Non-alcoholic fatty liver disease (NAFLD) is a chronic disease in which fat accumulates in the cells of the liver. NAFLD is one of the manifestations of metabolic syndrome, in addition to being overweight, obese, and having type 2 diabetes.
NAFLD is the most common liver disease in the world. It affects about a quarter of the adult population.
The non-alcoholic fatty liver disease shares common risk factors with dental disease, including periodontitis and caries. Risk factors include smoking and consumption of simple sugars: glucose and fructose. Chronic exposure to simple sugars can lead to inflammation, fat accumulation in the liver, NAFLD, and metabolic syndrome.
NAFLD and periodontitis share common etiological factors. Both diseases begin with an unbalanced inflammatory response. The P. gingivalis bacteria associated with periodontal disease can affect liver cells by inhibiting glycogen synthesis and stimulating the production of pro-inflammatory cytokines TNF-α and IL-1β. The progression of both disorders can be exacerbated by insulin resistance and increased levels of systemic inflammation, common in patients with diabetes and obesity.
Dental Problems Linked to Metabolic Syndrome
The two most common dental diseases are periodontitis and caries.
Periodontitis is an inflammatory destruction of the tissues that support the tooth and is the leading cause of tooth loss worldwide. Almost 50% of the adult population suffers from periodontitis.
Caries is a diet-dependent infectious disease. The prevalence of caries is 35% for all ages.
Periodontitis is associated with diabetes, cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, and all-cause and cardiovascular mortality. The relationship between periodontitis and diabetes is bidirectional, so it is believed that periodontitis is a complication of diabetes.
NAFLD is a Manifestation of The Metabolic Syndrome
NAFLD increases the likelihood of symptoms and consequences of metabolic syndrome:
- obesity by 45 times;
- hyperlipidemia by 38 times;
- impaired glucose tolerance by 35 times;
- diabetes mellitus type 2 by 33 times;
- obstructive sleep apnea syndrome by 16 times;
- stroke by 16 times;
- arterial hypertension by 14 times;
- transient ischemic attack by 11 times;
- cardiovascular diseases by 8 times.
Periodontitis is Associated with NAFLD
Adults with untreated caries, fewer than 20 teeth, and/or moderate to severe periodontitis are more likely to have NAFLD. More than 6 missing teeth are associated with a higher prevalence of NAFLD in men but not women.
Israeli scientists have shown that periodontitis and caries are associated with non-alcoholic fatty liver disease. Scientists used data from more than 132,000 patients, among whom 938 had NAFLD.
Patients with NAFLD are more likely to:
- visited a general practitioner and a dentist;
- removed tartar;
- received alignment of the surface of the roots of the teeth;
- missed a scheduled visit to the dentist.
Patients with NAFLD had worse dental and oral health. These patients are more likely to:
- diagnosed with periodontitis;
- found damage to the soft tissues of the oral cavity during a dental examination.
Risk Factors for NAFLD
After analyzing patient data, scientists compiled a list of factors predisposing to non-alcoholic fatty liver disease:
- Male gender. In women, estrogen may be protective against NAFLD.
- Type 2 diabetes. More than 70% of patients with type 2 diabetes have NAFLD.
- Arterial hypertension.
- High body mass index.
- Older age is associated with a higher prevalence and progression of NAFLD.
Smoking is one of the risk factors for periodontitis. Smoking also increases the risk of NAFLD by 12 times. Smoking and high body mass index have a synergistic effect on NAFLD.
Reduces the risk of NAFLD by brushing your teeth once a day or more often.
Conclusion
NAFLD is associated with dental diseases, especially periodontitis. Factors that increase the risk of NAFLD include older age, male gender, and manifestations of metabolic syndrome such as type 2 diabetes, hypertension, hyperlipidemia, high body mass index, and periodontitis.
Patients with NAFLD may require more dental care. Conversely, it is important for patients with periodontitis to monitor liver health and reduce exposure to risk factors for NAFLD.
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