Background
Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown.

Objective
The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis.

Methods
A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan–Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis etiology, Child–Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score.

Results
The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty-four percent of the patients died during follow-up. Severe periodontitis was associated with higher all-cause mortality in the crude analysis (HR 1.56, 95% CI 1.06–2.54), but not in the adjusted analysis (HR 1.45, 95% CI 0.79–2.45). Severe periodontitis was even more strongly associated with higher cirrhosis-related mortality (crude HR 2.19, 95% CI 1.07–4.50 and adjusted HR 2.29, 95% CI 1.04–4.99). No association was found between edentulism and mortality.

Conclusion
The presence of severe periodontitis predicted a more than double one-year cirrhosis mortality. These findings may motivate intervention trials on the effect of periodontitis treatment in patients with cirrhosis.