CHANGES IN THE DENTAL STATUS OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Emelyanov D.V. , Petrushanko T.O. 
Published: April 2022

Relevance. Periodontal disease has a close relationship with somatic diseases of various body systems. On the basis of the results of many scientific studies it has been indicated that there are common features for pathogenetic mechanisms of formation and development of generalized chronic periodontitis and chronic obstructive pulmonary diseases, cardiovascular diseases, diseases of the digestive system, and others. Against this background, it is clear that the functions of a dentist include not only restoring or whitening teeth. The active participation of the dentist in the treatment of patients with internal diseases is essential for prevention of the progression or occurrence of complications in different somatic pathology, as well as for breaking the existing comorbid connection. The prevalence of inflammatory-dystrophic periodontal diseases reaches 70-90%, and almost 70% of them are accompanied by the presence of somatic pathology in patients. Metabolic diseases, especially non-alcoholic fatty liver disease (NAFLD), are considered to be one of the most pressing problems in the world today. NAFLD is a chronic non-communicable disease that has reached a prevalence of over 30% of personns in Western Europe and the United States over the past decade. A characteristic clinical signs of this somatic pathology is the lack of a specific clinical course, which should attract the attention of the family doctor to this organ of the digestive system. Identification of dental changes in the oral cavity in patients with NAFLD allows detect the stomatological disorders, to suspect the presence of somatic pathology, and form correct tactics for cooperative activity with the physician.

Goal: study the character of dental complaints and their correlation with the data of objective examination of the oral cavity in patients with non-alcoholic fatty liver disease.

Materials and methods. The main group has been included 258 somatic patients with NAFLD. The prevalence age of patients in this group was 49.79 ± 0.662. In the main group, the subgroup A consisted of 177 people with steatosis; subgroup B included 81 patients with steatohepatitis. The control group consisted of 25 people without somatic pathology. The prevalence patients' age of the control group was 43.04 ± 1.378. Subjective examination methods were performed; the nature of nutrition and the level of oral hygiene were taken into account. Objective dental status was assessed by determining oral-Vermilion oral hygiene, RVI bleeding, Parma PMA, KPI, Schiller-Pisarev test.

Results. Patients in the main group had grade 1–2 obesity (body mass index – 35.20±0.49) and insulin resistance (HOMA index – 6.77±0.420). The most common complaint of patients with NAFLD was bleeding gums during brushing (58.5% of patients). Bleeding cases during eating was equal to 29.5% of patients. Dry mouth bothered more than 85.0% of patients in the main group. Bad breath (halitosis) and taste distortion (dysgeusia) were common in 86.4% and 82.6% of patients with NAFLD, respectively. Patients in the control group did not have the mentioned complaints. Correlation analysis showed a direct relationship between such complaints as bad breath and bleeding gums, and body mass index (r = 0.547 p = 0.003; r = 0.458 p = 0.014, respectively) and the degree of steatosis (r = 0.520 p = 0.000 ; r = 0.415 p = 0.001, respectively) in patients with NAFLD.

Conclusions. Diagnosis and treatment of dental diseases in patients with NAFLD will allow the dentist to break the "vicious circle" of comorbidity and will help in the complex therapy of such patients.