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Presence and consequence of tooth periapical radiolucency in patients with cirrhosis

Authors Grønkjær L, Holmstrup P, Schou S, Schwartz K, Kongstad J, Jepsen P, Vilstrup H

Received 26 May 2016

Accepted for publication 15 July 2016

Published 13 September 2016 Volume 2016:8 Pages 97—103


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Gerry Lake-Bakaar

Lea Ladegaard Grønkjær,1 Palle Holmstrup,2 Søren Schou,3 Kristoffer Schwartz,4 Johanne Kongstad,2 Peter Jepsen,1,5 Hendrik Vilstrup1

1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, 2Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, 3Section for Oral and Maxillofacial Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 4Department of Oral and Maxillofacial Surgery, 5Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

Background: Periapical radiolucency is the radiographic sign of inflammatory bone lesions around the apex of the tooth. We determined the prevalence and predictors of periapical radiolucency in patients with cirrhosis and the association with systemic inflammation status and cirrhosis-related complications.
Methods: A total of 110 cirrhosis patients were consecutively enrolled. Periapical radiolucency was defined as the presence of radiolucency or widening of the periapical periodontal ligament space to more than twice the normal width. Predictors of periapical radiolucency and the association with systemic inflammation markers and cirrhosis-related complications were explored by univariable and multivariable logistic regression analyses.
Results: Periapical radiolucency was present in one or more teeth in 46% of the patients. Strong predictors were gross caries (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.43–6.79) and severe periodontitis (OR 3.98, 95% CI 1.04–15.20). Also old age (OR 1.10, 95% CI 1.01–1.19) and smoking (OR 3.24, 95% CI 1.02–17.62) were predictors. However, cirrhosis etiology (alcoholic vs nonalcoholic) or severity (Model of End-Stage Liver Disease score) were not predictors. The patients with periapical radiolucency had higher C-reactive protein (15.8 mg/L vs 8.1 mg/L, P=0.02) and lower albumin contents (25 g/L vs 28 g/L, P=0.04) than those without. Furthermore, the patients with periapical radiolucency had a higher prevalence of cirrhosis-related complications such as ascites, hepatic encephalopathy, and/or variceal ­bleeding (46% vs 27%, P=0.05).
Conclusion: Periapical radiolucency is often present as an element of poor oral health status and likely has an adverse clinical significance, which should motivate diagnostic and clinical attention to the findings.

Keywords: apical periodontitis, cirrhosis, C-reactive protein, inflammation status, MELD score, periapical radiolucency

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