BackgroundPeriodontal disease associates with systemic diseases but corresponding links regarding apical periodontitis (AP) are not so clear. Hence our aim was to study association between AP and the prevalence of systemic diseases in a study population from Sweden.MethodsThe subjects were 150 patients from a randomly selected epidemiological sample of 1676 individuals. 120 accepted to participate and their basic and clinical examination data were available for these secondary analyses where dental radiographs were used to record signs for endodontic treatments and AP. Periapical Index and modified Total Dental Index scores were calculated from the x-rays to classify the severity of AP and dental infection burden, respectively. Demographic and hospital record data were collected from the Swedish National Statistics Center. T-test, chi-square and univariate analysis of covariance (ANCOVA) and regressions analyses were used for statistics.ResultsOf the 120 patients 41% had AP and 61% had received endodontic treatments of which 52% were radiographically unsatisfactory. AP patients were older and half of them were smokers. AP and periodontitis often appeared in the same patient (32.5%). From all hospital diagnoses, cardiovascular diseases (CVD) were most common, showing 20.4% prevalence in AP patients. Regression analyses, controlled for age, gender, income, smoking and periodontitis, showed AP to associate with CVD with odds ratio 3.83 (95% confidence interval 1.18–12.40; p = 0.025).ConclusionsThe results confirmed our hypothesis by showing that AP statistically associated with cardiovascular diseases. The finding that subjects with AP also often had periodontitis indicates an increased oral inflammatory burden.

Background: Infections of teeth are highly prevalent, often leading to tooth extractions. Missing teeth can thus be considered as proxy for chronic dental infections, caries or periodontitis. We followed-up a cohort for 24 years investigating the association between missing teeth and the incidence of cancer with the hypothesis that dental chronic inflammation links to cancer.Methods: WHO ICD-7-9-10 malignant diagnoses were recorded from the Swedish Cancer Registry from 1985 to 2009 in 1 390 individuals who had underwent clinical oral examination in 1985. The subjects appeared periodontally healthy and thus the probable reason for tooth extractions was deep caries. Using Fisher's exact t-test and multiple logistic regression analysis the results were analysed for the association between cancer incidence and baseline oral health parameters and a number of other explanatory factors.Results: Of the 1 390 subjects 71 had got cancer by year 2009. The results of the multiple regression analysis showed that between any type of cancer as a dependent variable, and several independent explanatory variables, missing second molar in the right mandible and age appeared as the principle independent predictors significantly associating with cancer, with an odds ratio (95% confidence interval) of 2.62 (1.18-5.78) and 1.91 (1.06-3.43), respectively.Conclusions: In periodontally healthy subjects extracted molars, proxy for past dental infections, seemed to predict cancer risk in the studied age group - hence supporting a role of chronic dental infection/inflammation in carcinogenesis.

We investigated serum and saliva concentrations of matrix metalloproteinases, MMP‐8, MMP‐9, and MMP‐13, and their tissue inhibitor TIMP‐1, in a group of patients with and without periodontitis from Sweden. The hypothesis was that these biomarkers are higher in the periodontitis patients. Ninety patients participated in this cross‐sectional study. Fifty‐one patients had periodontitis whereas 39 were periodontally healthy. Saliva and serum samples were analyzed with immunofluorometric, enzyme‐linked immunosorbent assay and western blot. Results were statistically analyzed with independent t test, Mann–Whitney U test, Bonferroni corrections, and regression analyses. MMP‐13 was not detected in serum, but in saliva, higher values were found among the periodontally healthy compared with periodontitis subjects (0.32 ± 0.26 vs. 0.21 ± 0.23 ng/ml, p < .05). Female gender and clinical attachment loss were the explanatory factors for higher salivary MMP‐13 values with odds ratio 3.08 (95% confidence interval [1.17, 8.11]) and 3.57 (95% confidence interval [1.08, 11.82]), respectively. No statistically significant differences between groups were found in serum and saliva values of MMP‐8, MMP‐9, and TIMP‐1. Contrary to our hypothesis, no statistically significant differences between patients with and without periodontitis were seen in MMP‐8, MMP‐9, and TIMP‐1 values. However, higher MMP‐13 concentrations in saliva were associated with female gender and higher clinical attachment loss. Metabolism of MMP‐13 may thus have some gender implications in periodontitis.