Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review

Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes

Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review

Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes

Lounasasiakkaiden asiakastyytyväisyys Pub Nostalgiassa

Tämän opinnäytetyön tarkoituksena oli tutkia lounasasiakkaiden tämän hetkistä asiakastyytyväisyyttä Pub Nostalgiassa. Tutkimus toteutettiin asiakastyytyväisyyskyselyllä sekä havainnoimalla lounasaikana. Teoriaviitekehys sisältää käsitteet asiakastyytyväisyys, palvelu sekä palvelun laatu. Teoriassa käsitellään myös asiakaskokemusta ja asiakaslähtöisyyttä. Tutkimuksen perusjoukko on lounasasiakkaat ja kyselyn otanta oli 97. Kyselyssä selvitettiin asiakastyytyväisyyttä eri osa-alueilla, joita olivat lounasaika, lounaan hinta, lounaan esillepano ja maku, palvelu sekä siisteys. Lisäksi kysyttiin vastaajan taustatietoja, mistä on kuullut pub Nostalgiasta, pyydettiin arvosanaa asiakaskokemukselle ja tiedusteltiin suositushalukkuutta. Tutkimustuloksista voidaan todeta asiakkaiden olleen tyytyväisiä hintaan, makuun, palveluun ja lounasaikaan. Huonolla tasolla ei ollut lounaan esillepano eikä siisteyskään. Asiakkaiden tyytyväisyydestä kertoo myös asiakaskokemuksen keskiarvo sekä suositteluinto. Asiakas arvioi kokemuksensa olleen kiitettävällä tasolla ja 92% vastanneista suosittelisi lounasta muille. Asiakastyytyväisyystutkimuksen tuloksia hyödynnetään liiketoiminnan kehittämisessä ja asiakaslähtöisyyden parantamisessa.The purpose of this thesis was to study the current customer satisfaction of lunch customers at Pub Nostalgia. The survey was conducted through a customer satisfaction survey and observed lunch time. The theory framework includes the concepts of customer satisfaction, service and quality of service. In the theory part, customer experience and customer orientation are also addressed. The target group of the survey was lunch customers and the sample of the questionnaire was 97. The survey examined customer satisfaction in various areas, such as lunch time, lunch price, presentation and taste of lunch, service and cleanliness. In addition, the respondents were asked to provide background information on how they had found out about pub Nostalgia. They were also asked to rate their customer experience and willingness to recommend lunch at the pub. The results of the research show that customers were satisfied with the price, taste, service and lunchtime. The staff were very friendly and helpful. Customer satisfaction was also reflected in the average of the customer experience and the enthusiasm for testimonial. The customer estimated that their experience was at a commendable level and 92% of respondents would recommend Nostalgia´s lunch to others. The results of the customer satisfaction survey are used to develop the business and improve customer orientation

