Periodontitis and chronic liver disease linked through proposed oral-gut-liver axisConceptual framework links liver, gut, immune, and oral health

This narrative review introduces the concept of a Liver-Gut-Immune-Oral Axis as a framework linking periodontitis and chronic liver disease. The authors synthesize evidence from mechanistic and associative studies to propose bidirectional pathways: periodontitis may exacerbate liver inflammation via oral pathogens entering the gut-liver circulation, while chronic liver disease may alter immune and metabolic states that worsen periodontal health. The review emphasizes that these pathways are currently inferred, not causally proven.

Key strategies discussed include targeting tissue inflammation (TI) with metabolic modulators, epigenetic drugs, or periodontal interventions to disrupt the proposed cycle. The authors suggest this approach could advance precision medicine for inflammatory comorbidities. However, they explicitly caution that the validity of the axis as an integrated, causally-linked biological system awaits direct experimental validation.

No specific study populations, sample sizes, interventions, or outcomes are reported, as this is a conceptual review. The review does not provide pooled effect sizes or quantitative results. Clinicians should interpret the proposed axis as a hypothesis-generating framework rather than a basis for clinical action. The authors acknowledge that causal links between the components remain unconfirmed.