Association Between Oral Health and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Among United States Adults

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease, yet extra-metabolic contributors such as oral health remain underexplored. While periodontitis has been linked to NAFLD, untreated caries and unmet dental care needs have been less examined under new MASLD criteria. We evaluated associations between examiner-assessed oral health indicators and MASLD in a nationally representative sample of U.S. adults. Methods: We analyzed 2,528 adults aged ≥18 years from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) with valid liver transient elastography. MASLD was defined as steatosis (controlled attenuation parameter ≥285 dB/m) plus ≥1 metabolic risk factor. Examined oral health indicators included examiner-assessed need for dental care, decayed teeth, gum disease, and a composite of decayed teeth or gum disease. Survey-weighted logistic regression estimated odds ratios (ORs) adjusted for sociodemographic and behavioral factors. Results: MASLD prevalence was 38.9%. In fully adjusted models, needing dental care (OR=1.42, 95% CI:1.02–1.95) and having decayed teeth (OR=1.52, 95% CI:1.05–2.20) were associated with higher MASLD odds. After false discovery rate correction, only dental care need remained significant (q=0.043). Sex-stratified analyses revealed pronounced associations in women, who had 91% higher MASLD odds if dental care was needed (OR=1.91, 95% CI:1.18–3.10) and 156% higher odds with decayed teeth (OR=2.56, 95% CI:1.35–4.84). Significant associations were also observed in adults aged 45-59 and ≥60 years. Conclusions: Unmet dental needs and caries are associated with MASLD, with particularly strong associations observed in women. These findings highlight oral health as a potential marker for MASLD risk and underscore the value of integrated oral-systemic assessments in preventive care.