Oral health in liver transplant recipients

Liver transplantation (LT) is the treatment of choice for patients with severe liver disease. Quality of life of patients after LT may be comparable to that of the general population, but permanent immunosuppression poses a high risk for infections. Highly prevalent dental diseases not promptly treated may compromise LT outcome. All possible infectious foci, including dental infections, should thus be treated prior to LT. This thesis aimed to investigate how liver diseases and long-term immunosuppression after LT affect oral health and whether dental infections are associated with liver disease progression or with LT outcome. The study design was retrospective, cross-sectional, and observational. The study comprised 263 adult recipients of a LT between 2000 and 2006 at the Helsinki University Central Hospital, Finland. Of these patients, 212 (81%) had chronic liver disease, and all underwent dental examinations and treatment prior to LT. The study investigated the effect of differing liver disease etiology and severity on oral health status; the effect of dental infections on the progression of liver cirrhosis was further studied in a subgroup of 116 cirrhotic patients awaiting LT. Of the study patients, 51 (19%) had acute or subacute liver failure; these were further stratified by whether or not they received pretransplant dental treatment. Post-transplant systemic infectious complications were evaluated from the Finnish Liver Transplant Registry. After a minimum 2-year follow-up (median follow-up 6 years, range 2-11), all 84 eligible LT recipients were recruited for a new oral health examination according to a fixed protocol. A structured questionnaire was used to assess dry-mouth-related symptoms, with oral Candida cultivated, and salivary flow rates measured. The results were compared with those of 252 matched controls from a national health survey. Subjects were grouped according to liver disease etiology and type of immunosuppression. Dental health status of LT candidates varied depending on the etiology and severity of their liver disease. Alcohol cirrhosis patients (n=37) had significantly more tooth extractions before LT than did primary sclerosing cholangitis patients (n=54) (6 vs. 3, P less than 0.005). Poor liver function, as observed in higher Model for End-Stage Liver Disease (MELD) scores, associated with fewer teeth (21 vs. 25, 95%CI: -6.7-(-)1.4, P less than 0.005) and more tooth extractions (5 vs. 2, 95%CI: 1.6-4.2, P less than 0.001). Tooth extractions were often associated with severe complications such as bleeding. Several dental infections in cirrhotic patients associated with worsening of the liver disease as seen in the shorter time between diagnosis and LT operation. Post-transplant infection risk, especially sepsis, was higher in those acute liver disease patients who received no dental treatment before LT due to their more urgent need for LT compared with that of patients who had received dental treatment (OR=8.54, 95%CI: 1.82 40.1, P less than 0.05). This risk was independent of age, gender, etiology of acute liver failure, waiting-list time, MELD score, or level of immunosuppression. Compared with controls, chronic LT recipients had significantly more caries (1.2 vs. 0.5, P less than 0.005) and a higher prevalence of dysphagia (23% vs. 12%, P less than 0.05). They also had lower unstimulated salivary flow rates than did the acute LT recipients (0.3 ml/min vs. 0.6 ml/min, P less than 0.05). Oral mucosal lesions were significantly more frequent in LT recipients than in controls (43% vs. 15%, P less than 0.001). Drug-induced gingival overgrowth was the most common type of oral lesion, and its prevalence was significantly higher in chronic LT recipients than in their controls (16% vs. 1%, P less than 0.001). Simultaneous use of cyclosporine-A and calcium- channel blockers increased the overgrowth prevalence even further compared with the tacrolimus group (47% vs. 8%, P less than 0.05). Precancerous oral mucosal lesions occurred twice as often in chronic LT recipients as in controls (13% vs. 6%, Ns). Oral Candida count was positive in more than half the LT patients; use of steroids raised its prevalence to 70%. The need for dental treatment hence was high before the LT operation with differences in oral health between groups differing in liver disease etiology and severity. Among cirrhotic patients, several dental infections were reflected in the liver disease progression. Those patients who lacked dental treatment before LT showed an 8-fold risk for systemic infections after transplantation. Compared to controls, immunosuppressive and other xerogenic medications predisposed especially the chronic LT recipients to more dry-mouth-related symptoms and caries, and led to a higher risk for oral mucosal lesions, of which some were precancerous. Thus, both pre- and post-transplant dental treatments are highly important for these patients.Hyvä suun ja hampaiden terveys on osa yleisterveyttä ja hammasinfektioiden on osoitettu olevan altistavana tekijänä monille kroonisille sairauksille. Maksasairauden ja suun välisiä yhteyksiä on kuitenkin tutkittu vähän ja erityisesti maksansiirtopotilaiden hampaistotutkimuksia on rajoitetusti. Tässä tutkimuksessa selvitettiin maksansiirtopotilaan suun terveyttä ennen ja jälkeen maksansiirron ja toisaalta tutkittiin miten hammasinfektioiden hoito vaikuttaa maksansiirtopotilaan ennusteeseen. Maksansiirtoa odottavan potilaan suun terveys oli hyvin erilainen riippuen siirron taustalla olevasta maksasairaudesta ja sen vaikeusasteesta. Hammasinfektiot olivat yleisiä mutta pisimmälle edennyttä maksakirroosia sairastavan potilaan hampaisto oli huonokuntoisin ja heidän hammashoitoon liittyi usein vuotokomplikaatioita. Alkoholikirroosi-ryhmässä oli huomattavasti enemmän hammasinfektioita kuin esim. primääri sklerosoiva kolangiitti-ryhmässä. Useat hammasinfektiot näyttivät liittyvän maksakirroosin huononemiseen, sillä ne potilaat joilla oli eniten hammasinfektioita, päätyivät aiemmin maksansiirtoon. Maksansiirtoa edeltävällä hampaistosaneerauksella todettiin olevan merkittävä hyöty siirtopotilaan ennusteelle, jos maksansiirto oli tehty äkillisen maksantoiminnan pettämisen vuoksi. Riski maksansiirron jälkeisille vakaville infektiokomplikaatioille (mm. sepsikset) oli 8-kertainen niillä potilailla, joille ei ehditty tehdä hampaistosaneerausta verrattuna hoidettuihin potilaisiin. Riski oli riippumaton useista sekoittavista tekijöistä, kuten iästä, hyljinnänestolääkityksesta, maksasairauden vaikeusasteesta tai siirron odotusajasta. Hyljinnänesto- ja muu lääkitys näkyi maksansiirtopotilaan suun terveydessä monin eri tavoin. Kroonisen maksasairauden vuoksi maksansiirron saaneilla potilailla oli merkitsevästi enemmän suun kuivumista, hampaiden reikiintymistä sekä suun limakalvomuutoksia kuin terveillä väestöverrokeilla. Limakalvomuutoksista yleisin oli ikenen liikakasvu mutta myös suusyövälle altistavia limakalvomuutoksia esiintyi kroonisilla potilailla kaksinkertaisesti verrokkeihin nähden. Tutkimuksen tulokset osoittavat hyvän suun terveyden merkitystä infektioherkillä maksansiirtopotilailla. Kaikki piilevätkin hammasinfektiot on hoidettava ennen siirtoa ja myös siirron jälkeen hammashoidosta ja hyvästä suuhygieniasta tulee huolehtia, jotta voidaan välttyä vakavilta siirron jälkeisiltä infektiokomplikaatioilta. Tutkimusaineiston muodostivat 263 aikuista maksansiirtopotilasta, joille tehtiin maksansiirto Suomessa vuosina 2000-2006. Kun maksansiirrosta oli kulunut vähintään 2 vuotta, 84 potilaan suun terveys tutkittiin uudelleen ja iän sukupuolen, ja asuinpaikan mukaan valitut verrokit saatiin Terveys 2000 -tutkimuksesta. Tietoja saatiin sairaskertomuksista, röntgenkuvista, kyselytutkimuksesta sekä Maksarekisteristä

