Cardiovascular diseases and apical periodontitis: association not always implies causality

Jiménez-Sánchez, María C; Cabanillas-Balsera, Daniel; Areal-Quecuty, Victoria; Velasco‐Ortega, Eugenio; Martín-González, Jénifer; Segura-Egea, Juan José

doi:10.4317/medoral.23665

Cited by 24 publications

(31 citation statements)

References 44 publications

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“…In addition, they agree with the studies that have found a higher prevalence of AP in patients with ACVD [ 25 , 50 , 51 , 52 , 53 , 54 ]. Although few longitudinal studies have been conducted investigating the relationship between AP and cardiovascular events [ 10 ], it has been found that in patients <40 years old, incident of radiolucent periapical lesions was significantly related to the development of coronary heart disease [ 20 ]. Another study showed that acute coronary syndrome is more frequent in subjects with untreated teeth with AP (OR = 2.72; p = 0.022) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The weighted average of teeth with AP in adult patients is 5.4%, with 36% of RFT associated with radiolucent periapical lesions [ 6 ], the radiographic sign of AP [ 7 ]. The possible relationship of AP with systemic pathologies has been raised [ 8 ], having found an association with diabetes [ 9 ] and cardiovascular disease [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, it has been reported that having RFT is associated with a lower probability of suffering coronary heart disease and a lower risk of mortality from cardiovascular events [ 30 ]. Despite all these findings, the causal association between oral infections and ACVD cannot be considered proven [ 10 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

González-Navarro

Segura-Egea

Estrugo‐Devesa

et al. 2020

JCM

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Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

González-Navarro

Segura-Egea

Estrugo‐Devesa

et al. 2020

JCM

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“…In the last years, an association between AP and some systemic diseases, such as diabetes mellitus ( 5 ) and cardiovascular disease ( 6 ), has been found. This association would be based on the presence of a pro-inflammatory status, as well as risk factors common to both AP and the systemic disease ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis

Borrego¹,

Segura-Egea²,

Martín-González³

et al. 2021

Med Oral

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Background Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). Material and Methods A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student’s t test, 2 test and multivariate logistic regression were used in the statistical analysis. Results Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome “periapical status” (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 – 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 – 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 – 472.15; p = 0.002), regardless of IBD type. Conclusions The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment. Key words: Apical periodontitis, Crohn’s disease, inflammatory bowel disease, toot canal treatment, ulcerative colitis.

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“…Smoking patients should also know that their prognosis for RCT has lower expectations of success. If, in addition to smoking, patients have other risk factors such as cardiovascular disease [ 44 , 45 ] or diabetes [ 18 , 46 , 47 ], smokers should know that their RFTs have very high likelihood to end up being lost.…”

Section: Discussionmentioning

confidence: 99%

Cigarette Smoking and Root Filled Teeth Extraction: Systematic Review and Meta-Analysis

Cabanillas-Balsera

Segura-Egea

Jiménez-Sánchez

et al. 2020

JCM

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Aim: The aim of this systematic review and meta-analysis was to investigate the possible association between smoking habits and the occurrence of root-filled teeth (RFT) extraction. Material and Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was in adult patients who had RFT, does the absence or presence of smoking habits affect the prevalence of extracted RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and PRISMA protocol was used to evaluate and present the results. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: After search strategy, 571 articles were recovered, seven were selected for full-text analysis, and two reported data on inclusion criteria, including 516 RFT, 351 in non-smokers, and 165 in smoker subjects. The meta-analysis provided an odds ratio indicating significant association between smoking and the prevalence of extracted RFT (OR = 3.43, 95% CI = 1.17–10.05, p = 0.02, I² = 64%). The certainty of the literature assessment was low per GRADE. Both studies were considered as moderate risk of bias. Conclusions: Tobacco smoking should be considered a negative prognostic factor for the outcome of root canal treatment, although the quality of the evidence is low. RFT of smoking patients are three times more likely to be extracted. Continuing to smoke after endodontic treatment may increase the risk of treatment failure. However, the overall strength of evidence is low. This must be considered a limitation of the present study and the conclusion should be valued with caution.

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Cardiovascular diseases and apical periodontitis: association not always implies causality

Cited by 24 publications

References 44 publications

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis

Cigarette Smoking and Root Filled Teeth Extraction: Systematic Review and Meta-Analysis

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