Periodontal status and microbial profiles across the clinical spectrum of liver cirrhosis

J B O Batista; E H de Souza Oliveira; L A M Penteado; V X Nascimento; S Matsumura; J M M Silva; D F Nóbrega; B Retamal-Valdes; M Feres; S M S Ferreira

doi:10.1080/20002297.2026.2678639

Periodontal status and microbial profiles across the clinical spectrum of liver cirrhosis

J Oral Microbiol. 2026 May 26;18(1):2678639. doi: 10.1080/20002297.2026.2678639. eCollection 2026.

Authors

J B O Batista^{1

2}, E H de Souza Oliveira³, L A M Penteado², V X Nascimento², S Matsumura^{3

4}, J M M Silva², D F Nóbrega², B Retamal-Valdes^{5

6

7}, M Feres^{3

8}, S M S Ferreira²

Affiliations

¹ Hospital Universitário Professor Alberto Antunes (HUPAA), Maceió, AL, Brazil.
² Centro Universitário CESMAC, Maceió, AL, Brazil.
³ Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
⁴ Department of Periodontology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
⁵ Department of Periodontology, RS Master Saúde, Aruja, SP, Brazil.
⁶ Department of Periodontology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.
⁷ Department of Dental Sciences, Technical University of Oruro, Oruro, Bolivia.
⁸ Dental Research Division, Department of Periodontology, Universidade Guarulhos (Guarulhos University), Guarulhos, SP, Brazil.

Abstract

Objectives: Periodontitis is common in patients with cirrhosis, but this association remains underexplored. This cross-sectional study aimed to assess periodontal conditions and characterize periodontal biofilm composition in individuals with liver cirrhosis.

Methods: Adults with liver cirrhosis were enrolled. Periodontal parameters were recorded, and supragingival and subgingival biofilm samples were collected. Forty bacterial species were quantified using checkerboard DNA-DNA hybridization. Findings were stratified by Child-Pugh class and MELD score.

Results: Forty-five patients were included; 88.9% exhibited periodontal disease (57.8% gingivitis on a reduced periodontium, 31.1% periodontitis), and 11.1% were periodontally healthy. Periodontal diagnosis was not associated with liver-disease severity (p > 0.05). Gingivitis showed the highest supragingival bacterial load, with enrichment of orange- and red-complex pathogens, particularly Tannerella forsythia. Patients with compensated liver disease (Child-Pugh A; MELD < 15) showed higher counts of Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum ssp. nucleatum (p < 0.05). Among patients with periodontitis, higher subgingival proportions of red-complex pathogens were observed in those with MELD < 15.

Conclusions: Periodontal disease was highly prevalent in patients with cirrhosis. Although periodontal diagnosis was not associated with liver-disease severity, distinct microbiological patterns were observed. These findings highlight the potential relevance of periodontal monitoring in patients with cirrhosis and warrant further investigation in larger, longitudinal studies.

Keywords: Liver cirrhosis; hybridization; microbiota; nucleic acid; periodontal diseases; periodontitis; subgingival plaque.

Plain language summary

In patients with liver cirrhosis, gingivitis was characterized by the highest supragingival bacterial burden and marked enrichment of orange- and red-complex species, particularly Tannerella forsythia, suggesting this clinical stage represents a state of heightened supragingival dysbiosis.Periodontitis patients with compensated liver disease (MELD < 15) harboured higher subgingival proportions of red-complex pathogens than those with more advanced cirrhosis, indicating a non-linear, host-modulated relationship between hepatic dysfunction and periodontal microbial ecology.Distinct microbial signatures were observed across supragingival and subgingival niches and liver disease severity strata, supporting the value of niche-specific microbiological profiling in medically compromised populations.