Responses of the fish community in a eutrophicated lake to long-term food web management assessed by multiple sampling methods

Fish community responses to long-term mass removal of planktivorous fish from eutrophicated Lake Tuusulanjarvi were examined during 1996-2018 by gill net test fishing, hydroacoustics with simultaneous trawling, virtual population analysis (VPA) and fish growth measurements. The gillnet catches of white bream and roach increased first while bream and bleak decreased but recovered in the early 2000s. Perch and pikeperch increased but ruffe decreased and remained low. According to hydroacoustics, pelagic fish biomass decreased. Smelt was the most abundant species at the beginning and the end of the monitoring period but bream dominated the fish biomass in most years. VPA calculations indicated a five- and threefold increase in the biomass of bream and white bream, respectively, during 2005-2011. Significant increases appeared in the growth of perch, bream and roach. Overall, the responses in the fish community structure and fish abundance to the food web management were slight and mostly masked by changes in reproduction and growth of fish and annual variability in environmental conditions such as temperature and water turbidity. Gillnet test fishing and echo sounding complemented each other well in monitoring the effects of management fishing. Where bream is one of the dominant species VPA is also recommended.peerReviewe

Extrapyramidal symptoms predict cognitive performance after first-episode psychosis

Publisher Copyright: © 2022, The Author(s).Extrapyramidal (EP) symptoms such as tremor, rigidity, and bradykinesia are common side effects of most antipsychotics, and may associate with impaired performance in neurocognitive testing. We studied EP symptoms in first-episode psychosis (FEP; n = 113). Cognitive testing and EP symptoms (three items of the Simpson-Angus Scale) were assessed at baseline and follow-up (mean follow-up time 12 months). Mild EP symptoms were present at treatment onset in 40% of the participants. EP symptoms were related with lower performance in neurocognitive testing at baseline and at follow-up, especially among those with nonaffective psychotic disorder, and especially in tasks requiring speed of processing. No associations between EP symptoms and social cognition were detected. In linear regression models, when positive and negative symptom levels and chlorpromazine equivalents were accounted for, baseline EP symptoms were associated with worse baseline global neurocognition and visuomotor performance. Baseline EP symptoms also longitudinally predicted global, verbal, and visuomotor cognition. However, there were no cross-sectional associations between EP symptoms and cognitive performance at follow-up. In sum, we found both cross-sectional and longitudinal associations between EP symptoms and neurocognitive task performance in the early course of psychosis. Those without EP symptoms at the start of treatment had higher baseline and follow-up neurocognitive performance. Even mild EP symptoms may represent early markers of long-term neurocognitive impairment.Peer reviewe

Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes : Salivary biomarkers in liver transplant recipients

Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels (p < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios (p < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health (p < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients.Peer reviewe

Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes

Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels (p < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios (p < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health (p < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients

Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes

Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels (p < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios (p < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health (p < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients

Triage and urgent dental care for COVID-19 patients in the Hospital District of Helsinki and Uusimaa

Objective This paper describes and reports the patient-specific characteristics of an urgent dental care clinic for COVID-19 infected, suspected, exposed or quarantined patients from March to December 2020 in the Hospital District of Helsinki and Uusimaa, Finland. Material and methods The triage and the treatment protocol were established based on the scientific data. Patient files were evaluated from the hospital district's electronic medical record system. IBM SPSS software was used for statistical analysis. Results There were 1114 consultations and 257 visits at the clinic. Most of the patients were generally healthy with mean age of 35, had toothache and were suspected to be SARS-CoV-2 positive. Seventeen of the patients received positive tests for COVID-19 infection. The main treatment was tooth extraction, mostly due to caries. Statistically significant differences between COVID-19 infected and other patients occurred in age (45 vs 34 years-of-age, p = .009) and number of teeth (25 vs 28, p = .031). No SARS-CoV-2 infection transmission chains were traced to the clinic. Conclusion During the challenging pandemic time, patients were carefully screened by specialists in clinical dentistry and treated safely and effectively. Patient-specific characteristics revealed no differences between COVID-19 infected and other patients in terms of symptoms or treatment needs.Peer reviewe