis/dental codes.

Regular dental prophylaxis and periodontal maintenance (≥1/year) were independently associated with lower rates of decompensation, HCC, and hospitalizations in compensated cirrhosis. Incorporating routine oral care into cirrhosis management may improve clinical outcomes.

Oro-dental health can affect systemic health, including progression of liver disease and cirrhosis but dental care is usually not prioritized in cirrhosis. Prior smaller studies have shown the benefit of dental prophylaxis in established cirrhosis, however, larger studies to study the impact of dental prophylactic interventions on the course of cirrhosis decompensation are needed. In a national analysis of US Veterans with compensated cirrhosis that are eligible for dental care, we found that those who undertook dental prophylactic interventions in a timeframe of 2 years before and 2 year after cirrhosis diagnosis had a significantly lower rate of new-onset decompensation, hepatocellular cancer development, and hospitalizations that was not seen with colonoscopy screening. Regular dental cleanings including dental prophylaxis and periodontal maintenance may be an important tool to improve cirrhosis severity and should be considered by clinicians taking care of these patients.