Oral–Gut–Liver axis: A Novel Link in the Pathogenesis of Metabolic Dysfunction–Associated Steatotic Liver Disease

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common chronic liver disease worldwide. It has become one of the leading reasons for liver transplants, and it is strongly linked to metabolic syndrome, obesity, insulin resistance, and type 2 diabetes. Despite growing awareness of its clinical impact, the mechanisms that drive MASLD progression to steatohepatitis and cirrhosis are not fully understood, and there is currently no approved medication to stop disease progression. Recent studies indicate that oral health issues, especially periodontal disease, may influence the progression and severity of MASLD. Periodontal disease, especially periodontitis, is a chronic inflammatory condition affecting the supporting structures of the teeth and is increasingly recognized as a potential contributor to systemic diseases. Recent research shows a notable link between MASLD and periodontal disease, driven by shared metabolic risk factors, chronic systemic inflammation, and microbial imbalance. The oral–gut–liver axis has emerged as a potential biological mechanism linking periodontal pathogens to liver inflammation and metabolic disorders. This narrative review summarizes current epidemiological evidence, explores the biological mechanisms behind the link between MASLD and periodontal disease, and discusses potential clinical implications for integrated patient care. 

Cite this article as: Bascil S, Bağır GŞ. Oral–gut–liver axis: A novel link in the pathogenesis of metabolic dysfunction– associated steatotic liver disease. Endocrinol Res Pract. Published online August 1, 2026. doi: 10.5152/erp.2026.26982.