Oral health status of patients with decompensated liver cirrhosis in two hospitals of Yaoundé Cameroon: A comparative study
Authors:   1Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon,   2University Hospital Centre, Yaoundé, Cameroon,   3Yaoundé General Hospital, Yaoundé, Cameroon,   4Yaoundé Central Hospital, Yaoundé, Cameroon
Published: January 2021

Background: Liver cirrhosis is an ultimate complication of all chronic liver diseases. The oral cavity especially the periodontium is affected by malnutrition, coagulation disorders, immunodeficiency which are some of the main features present in patients with liver cirrhosis. The aim of this study was to determine the prevalence and determinants of oral pathologies in patients with decompensated liver cirrhosis in two hospitals of Yaoundé Cameroon. Patients and Methods: This was a cross-sectional and analytical study comparing the oral health status of decompensated liver cirrhotic patients in Yaoundé with sex and age (±3 years) matched healthy controls from the same area. We enrolled patients with liver cirrhosis (Child Pugh score greater than or equal to 7) and their corresponding healthy controls. For each participant, socio-demographic data, clinical data on liver cirrhosis and on oral examination were collected. Oral examination evaluated the level of oral hygiene, gingival index (GI), probing depth (PD) and Clinical attachment loss (CAL), determined and identified oral mucosal lesions. The mean Decayed-Missing-Filled-Teeth (DMFT) index and prevalence of dental caries were also determined. The groups were then compared with regards to periodontal oral mucosal and dental variables using chi square test and Mantel – Haenszel odds ratio was used to determine the strength of association between decompensated liver cirrhosis and oral pathologies. The student‘s T-test was used to compare mean values of quantitative variables. A p-value ˂ 0.05 was statistically significant. Results: We included a total of 80 participants among which 40 liver cirrhotic patients and 40 sex and age (±3 years) matched controls. The mean age was 50.0(±19.0) years for the cases and 52.4(±17.9) years for the healthy controls. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) were the main aetiology of liver cirrhosis representing 42.5% and 30% respectively and Child Pugh class B (65% of cases) was the most represented stage of the disease. A number of past bucco-dental consultations was significantly less frequent in the cases than the controls (09 versus 18, p = 0.03). Over 80% of cases used an inappropriate brushing technique compared to 60% of controls and 55% of cases used toothbrushes and toothpaste compared to 85% controls (p=0.09). A frequency of brushing at least twice daily was 42.5% in cases compared to 55% in controls (p=0.19). Patients with decompensated liver cirrhosis had a significantly greater prevalence of periodontal disease than the controls (95% versus 77.5%, p = 0.013). In addition, they had greater mean PI (1.8(±0.7) versus 1.6(±0.5), p = 0.182), mean GI index (1.9(±0.8) versus 1.3(±0.64), p = 0.004) and periodontal recession (77.5% versus 47.5%). Oral mucosal lesions and salivary lesions were more frequent in cirrhotic patients than in the healthy controls. These lesions include xerostomia (45% versus 17.5%, p ˂0.001), oral candidiasis (7.5% versus 0%, p = 0.120), lichen planus (17.5% versus 2.5%, p = 0.028), petechiae (57.5% versus 5%, p ˂ 0.001), halitosis (50% versus 7.5%, p ˂0.001) and sialadenitis (17.5% versus 0%, p = 0.006). Higher prevalence’s of dental and mean DMFT index were found in cases than in controls. Factors associated with the development of oral pathologies in decompensated cirrhotic patients were oral consultations (p = 0.046), presence of cytolysis (OR = 2.58, p = 0.042) and inadequate brushing technique (p = 0.004). Conclusion: The prevalence of oral pathologies is higher in patients with decompensated liver cirrhosis than corresponding age-sex matched healthy controls.