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Ideo F, Mercuro G, Sanna S, Bardini G, Niazi S, Mannocci F, Cotti E. Evidence of an effect of statins on lesions originating from dental infection. A retrospective clinical investigation. Int J Cardiol 2024; 415:132458. [PMID: 39154756 DOI: 10.1016/j.ijcard.2024.132458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Apical periodontitis (AP) is an inflammatory dental disease caused by bacterial infections of the endodontic system. The correlation between AP and cardiovascular diseases. (CVD) has been consistently investigated. Statins are a class of drugs that are used to treat hypercholesterolemia and prevent atherosclerotic vascular diseases. They have other beneficial pleiotropic effects such as anti-inflammatory, antithrombotic, and antioxidant activities. The aim of this study was to evaluate the oral health status and prevalence of AP in patients treated with statins (Group S) in comparison with untreated patients (Group C) to understand whether the anti-inflammatory action of these drugs can influence the prevalence of AP. METHODS The records of seventy-nine patients (43 men and 36 women, mean age 68 ± 11 years, 1716 teeth) treated with statins and referred to the University clinic for dental evaluation were reviewed. Seventy patients free from systemic diseases and without therapy (39 men and 31 women, mean age 62 ± 9 years, 1720 teeth) constituted the control group. All subjects underwent complete oral, dental, and radiographic examinations to determine the presence and severity of AP. Periapical index (PAI) and decayed, missed, and filled teeth (DMFT) scores were obtained. RESULTS AP was significantly less common in Group S (22,8%) than in Group C (50%) (P < 0.05). Furthermore, the mean value of the qualitative rank of the severity of AP (PAI score) was higher in Group C than in Group S (P ≤ 0.05). CONCLUSIONS Our results suggest that statins can attenuate the prevalence of AP, which is associated to CVD.
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Affiliation(s)
- Francesca Ideo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Silvia Sanna
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giulia Bardini
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Sadia Niazi
- Department of Endodontology, Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's college of London, London, United Kingdom
| | - Francesco Mannocci
- Department of Endodontology, Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's college of London, London, United Kingdom
| | - Elisabetta Cotti
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Al-Abdulla N, Bakhsh A, Mannocci F, Proctor G, Moyes D, Niazi SA. Successful endodontic treatment reduces serum levels of cardiovascular disease risk biomarkers-high-sensitivity C-reactive protein, asymmetric dimethylarginine, and matrix metalloprotease-2. Int Endod J 2023; 56:1499-1516. [PMID: 37787168 DOI: 10.1111/iej.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
AIM To investigate serum biomarkers of inflammation 2 years following non-surgical root canal re-treatment (Re-RCT) and peri-apical surgery (PS). The results were correlated with signs and symptoms, treatment outcome, metabolic syndrome factors, infection with severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 (COVID-19) infection and COVID-19 vaccination. METHODOLOGY Subjects from our previous study were recalled for 2 years post-treatment follow-up. Changes to the patient's history (medical, dental, social) were noted. Periapical health of the treated teeth was examined both clinically and radiographically. Blood pressure, fasting HbA1C and low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and total cholesterol (TC) levels were measured. Serum inflammatory marker levels were assayed using a Bio-Rad Bio-Plex 200 analyser and values at different time points within the same group were compared using a Wilcoxon signed-rank test and differences between groups with a Mann-Whitney test. Linear associations were tested using Pearson's correlations. RESULTS The recall percentage at 2 years was 56.9% (n = 37), with a 100% radiographic success rate using periapical radiographs. In total, 21 cases (56.8%) were completely healed, and 16 cases (43.2%) were healing. Higher matrix metalloprotease 2 (MMP2) levels were present in the healing group compared to the healed group. Serum levels of high-sensitivity C-reactive protein (hs-CRP), asymmetric dimethylarginine (ADMA) and MMP-2 were significantly reduced (p ≤ .001) whereas other biomarkers showed significant increases at 2 year compared to pre-operative levels, while FGF-23 and ICAM-1 were not significantly increased. HbA1C (p = .015), TC (p = .003), LDL (p = .003) and HDL (p = .003) reduced significantly at 2 years post-treatment compared to their preoperative levels. COVID infection showed a significant association with MMP-9 (p = .048). CONCLUSIONS hs-CRP, ADMA and MMP-2 can be regarded as prognostic biomarkers of successful Re-RCT and PS as they reduced at 2 year recall in cases which showed evidence of clinical and radiographic success. The successful treatment of chronic apical periodontitis is correlated with improvements in metabolic syndrome indicators, better glycemic control, and reduction at 2 year of some systemic inflammatory markers which are related to risks of cardiovascular disease events.
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Affiliation(s)
- Noor Al-Abdulla
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
| | - Abdulaziz Bakhsh
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
- Department of Restorative Dentistry, Division of Endodontics, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Francesco Mannocci
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
| | - Gordon Proctor
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
| | - David Moyes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
| | - Sadia Ambreen Niazi
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Dental Hospital, King's College London, London, UK
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Sangalli L, Souza LC, Letra A, Shaddox L, Ioannidou E. Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects. J Dent Res 2023; 102:1395-1416. [PMID: 37967405 DOI: 10.1177/00220345231197143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.
