Teeth and Liver Disease

Children with liver disease commonly suffer from dental problems that healthy children experience. These are tooth decay, gum disease and tooth wear.

Tooth decay

Tooth decay is caused by sugar in your child’s food and drink. The bacteria (germs) in dental plaque on the teeth digest (metabolise) sugars and processed starches to make acid. The acid dissolves away your child’s teeth to make holes. Children with liver disease can be at more risk of tooth decay as they may be on high sugar (high calorie) diets.

Tooth decay can cause: toothache, dental abscess, swelling and spreading infection, tooth loss

Gum disease

Bacteria in dental plaque irritate gums causing swelling, soreness and bleeding.

Prolonged gum disease can cause: loose teeth, gum abscess, tooth loss

Tooth wear

Tooth wear is caused by fizzy and acidic drinks, acidic foods and sometimes gastric reflux. The acid dissolves teeth. This can cause sensitive teeth and in severe cases toothache.

How can I keep my child’s teeth healthy?

The most important thing parents can do is to ensure children’s teeth remain health and decay free.

Top tips for healthy, sparkling teeth:

  1. Start brushing as soon as the first tooth comes through (usually about 6 months of age)
  2. Children should brush their teeth at least twice a day (at bedtime and one other time) with fluoride toothpaste. Adults will need to help brush teeth of children less than 7 years old
  3. For children 0-3 years old use a SMEAR of toothpaste containing at least 1000 parts per million (ppm) fluoride
  4. Use a PEA sized amount of at least 1000 ppm fluoride toothpaste for children 3-6 years old
  5. Children over 6 years old should use a PEA sized amount of 1350-1500 ppm fluoride toothpaste
  6. SPIT OUT toothpaste after brushing and NO rinsing
  7. Use a small toothbrush head, medium texture. Brush the gum line and every part of the tooth. Replace your child’s toothbrush when the bristles are worn (about three months). Disclosing tables show up plaque which helps you brush in the right places
  8. Take your child to visit a dentist to have their teeth checked every six months
  9. If children do not like the taste or foaming-feeling toothpaste can have, some companies produce a non-foaming and unflavoured fluoride paste for children
  10. Sometimes teeth can be sensitive. Sensitive toothpaste can help such as proenamel or sensydyne, or in addition using GC Tooth Mousse.

Maximum protection for children from tooth decay

  1. For maximum prevention from tooth decay for children aged 0-6 years use 1350-1500 ppm fluoride toothpaste
  2. Children from 8 years old can use a daily 0.05% sodium fluoride mouthwash. Use the mouthwash at a different time to brushing (when you come in from school or before / after a sugar intake)
  3. Concentrated fluoride toothpaste can be prescribed by doctors and dentists to give additional protection for older children’s teeth:
    1. Children from 10 years old: 2800 ppm fluoride toothpaste
    2. Children from 16 years old: 5000 ppm fluoride toothpaste

​Delivering better oral health: an evidence-based toolkit for prevention, Third Edition. March 2017, Public Health England  

Healthy eating advice to keep your child’s teeth decay free

For babies and toddlers

  • Stop feeding children from a bottle by one year old
  • Between mealtimes only give children plain milk or water to drink
  • Wean onto sugar-free foods and drinks

For all children and young people

  • Try to have less sugar and only have sugary food and drink at mealtimes
  • When your child is ill try to give them only sugar-free medicines
  • Avoid fizzy and acidic drinks and acidic foods

Snacks containing sugar to avoid between mealtimes:

  • Flavoured fromage frais
  • Prescribed supplement drinks (juice/milkshakes)
  • Milkshakes and yoghurt drinks
  • Adding jam, marmalade, honey or syrup to foods and drinks
  • Ice cream or cream
  • Fruit, fruit puree, smoothies and dried fruit
  • Prescribed powdered supplements (“Maxijul” or “Duocal”)

When your child has medicines or feeds which contain sugar you can help protect their teeth by:

  • Brushing with fluoride toothpaste (spit out the paste and do not rinse)
  • Rinsing with 10mls of a daily fluoride mouthwash (0.05% sodium fluoride) for 1 minute
  • Giving cheese after a sugar intake

Dental problems that children may suffer relating to their liver disease are: tooth staining, enamel hypoplasia (poorly formed enamel), drug induced gum overgrowth, and a delay in teeth coming through

Teeth forming whilst a child is unwell with liver disease can have:

  • Permanent grey-green staining
  • Enamel Hypoplasia (teeth can have yellow-white patches, easily wear or sometimes be small and misshapen)

Tooth staining

Teeth with grey-green staining

The grey-green stain is permanent and is caused by biliverdin (a green pigment made when haemoglobin is broken down) being added into the forming tooth. Adult teeth begin to develop at birth. From this time until around 3 years of age all the front teeth and the four back adult teeth are forming. Only the part of the tooth forming at the time a child has liver disease and jaundice will be permanently stained. Once the liver condition has been treated successfully, teeth continue to develop normally without staining. These stains cannot be removed with tooth brushing.

