Hepatitis and periodontal health: an emerging oral-liver axis

Abstract

Periodontitis and viral liver infections, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), are chronic inflammatory conditions with a high prevalence worldwide. Recent evidence establishes a possible bidirectional relationship between the two, based on shared immunological, microbial, and inflammatory mechanisms. The objective of this study was to analyze and synthesize the scientific literature on the interactions between viral hepatitis and periodontal health. Through a structured search of the PubMed, Scopus, and Web of Science databases, studies published in the last 20 years that explored the link between viral hepatitis and periodontitis were integrated. The findings from the reviewed studies show consistent, positive associations between HBV and HCV viruses and a higher prevalence and severity of periodontitis. Some studies show increased levels of proinflammatory cytokines (such as IL-6 and TNF-α) and immune dysfunction in participants with both diseases. Additionally, viral markers (such as HBsAg and HCV RNA) have been identified in gingival crevicular fluid, suggesting the presence of oral viral reservoirs. Ultimately, scientific evidence suggests a bidirectional relationship between viral hepatitis and periodontitis, influenced by systemic inflammation, immunological alterations, and microbial dysbiosis. The collected data support the relevance of interdisciplinary management between medical and dental professionals in patients with viral liver conditions.

Keywords: chronic inflammation; liver disease; oral microbiota; periodontitis; viral hepatitis.

Figure 1.

Oro-intestine-liver axis. People with periodontitis present microbial dysbiosis in different compartments of the oral cavity, especially in the periodontal pockets. This dysbiosis is also accompanied by dysbiosis in the intestinal microbiota. This intestinal dysbiosis can generate mucosal permeability, allowing microbiota to travel from the intestine to the liver. Similarly, this microbiota transport may travel from the small intestine to the gallbladder and liver.