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Affiliation(s)
- L Sangalli
- College of Dental Medicine-Illinois, Midwestern University, Downers Grove, IL, USA
| | - L C Souza
- Center for Craniofacial Research, Department of Endodontics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Letra
- Departments of Oral and Craniofacial Sciences, Endodontics, and Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - L Shaddox
- Center for Oral Health Research, Division of Periodontology, University of Kentucky, College of Dentistry, Lexington, KY, USA
| | - E Ioannidou
- UCSF, Department of Orofacial Sciences, San Francisco, CA, USA
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Jakovljevic A, Ideo F, Jacimovic J, Aminoshariae A, Nagendrababu V, Azarpazhooh A, Cotti E. The Link Between Apical Periodontitis and Gastrointestinal Diseases-A Systematic Review. J Endod 2023; 49:1421-1431. [PMID: 37558178 DOI: 10.1016/j.joen.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION This systematic review aimed to examine a potential link between apical periodontitis (AP) and gastrointestinal diseases (GIDs). METHODS The protocol of the review has been registered in PROSPERO (CRD42022330771). The following engines were used with the aim of searching for relevant literature: PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and grey literature, from inception to May 2022. There were no language restrictions included. Study selection, data collection, and synthesis have been performed by 2 independent reviewers. For the purpose of estimating the quality of studies, the Newcastle-Ottawa Scale was used. RESULTS Four matched case control studies, as well as a single longitudinal cohort study were included in the final review. These were published between 2012 and 2017, and comprised 537 participants whose age range was 18 to 87 years. It was not possible to perform a meta-analysis due to different study designs and evaluated outcomes of included studies. Except for one study that was categorized as "Good," overall, for 4 out of 5 studies the quality was assessed as "Fair". CONCLUSIONS This review highlighted sparse knowledge present in the literature concerned with the association between AP and GIDs. Available evidence reveals a potential link between impaired endodontic status, assessed by the number of root-filled teeth with periapical radiolucency, and GIDs. More research is needed to ascertain this association.
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Affiliation(s)
- Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Jelena Jacimovic
- Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Anita Aminoshariae
- Department of Endodontics, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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Sathyanarayanan K, Ranjana NI, Bhavana M, R M, Sankar A, Mirnalini S. Asymptomatic Apical Periodontitis Lesions and Their Association With Systemic Inflammatory Burden: A Preliminary Prospective Clinical Study. Cureus 2023; 15:e46357. [PMID: 37920638 PMCID: PMC10619333 DOI: 10.7759/cureus.46357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Background: Apical periodontitis (AP) is an inflammatory disorder of the periapical tissues caused by the persistence of a microbial infection within the root canal system of the affected tooth. Clinically, it is symptomatic or asymptomatic depending on several factors such as the type of microorganisms, bacterial load, immunological reaction, and local tissue mediators. Chronic or asymptomatic infections may initiate and modulate intravascular accumulation of inflammatory cells resulting in endothelial dysfunction which subsequently represents a possible systemic inflammatory burden. Aim: The present study aimed to evaluate the relationship between asymptomatic AP and systemic inflammatory burden by assessing the levels of chronic inflammatory cells. Methodology: A total of 25 patients diagnosed with asymptomatic AP who showed a negative response to the pulp sensitivity test with no history of any systemic diseases were included in this preliminary prospective observational study. Blood samples were collected at each phase of the study, and a complete hemogram was carried out. All hematological parameters were recorded before and after root canal therapy and they were analyzed for statistical significance at p <.05 using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results: Evaluation of the mean total leukocyte count (TLC), lymphocyte, and eosinophil cell count showed a significant reduction in the number of cells before and after root canal therapy treatment respectively (p<.05). One-way analysis of variance also revealed statistical significance at p < .05 with a weak positive correlation between the TLC, lymphocyte, and eosinophil count before and after treatment. Conclusion: The present study showed that systemically healthy individuals with asymptomatic AP had increased inflammatory burden in the circulation, and thus, it is essential to identify and quantify the risk associated. It was evident that complete healing of the asymptomatic AP lesions results in an overall reduction of systemic inflammatory cells ultimately reducing the burden and risk of associated systemic inflammatory diseases.