What can be done to improve the appearance of these teeth?

A children’s dentist (paediatric dentist) can carry out the following treatment for stained teeth:

Baby teeth

Very little treatment can be carried out for primary teeth

Adult teeth

Removing staining can be difficult. A paediatric dentist can carry out a variety of treatments to make the staining less noticeable. This may include tooth whitening (bleaching), placing a white filling to cover the staining (composite masking) or a combination of techniques.

Tooth whitening (bleaching)

This treatment uses a mild bleaching gel inside a specially made mouth guard at night time. This can be a long process and in some cases takes 6 months or longer. Although the staining improves it, it is often not possible to completely remove it.

Composite masking

In addition to tooth whitening, a white filling material (composite) can be used to cover the remaining staining. In children and young adults porcelain veneers and crowns should be avoided as both these treatments involve removing healthy tooth tissue (enamel) to make space for the veneer or crown which significantly weakens teeth.

Sometimes in adulthood porcelain veneers or crowns are fitted to help improve the appearance of these teeth, but this is always the last treatment of choice.

When can my child have treatment carried out?

Is it better to wait until most adult teeth have come through (12 years onwards) to reduce the need for repeating the treatment and to get the best results. However, if children are being bullied or are upset by the appearance of their teeth, treatment can be started earlier provided they can cope with it.

Enamel hypoplasia (teeth with yellow, patchy and easily worn tooth surfaces)

The tooth surface (enamel) can be yellow-white, patch, easily worn and sensitive. These defects are permanent and are likes to be caused by illness temporally upsetting the cells that form enamel (ameloblasts). Adult teeth begin to develop at birth. From this time until around 3 years of age all the front teeth and the four back adult teeth are forming. Only the part of the tooth forming at the time children are ill will be affected. Once children are in good health teeth continue to develop normally.

What can be done to improve the appearance of these teeth?

Front baby (primary) teeth

Very little treatment can be carried out for primary teeth.

Back baby (primary) teeth

Baby back teeth (primary molars) which begin to come through around the age of 18 months should be protected to stop the surface from wearing away. The type of treatment will depend upon how worn the teeth are and children’s ability to copy with treatment. These can vary from:

  • Plastic coating (fissure sealant) / Glass Ionomer Cement (temporary sealant)
  • White filling material (composite) and fissure sealant
  • Stainless steel crown
  • Extraction (if unrestorable / infected)

Adult front teeth

To improve the appearance of your child’s teeth they may require either tooth whitening, a white filling to cover the affected area (composite masking) or a combination of both techniques.

Adult back teeth (first permanent molars)

These teeth begin to come through around the age of six and should be protected to stop sensitivity, prevent tooth decay and wear. The type of treatment will depend on how worn the teeth are and can vary from:

  • Plastic coating (fissure sealant)
  • White filling material (composite) and fissure sealant
  • Stainless steel crown
  • Gold / cast metal onlay

If teeth are severely worn or decayed they may need to be removed when children are around 9-10 years old which allows space to be closed by other teeth still growing.

Overgrown gums (gingival overgrowth) due to medicines

Some medicines can cause gums to overgrow (gingival overgrowth) in susceptible transplant patients.

What can be done to avoid this happening?

This condition is rarer now as newer medicines such as Tacrolimus and Sirolimus are less likely to cause gingival overgrowth. Good, regular tooth brushing (twice a day) and visiting the dentist for a professional clean can help reduce the risk of this happening. In severe cases the medicines may need to be changed by your child’s doctor, or gum surgery (gingivectomy) carried out by a paediatric dentist or periodontist (gum specialist).

Delay in teeth coming through (erupting) 

Children’s teeth may take longer to come through (up to 22 months). This could be due to illness but no one really knows the true cause.

What can be done to encourage my child’s baby teeth to come through?

For baby teeth it is recommended that children and seen and monitored by a paediatric dentist. Teething rings or gentle massage of gums with a toothbrush may help encourage the teeth to come through.

What can be done to encourage my child’s adult teeth to come through?

If adult teeth fail to come through your child may need dental surgery (surgical exposure) to uncover their teeth. This will require careful planning with the dental team (paediatric dentist, orthodontist and oral surgeon) and your child’s medical team.

The information on this site is for guidance only. It is not a substitute for professional medical care by a qualified doctor or other health care professional. ALWAYS check with your medical team if you have any concerns about your condition or treatment. CLDF is not responsible or liable, directly or indirectly, for any form of damages resulting from the use (or misuse) of information contained in or implied by the information on this site.