Elevated Systemic Inflammatory Burden and Cardiovascular Risk in Young Adults with Endodontic Apical Lesions

Garrido, Mauricio; Cárdenas, Angélica M.; Astorga, Jessica; Quinlan, Francisca; Valdés, Macarena; Chaparro, Alejandra; Carvajal, Paola; Pussinen, Pirkko J.; Huamán-Chipana, Patricia; Jalil, Jorge; Hernández, Marcela

doi:10.1016/j.joen.2018.11.014

Cited by 57 publications

(87 citation statements)

References 31 publications

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“…The possibility of comparisons between studies carried out with calibrated observers makes this system attractive [ 44 ] to better standardize the evaluations and allow comparison with the results of other researchers. Additionally, although the PAI score system was first described for periapical radiographs [ 26 ], it has been used in many epidemiological studies for panoramic radiographs [ 22 , 24 , 27 , 37 , 38 , 45 , 46 ]. The possibility of comparisons among the studies carried out with calibrated observers makes this system attractive [ 41 ], in order to better standardize the evaluations and allow the comparison with the result of other investigators.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, an experimental study conducted in rats has found an association between AP and atherosclerosis, the major contributor to ACVD [ 17 ]. Moreover, several observational studies have reported statistically significant excess risk for ACVD and cardiovascular events in patients with oral inflammation [ 18 , 19 ] including periodontal disease [ 15 ] and AP [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. AP has also been associated with poor endothelial flow reserve and early endothelial dysfunction in young adults [ 28 ].…”

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%

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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“…As one antimicrobial strategy, apical periodontitis is also associated with oxidative stress [12]. Some studies suggest a modest contribution of endodontic infections to the plasmatic inflammatory markers [13,14], while a recent study found a significant association between endodontic lesions and systemic inflammatory burden in young adults [15].…”

Section: Introductionmentioning

confidence: 99%

Saliva and Serum Immune Responses in Apical Periodontitis

Pietiäinen

Liljestrand

Akhi

et al. 2019

JCM

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Apical periodontitis is an inflammatory reaction at the apex of an infected tooth. Its microbiota resembles that of marginal periodontitis and may induce local and systemic antibodies binding to bacteria- and host-derived epitopes. Our aim was to investigate the features of the adaptive immune response in apical periodontitis. The present Parogene cohort (n = 453) comprises patients with cardiac symptoms. Clinical and radiographic oral examination was performed to diagnose apical and marginal periodontitis. A three-category endodontic lesion score was designed. Antibodies binding to the bacteria- and host-derived epitopes were determined from saliva and serum, and bacterial compositions were examined from saliva and subgingival samples. The significant ORs (95% CI) for the highest endodontic scores were observed for saliva IgA and IgG to bacterial antigens (2.90 (1.01–8.33) and 4.91 (2.48–9.71)/log10 unit), saliva cross-reacting IgG (2.10 (1.48–2.97)), serum IgG to bacterial antigens (4.66 (1.22–10.1)), and Gram-negative subgingival species (1.98 (1.16–3.37)). In a subgroup without marginal periodontitis, only saliva IgG against bacterial antigens associated with untreated apical periodontitis (4.77 (1.05–21.7)). Apical periodontitis associates with versatile adaptive immune responses against both bacterial- and host-derived epitopes independently of marginal periodontitis. Saliva immunoglobulins could be useful biomarkers of oral infections including apical periodontitis—a putative risk factor for systemic diseases.

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“…In multivariate analysis, periapical lesions were significantly associated with hsCRP levels ≥1 mg/L (OR = 5.1-12.8) independently of the adjustment model. Pariapical lesions also associated with CRP levels >3 mg/L (OR = 4.0), supporting a mechanistic link for cardiovascular diseases in young adults ( 32 ). On the other hand, TNF-α and IL-1 increase the binding of low density lipoproteins (LDL) to endothelium and smooth muscle, up-regulating the LDL receptor gene, inducing endothelial dysfunction and smooth muscle cell proliferation ( 33 ).…”

Section: Resultsmentioning

confidence: 81%

Cardiovascular diseases and apical periodontitis: association not always implies causality

et al. 2020

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Background Several studies published in the last two decades have found an association between the prevalence of apical periodontitis (AP) or root canal treatment (RCT) and cardiovascular diseases (CVDs). However, the demonstration of association does not prove by itself the existence of a cause–effect relationship. Two diseases can appear as statistically related without any of them directly affecting the values of the other, resulting in a non-causal relationship. The aim of this narrative review is to summarize the current state of knowledge regarding the association between AP and CVDs, analysing it according to the Hill's causality criteria. Material and Methods Epidemiological studies carried out on the association between CVDs and AP or RCT published in English until 8 December 2019 were identified. Forty-four articles were selected and its results were analysed. Results Numerous cross-sectional epidemiological studies have found significant relationship between CVDs and AP. The odds ratio values range 1.6 - 5.4. However, other studies have not found significant association. Respect to RCT, some studies found correlation, but others found no association or even found that RCT is a protective factor against CVDs. Conclusions The results are inconsistent and a causal relationship between CVDS and endodontic disease cannot be stablished. The risk factors common to both diseases can act as confounding factors, biasing the results. To reach definitive conclusions about the type of association (causal or non-causal) between both diseases, longitudinal epidemiological studies must be carried out to establish the temporal relationship and the dose-response gradient. Key words: Apical periodontitis, atherosclerosis, cardiovascular disease, coronary heart disease, endodontic medicine, root canal treatment.

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Elevated Systemic Inflammatory Burden and Cardiovascular Risk in Young Adults with Endodontic Apical Lesions

Cited by 57 publications

References 31 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

Saliva and Serum Immune Responses in Apical Periodontitis

Cardiovascular diseases and apical periodontitis: association not always implies causality

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