Hidden Clues in the Mouth: What Oral Symptoms Reveal About Chronic Hepatitis C

A Silent Infection With Visible Signs

Hepatitis C is best known as a liver infection — but scientists have long known it can affect far more than the liver. In fact, millions of people worldwide may carry the virus without showing any typical liver-related symptoms. Because of this, subtle clues elsewhere in the body can play a surprisingly important role in early detection.

A new study published in BMC Oral Health turns the spotlight toward the mouth, asking a key question: Can oral symptoms help clinicians identify chronic hepatitis C earlier?

The answer, the researchers suggest, is yes.

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Why Look at the Mouth?

Hepatitis C is a systemic disease — meaning it affects multiple organs, not just the liver. Its extrahepatic (outside-the-liver) manifestations are common, but often overlooked.

One area strongly suspected of revealing early signs is the oral cavity. Previous research has linked Hepatitis C to conditions such as oral lichen planus, xerostomia (dry mouth), and recurrent fungal infections. However, comprehensive, real-world data comparing patients with healthy controls has been limited.

This study fills that gap.

What the Researchers Did

A team in Poland examined 153 patients with chronic hepatitis C and compared them with 50 healthy individuals.

They conducted:

• Medical and laboratory assessments

• Detailed oral symptom interviews

• Clinical examinations of the mouth, gums, tongue, and teeth

• Microscopic testing for fungal infections

• Evaluation of oral hygiene and periodontal (gum) health

Importantly, all patients were examined before antiviral treatment, ensuring results reflected untreated chronic infection.

What They Found: Clear Differences in Oral Health

1. Subjective Symptoms Were Twice as Common

Patients with Hepatitis C reported oral discomfort far more frequently than healthy controls.

Most common complaints:

• Dry mouth (47% vs. 6%)

• Oral pain and burning

• Gum bleeding

Using the Challacombe scale, one-third of HCV patients experienced moderate to severe dryness, while none of the controls did.

2. Visible Oral Lesions Were Strikingly Higher

Pathological changes were found in:

• 73.2% of Hepatitis C patients, compared to

• 32% of the control group

The most frequent findings were:

• Oral candidiasis (fungal infection)

• Angular cheilitis (inflamed cracks at the mouth corners)

• Oral lichen planus, a condition long linked to HCV

Some lesions — like sublingual varices — appeared only in the HCV group, though not always in patients with advanced liver disease, suggesting a broader cause than cirrhosis alone.

3. Gum Disease and Poor Oral Hygiene Were More Common

Even though the number of teeth with fillings was lower, patients with Hepatitis C had:

• More teeth lost to caries

• Worse oral hygiene scores

• Higher need for periodontal (gum) treatment

Systemic inflammation, altered immunity, and dry mouth may all contribute.

4. Who Is Most at Risk?

Through statistical modeling, the researchers identified predictors of oral abnormalities:

Higher risk:

• Age ≥ 40 years

• HCV genotype 1b (the most common genotype in the study)

Lower risk:

• Absence of mouth dryness — underscoring how important saliva-related symptoms are as clinical clues.

Why These Findings Matter

The study highlights a crucial, practical message:

Dentists may be among the first clinicians to spot undiagnosed Hepatitis C.

Common oral findings such as persistent dry mouth, recurrent fungal infections, or lichen planus — particularly in middle-aged adults — should prompt consideration of underlying systemic disease, including Hepatitis C.

In the era of highly effective antiviral therapies (DAAs), early detection means patients can be treated before liver damage or complications develop.

Conclusion

This study provides strong evidence that oral health reflects systemic effects of chronic Hepatitis C. Patients show significantly higher rates of both symptoms and clinically detectable lesions, especially fungal infections, angular cheilitis, and oral lichen planus.

For healthcare providers — especially dentists — these findings reinforce the mouth’s role as an important diagnostic window.

For patients, they emphasize the value of regular oral check-ups and the importance of discussing persistent symptoms with healthcare professionals.

Original Article

Brzdęk M, Gałuszka-Garnuszek J, Dobrowolska K, et al.

Oral manifestations in patients with chronic hepatitis C.

BMC Oral Health. 2025;25:944.

DOI: 10.1186/s12903-025-06307-5