MODERN PERCEPTIONS ON THE ETIOLOGY AND PATHOGENESIS OF PARODONTITIS IN PATIENTS WITH METABOLICALLY ASSOCIATED FAT DISEASES OF THE LIVER
Keywords:
periodontitis, MASLD, systemic inflammation, metabolic pathways, insulin resistance, prognosis, preventionAbstract
The article examines modern understanding of the relationship between periodontitis and metabolically associated fatty liver disease (MASLD). An analysis of literature data confirming the presence of general pathogenetic mechanisms, including systemic inflammation, oxidative stress, microbiota dysbiosis, and insulin resistance, was conducted. Periodontal pathogens, by penetrating the systemic bloodstream, contribute to the activation of liver Toll-like receptors and the enhancement of the inflammatory response, which plays a role in the development of steatosis and liver fibrosis. In turn, metabolic disorders in MASLD exacerbate the course of periodontitis due to a decrease in antioxidant defense and changes in vascular reactivity. Key metabolic pathways linking both diseases, including TLR4/NF-κB activation, insulin signaling disorder (PI3K/Akt), and PPAR-γ dysregulation, have been identified. Potential prognostic criteria are presented - levels of CRP, IL-6, TNF-α, HOMA-IR indicators and liver enzyme activity, as well as clinical periodontal indices. The need for a multidisciplinary approach and early prevention aimed at correcting inflammatory and metabolic disorders is noted.
References
Kinane D.F., Stathopoulou P.G., Papapanou P.N. Periodontal diseases. Nat Rev Dis Primers, 2017; 3:17038.
Eslam M., Newsome P.N., et al. A new definition for metabolic dysfunction-associated steatotic liver disease. J Hepatol, 2023;78(2):379–392.
Hotamisligil G.S. Inflammation and metabolic disorders. Nature, 2022;604(7907):517–526.
Sasaki N., et al. Porphyromonas gingivalis infection and liver steatosis. J Gastroenterol Hepatol, 2018;33(4):944–951.
Kobayashi R., et al. Relationship between periodontal disease and non-alcoholic fatty liver disease. J Clin Periodontol, 2020;47(6):651–661.
Akazawa H., et al. Effects of periodontal therapy on systemic inflammation and liver enzymes. Clin Oral Investig, 2021;25(12):6517–6525.
Yoneda M., et al. Periodontitis and metabolic syndrome: systemic inflammatory network. J Hepatol, 2022;76(3):734–743.
Wang X., et al. Interaction between insulin resistance and periodontitis. Front Endocrinol, 2021;12:665240.
Bartold P.M., Van Dyke T.E. An appraisal of the role of specific bacteria in the initial pathogenesis of periodontitis. J Clin Periodontol. 2019;46:6–11.
Targher G., Byrne C.D., Tilg H. Non-alcoholic fatty liver disease: a multisystem disease. J Hepatol. 2020;72:371–384.
Preshaw P.M., Alba A.L., Herrera D. Periodontitis and systemic health: current status. J Clin Periodontol. 2012;39:14–19.
Amar S., et al. Periodontal disease, systemic inflammation, and metabolic syndrome. J Dent Res. 2007;86:400–410.
Shibata Y., et al. Inflammatory markers in periodontitis and NAFLD. Clin Oral Investig. 2018;22:283–292.
Socransky S.S., Haffajee A.D. Microbial complexes in subgingival plaque. J Clin Periodontol. 2005;25:134–144.
Akinkugbe A.O., et al. Insulin resistance and periodontal disease in NAFLD patients. Diabetes Care. 2016;39:1392–1398.
Al-Khabbaz A.K., et al. Lipid metabolism and periodontal inflammation. J Periodontol. 2013;84:1435–1443.
Laine M.L., et al. Genetic susceptibility to periodontitis. Periodontol 2000. 2012;58:37–49.
Kinane D.F., et al. Host–response mechanisms in periodontitis. Periodontol 2000. 2017;75:11–20.
Preshaw P.M., et al. Oxidative stress in periodontal disease. Periodontol 2000. 2011;55:107–125.
Sanz M., et al. Periodontitis and systemic diseases: association with liver disease. J Clin Periodontol. 2019;46:119–136.
Yoneda M., et al. Association between periodontitis and liver fibrosis in NAFLD patients. Hepatol Res. 2017;47:1276–1283.
Tonetti M.S., et al. Periodontitis: clinical practice guideline. J Clin Periodontol. 2020;47:4–60.
Preshaw P.M., et al. Periodontal therapy in patients with systemic diseases. Periodontol 2000. 2019;80:190–206.
Lee et al. (2024). Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Chronic Periodontitis: A Nationwide Cohort Study. BMC Oral Health. https://pubmed.ncbi.nlm.nih.gov/39796559/
Li et al. (2025). Association between periodontitis and mortality in participants with metabolic dysfunction-associated steatotic liver disease: results from NHANES. BMC Oral Health. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-025-05959-7
Sato et al. (2023). The Presence of Periodontitis Exacerbates Non-Alcoholic Fatty Liver Disease via Sphingolipid Metabolism-Associated Insulin Resistance and Hepatic Inflammation in Mice with Metabolic Syndrome. Int. J. Mol. Sci. https://www.mdpi.com/1422-0067/24/9/8322
