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Periodontal Disease and Nonalcoholic Fatty Liver Disease: New Microbiome-Targeted Therapy Based on the Oral–Gut–Liver Axis Concept

  • Oral Disease and Nutrition (F Nishimura, Section Editor)
  • Published:
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Abstract

Purpose of Review

There has been emerging data and a growing appreciation of the negative effects of periodontal disease on nonalcoholic fatty liver disease (NAFLD), which is currently the most prevalent chronic liver disease worldwide. A subgroup of these NAFLD patients develops more severe and progressive forms of liver disease, namely, nonalcoholic steatohepatitis (NASH), which are a risk for developing cirrhosis and hepatocellular carcinoma. In this review, we will summarize the recent epidemiological, basic, and clinical research findings on the relationship between periodontal disease and NAFLD/NASH and discuss the pathogenesis of NAFLD/NASH and potential new treatment options with a particular focus on the gut microbiota.

Recent Findings

In terms of the mechanism by which harmful factors are transported from diseased periodontal tissue to the liver, two routes of transmission have been proposed based on the unique anatomical characteristics of the liver, namely, through a hematogenous diffusion via the systemic circulation and through a gut–liver axis via the gastrointestinal tract. In particular, with respect to enteral diffusion, gut microbiome dysbiosis induced by enteral translocation of periodontopathic bacteria may be involved in NAFLD. In terms of a gut–liver axis, one mechanism assumed to link the gut microbiome to NAFLD is the disruption of the gut epithelial barrier, which may allow leakage of microbial products and metabolites into the portal circulation. Namely, changes in lipopolysaccharide and bacterial metabolites due to gut dysbiosis can induce intestinal inflammation and increase permeability, thereby promoting hepatic exposure to these components, which can directly cause NAFLD and liver fibrosis. Porphyromonas gingivalis, a common periodontopathic bacteria, may be involved in the pathogenesis of both the gut dysbiosis and NAFLD via several different pathways. Therefore, diverse strategies for manipulating the gut microbiome in the management of NAFLD related to periodontal disease have been proposed, including the use of antibiotics, probiotics, and prebiotics.

Summary

Despite research limitations, there is a large body of evidence supporting the relationship between periodontal disease and NAFLD/NASH. The importance of the oral–gut–liver axis in the pathogenesis of NAFLD is increasing, and future research on microbiome-targeted therapy to improve periodontal disease-related gut dysbiosis is warranted.

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  1. Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan

    Ryutaro Kuraji & Yukihiro Numabe

  2. Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA

    Yvonne Kapila

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Kuraji, R., Kapila, Y. & Numabe, Y. Periodontal Disease and Nonalcoholic Fatty Liver Disease: New Microbiome-Targeted Therapy Based on the Oral–Gut–Liver Axis Concept. Curr Oral Health Rep 9, 89–102 (2022). https://doi.org/10.1007/s40496-022-00312-1

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