Can Frequent Toothbrushing Reduce the Risk of Cirrhosis among Patients with Non-alcoholic Fatty Liver Disease? Hints from a Registry-based Study.

Keklikkiran C., Stepanova M., Younossi Z., Yilmaz Y.

Digestive diseases (Basel, Switzerland), 2023 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Volume:
  • Publication Date: 2023
  • Doi Number: 10.1159/000531981
  • Journal Name: Digestive diseases (Basel, Switzerland)
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, EMBASE, Food Science & Technology Abstracts, MEDLINE, Veterinary Science Database
  • Recep Tayyip Erdoğan University Affiliated: No


Introduction: While poor oral hygiene has been previously associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), its association with hepatic fibrosis remains unclear. Here, we sought to analyze if toothbrushing frequency, an easy-to-assess indicator of oral health habits, would be associated with liver stiffness measurement (LSM) by transient elastography (TE) in patients with an established diagnosis of NAFLD.

Methods: In this registry-based study, LSM was measured in 1156 patients with NAFLD and analyzed in relation to the self-reported daily frequency of toothbrushing. LSM values ≥12 kPa were considered as indicative of cirrhosis.

Results: A trend towards a stepwise decrease (cross-sectional p = 0.13) in LSM was found in patients who reported having their teeth brushed more frequently: less than once a day (10.6 ± 8.6 kPa; 13% of the study sample), once a day (9.95 ± 8.40 kPa; 40%), twice a day (9.21 ± 7.63 kPa; 43%), and after every meal (8.91 ± 5.30 kPa; 4%). Patients who brushed their teeth less than once a day had a significantly higher prevalence of LSM values ≥12 kPa (p < 0.05). In multivariable logistic regression analysis, the association of LSM values ≥ 12 kPa with toothbrushing habits remained statistically significant for less than once a day (odds ratio = 1.69, 95% confidence interval = 1.07-2.66, p = 0.02) with reference to twice a day or after every meal.

Conclusion: Among patients with NAFLD, there is an independent association between brushing teeth less than once a day and TE-established cirrhosis.