Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population

Meurman, Jukka H.; Janket, Sok‐Ja; Surakka, Markku; Jackson, Elizabeth A.; Ackerson, Leland K.; Fakhri, Hiba; Chogle, Sami; Walls, Angus

doi:10.1111/iej.12772

Cited by 22 publications

(18 citation statements)

References 54 publications

(106 reference statements)

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“…The prevalence of RFT was not associated with cardiovascular events. This result is in accordance with previous findings [ 58 ], although other studies have found an association between endodontic status and the risk of cardiovascular event, both in the sense of increasing it [ 21 , 60 ] or decreasing it [ 30 ].…”

Section: Discussionsupporting

confidence: 93%

“…Conversely, treatment of AP through root canal treatment (RCT) has been shown to improve systemic inflammation, ameliorating early endothelial dysfunction [ 29 ]. 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: Discussionsupporting

confidence: 93%

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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“…2009), and others suggest even protective features of root canal fillings, noting that they might be subject to bias (Meurman et al . 2017, Cowan et al . 2020).…”

Section: Introductionmentioning

confidence: 99%

Association between dental factors and mortality

et al. 2020

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Aim To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular-and all-cause mortality in a follow-up of approximately 8 years. Methodology The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses. Results A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00-I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (allcause 0.91; 0.86-0.96, CVD mortality 0.89; 0.83-0.96), use of removable dentures (all-cause 0.24; 0.09-0.62, CVD mortality 0.20; 0.06-0.72), root canal fillings (all-cause 0.82; 0.70-0.94, CVD mortality 0.79; 0.63-0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06-0.79, CVD mortality 0.09; 0.01-0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for. Conclusions The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.

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“…= 1.04–3.02; p < 0.05) ( 20 ). However, it has been also shown that having ≥1 RFT is associated with significantly lower odds for prevalent coronary artery disease and lower risk of cardiovascular mortality ( 21 ).…”

Section: Resultsmentioning

confidence: 99%

“…Respect to RCT, the results are obviously inconsistent. Some studies find correlation between the prevalence of RCT and CVDs ( 18 , 19 ), but other find no association ( 43 ), or even other find that RCT is a protective factor against CVDs ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

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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Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population

Abstract: Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.

Cited by 22 publications

References 54 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

Association between dental factors and mortality

Cardiovascular diseases and apical periodontitis: association not always implies causality

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