I have written this letter: "We read with great interest the study by Keklikkiran et al. showing that patients with NAFLD who brushed their teeth less than once daily had a notably higher prevalence of liver stiffness measurement values equal to or above 12 kPa, a key indicator of hepatic cirrhosis. Furthermore, the authors discovered an independent association between less frequent toothbrushing and a transient elastography (TE)-established diagnosis of cirrhosis in NAFLD. Given the increasing burden of NAFLD, cirrhosis has become a serious public health problem. Keklikkiran et al. be commended for their findings as, in our opinion, they could reveal toothbrushing as a simple yet effective for reversing NAFLD-related cirrhosis. Indeed, recent studies have challenged the traditional notion that cirrhosis is unalterable and permanent. In this context, Pose et al.7 have demonstrated that 1.4% of liver transplant candidates diagnosed with NAFLD or cryptogenic cirrhosis can be removed from the waiting list due to notable clinical improvements. Considering these findings, and based on the research by Keklikkiran et al., we also suggest a thorough examination of toothbrushing frequency from NAFLD patients who experience cirrhosis recompensation and are subsequently delisted. Comparing these results with patients who remain listed may help determine if toothbrushing – as a daily means to maintain oral health by cleaning out the food debris, reduce microorganisms and inflammation - may promote recompensation while awaiting a transplant. In a separate investigation, Chen and colleagues [4] found a positive correlation between tooth loss and the risk of liver cirrhosis. Interestingly, in another recent paper, the authors found that the progression of NASH could be potentially tempered through regular oral health care liver stiffness measurement. In addition, LSM through TE had a significant correlation with an increase in specific periodontal parameters such as pocket-probing-depths and bleeding-on-probing. Consequently, hepatologists should emphasize to their patients the significance of periodic dental check-ups. In summary, the findings by Keklikkiran et al. provide a new outlook onto the role of oral health into the natural progression of end-stage liver disease and shed light on novel research avenues on toothbrushing for promoting reversal of NAFLD-related cirrhosis. To fully comprehend the complex interplay between oral health and cirrhosis, more studies are needed, especially those utilizing the new nomenclature framework (Metabolic dysfunction associated steatotic liver disease or MASLD) set to replace the current NAFLD definition". Do you have any comments or additions?