Oral Medicine Journal

Reading
Oral Health and Liver Function in Children
and Adolescents with Cirrhosis of the Liver

Supervisor: Riani Setiadhi,

drg, Sp.PM
Presenter: Low Tee Eng

Introduction
Oral cavity is an important indicator
Manifestation of liver disease
include:
Malnutrition
Edema
Esophageal varices
Coagulation disorder

Medication of liver disease:

glucocorticoid

Literature Review
Oral candidiasis
Petechia and
Oral
gingival
manifestati bleeding
on of liver Angular cheilitis
diseases Membrane
jaundice
Atrophic
glossitis

Oral candidiasis
Candida albican
White patches known as plaques
Bleeding/edematous surface is
observed when removed
mechanically
Patients with liver disease are
immunocompromised

Oral candidiasis
Topical antifungal
Nystatin (4X daily for 2 weeks) and amphotericin
Miconazole (imidazole)
Clotrimazole
Ketoconazole

Systemic antifungal
Triazole (1X daily)
Ketoconazole (hepatoxicity)
Fluconazole
Troconazole

Pseudomembranous oral candidiasis with

plaques on the buccal and sever thrush on
tongue (Akpan & Morgan, 2002)

Petechia and gingival

bleeding
Liver synthesizes many clotting
factors
Vitamin K requires proper liver
function
No treatment required
Normally would resolves within 2 weeks

Petechia located on the

vestibulum in the oral cavity
(Finkelstein M, 2013)

Angular Cheilitis
Inflammation affecting the oral
commissures
Etiology:
Nutritional deficiency of folate, iron or
B12
Poor oral hygiene
Fungal infection (staphylococcus aureus)
Poorly maintained dentures
Immunosuppressant drugs

 Treatment:
Petroleum jelly
Topical treatment with combination of
mupirocin or fusidic acid and 1%
hydrocrotisone cream
Antifungal ketoconazole
Correcting nutritional deficiencies

Angular cheilitis located on both borders

of the vermillion (Stoopler E, et al, 2013)

Membrane Jaundice
Yellow pigmentation observed in the
oral mucosa
Excess bilirubin in the blood
Yellowish or greenish pigmentation
occurs in teeth of children

Jaundice at the junction between hard and

soft palate (Gomez I, et al, 2007)

Atrophic Glossitis
Inflammation of the filiform and
fungiform papilla
Normally due to nutritional deficiency
Replacement therapy

Picture of atrophic glossitis also

commonly known as the smooth
tongue (Daley T and Armstrong J,
2007)

Discussion
Common causes of liver disease:
Viral infection
Alcohol abuse
Lipid and carbohydrates metabolic
disorder

 Function of liver include:

Maintaining hemeostasis
Synthesize most essential serum
proteins
Produce bile and its transporter
Intervene in the regulation of nutrients

 Liver dysfunction alters metabolism

of:
Carbohydrates
Lipids
Proteins
Drugs
Bilirubin
Hormones

 Hepatitis of viral origin

6 different types of virus (A, B, C, D, E, and
G)

Alcoholic liver disease

10 of the most common cause of
Ranges from simple liver steatosis with
alcohol hepatitis to more severe
steatihepatitis or cirrhosis
Accompanied with:

febricula
jaundice
Leukocytosis
liver enzyme elevations

 Non- alcoholic fatty liver:

Accumulation of fats in the liver
Ranges from steatosis to steatohepatitis
Associated:

Obesity
Diabetes
Hyperlipidemia
Insulin resistance
Excessive triglyceride accumulation within
the liver cells

 Liver cirrhosis
Destruction of the liver parenchyma
Irreversible
Formation of fibrous scarring
formation of regeneration nodules
resistance to blood flow

 The oral cavity can reflect liver

dysfunction:
Mucosal membrane jaundice
Bleeding disorder
Angular cheilitis
Smooth and atrophic tongue
Oral candidiasis

 Oral manifestations of patients with

liver dysfunctions are due to:
Drugs
Malnutrition

Conclusion

Made known to all dentists

Avoid traumatic procedures
Cautionary steps taken by the dentist
Drugs prescribed should be taken
into consideration

THANK YOU FOR YOUR ATTENTION!!!!