Association between cardiovascular diseases and apical periodontitis: an umbrella review

Abstract

Background The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive. Objective To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults. Methods The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics’ Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta‐analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of ‘high’, ‘moderate’, ‘low’ or ‘critically low’ quality. Results Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as ‘moderate’ quality, whereas one review was graded as ‘critically low’ quality. Discussion Only one systematic review included a meta‐analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis. Conclusions From the limited ‘moderate’ to ‘critically low’ quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well‐designed, longitudinal clinical studies with long‐term follow‐up are required.

The association between apical periodontitis and adverse pregnancy outcomes: a systematic review

“…As the highest level of secondary evidence, only two umbrella reviews dealt with the potential bi‐directional association between apical periodontitis and systemic diseases. Nagendrababu et al (2020) revealed that diabetes mellitus is associated with a reduced outcome for root canal treatment, while Jakovljevic et al (2020b) demonstrated the existence of a weak association between apical periodontitis and cardiovascular diseases. The principle problems facing systematic reviews in this field are related to methodological shortcomings of the available primary studies, including inappropriate study designs, unjustified sample sizes, unmatched study groups, inadequate markers and/or surrogate models, unadjusted confounding factors, incomparable results, among others.…”

“…In an umbrella review, Nagendrababu et al (2020) reported that diabetes mellitus was associated with a reduced outcome for root canal treatment and should be considered as a negative preoperative prognostic factor. In a separate umbrella review, Jakovljevic et al (2020b) reported the existence of a weak association between apical periodontitis and cardiovascular diseases, with the weak association probably due to the small number of primary studies and the significant methodological inconsistencies between them.…”

Prevalence and risk factors of Apical periodontitis in endodontically treated teeth: cross-sectional study in an Adult Moroccan subpopulation

“…Endodontic infections were also recorded to be statistically associated with cardiovascular diseases [17]. Therefore, there is a persistent need for resolving this oral health condition since there is an increasing evidence of the association between AP and impaired systemic health [51,52].…”

Cardiac, biochemical and histopathological analysis reveals impaired heart function in hypertensive rats with apical periodontitis

“…CVDs originate from inflammatory endothelial dysfunction (Bergandi et al, 2019) under the significant impact of risk factors such as age, smoking, hypertension, dyslipidaemia, diabetes and sedentary lifestyle (Venturelli et al, 2015). However, in the last decade, studies have analysed the link between CVD and apical periodontitis (AP), and revealed that the quality of the available evidence was limited, and a causal relationship could not be determined (Berlin‐Broner et al, 2017; Jakovljevic et al, 2020a; Jiménez‐Sánchez et al, 2020). AP is a periapical inflammatory process induced by microbial infection of the root canal system (Messing et al, 2019).…”

“…In chronic AP, microbiological agents and their products may stimulate local inflammation in arterial walls, activate immunoinflammatory responses and cause cellular alterations leading to the formation of atherosclerotic plaques. Such increased inflammation, in most instances, may cause rupture and thrombus creation leading to ischaemia and infarction of the affected tissues (Jakovljevic et al, 2020a).…”