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Affiliation(s)
| | - N I Ranjana
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Mohan Bhavana
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Megavarnan R
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Aravinthan Sankar
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Selvakumar Mirnalini
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
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Chauhan N, Mittal S, Tewari S, Sen J, Laller K. Effect of endodontic treatment on endothelial dysfunction and subclinical atherosclerosis-a prospective intervention study. Clin Oral Investig 2023; 27:5617-5625. [PMID: 37522992 DOI: 10.1007/s00784-023-05183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the effect of endodontic treatment on flow-mediated dilatation (FMD) and carotid intima-media thickness (c-IMT) in patients with apical periodontitis (AP). MATERIAL AND METHOD The study includes 32 young men having AP with a mean age of 25.78 years free from cardiovascular disease (CVD) and its risk factors, including periodontitis. All subjects underwent complete physical and dental examination, echocardiography, and ultrasound assessment of FMD on the brachial artery and c-IMT on the carotid artery at baseline and 12 months after the endodontic treatment. Data were analyzed using paired Student's t-test and Pearson's correlation coefficient (r) test using SPSS 26 version. RESULTS Endodontic treatment leads to the improvement of FMD significantly from a pooled baseline value of 4.84 ± 1.55% to 7.68 ± 2.08% (p < 0.05). The study also depicts a statistically significant difference between c-IMT (mean = 0.62 ± 0.11 mm) before treatment as compared to 12 months after treatment (mean = 0.59 ± 0.11 mm) (p < 0.05). CONCLUSION Endodontic treatment leads to improved FMD and decreased c-IMT suggesting that treating AP can be help revert the early stages of CVD. CLINICAL RELEVANCE AP could be a potential etiological factor of future CVD and should be treated as soon as diagnosed.
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Affiliation(s)
- Nishant Chauhan
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India.
| | - Shweta Mittal
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India
| | - Jyotsna Sen
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Kuldip Laller
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Georgiou AC, Twisk JWR, Crielaard W, Ouwerling P, Schoneveld AH, van der Waal SV. The influence of apical periodontitis on circulatory inflammatory mediators in peripheral blood: A prospective case-control study. Int Endod J 2023; 56:130-145. [PMID: 36284462 PMCID: PMC10098678 DOI: 10.1111/iej.13854] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 01/17/2023]
Abstract
AIM To explore the influence of apical periodontitis (AP) on inflammatory markers in blood of otherwise healthy individuals and to depict the inflammatory profile of the healing after dental extraction. METHODOLOGY This is a prospective case-control intervention study, during which, individuals with a diagnosis of AP of one affected tooth were included, along with a control group matched for age and gender. A broad panel of blood inflammatory mediators was examined longitudinally in all subjects during six visits. In the case of the AP subjects, the tooth with AP was extracted at the third visit. Results were analysed by linear regression analyses and linear mixed-model analyses. RESULTS A total of 53 subjects were included in the study, 27 with AP and 26 without. Fifteen females and 12 males were included in the AP group, and 14 females and 12 males in the control group. At baseline, granulocyte colony-stimulating factor (p < .001), interleukin (IL)-1β (p = .03) and IL-4 (p = .01) were significantly lower in AP subjects than in controls. Comparison of the differences between baseline and the last visit, i.e. 3 months after the tooth extraction, showed a significant reduction in IL-10 (p = .03) and IL-12p70 (p = .01). CONCLUSIONS The immunologic profile of chronic AP in one tooth and its healing profile reveals a systemic low-grade inflammation through compensatory immunosuppression. A larger lesion or multiple lesions could disrupt the balance that the system is trying to maintain, resulting in loss of homeostasis.
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Affiliation(s)
- Athina Christina Georgiou
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Peter Ouwerling
- Tandheelkundig Centrum Molenvliet, Alphen aan den Rijn, The Netherlands
| | - Arjan H Schoneveld
- Division LAB, Department Central Diagnostic Laboratory, UMC Utrecht, Utrecht, The Netherlands
| | - Suzette Veronica van der Waal
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.,Department of Endodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
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Niazi SA, Bakhsh A. Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58070931. [PMID: 35888650 PMCID: PMC9319780 DOI: 10.3390/medicina58070931] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023] Open
Abstract
The ‘Focal Infection Era in Dentistry’ in the late 19th and early 20th century resulted in widespread implementation of tooth extraction and limited the progress of endodontics. The theory proposed that bacteria and toxins entrapped in dentinal tubules could disseminate systemically to remote body parts, resulting in many types of degenerative systemic diseases. This theory was eventually refuted due to anecdotal evidence. However, lately there has been increased interest in investigating whether endodontic disease could have an impact on general health. There are reviews that have previously been carried out on this subject, but as new data have emerged since then, this review aims to appraise the available literature investigating the dynamic associations between apical periodontitis, endodontic treatment, and systemic health. The available evidence regarding focal infection theory, bacteraemia and inflammatory markers was appraised. The review also collated the available research arguing the associations of apical periodontitis with cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome and autoimmune disorders, along with the effect of statins and immunomodulators on apical periodontitis prevalence and endodontic treatment prognosis. There is emerging evidence that bacteraemia and low-grade systemic inflammation associated with apical periodontitis may negatively impact systemic health, e.g., development of cardiovascular diseases, adverse pregnancy outcomes, and diabetic metabolic dyscontrol. However, there is limited information supporting the effect of diabetes mellitus or autoimmune disorders on the prevalence and prognosis post endodontic treatment. Furthermore, convincing evidence supports that successful root canal treatment has a beneficial impact on systemic health by reducing the inflammatory burden, thereby dismissing the misconceptions of focal infection theory. Although compelling evidence regarding the association between apical periodontitis and systemic health is present, further high-quality research is required to support and establish the benefits of endodontic treatment on systemic health.
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Affiliation(s)
- Sadia Ambreen Niazi
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy’s Dental Hospital, King’s College London, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)207188-7459
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah 24381, Saudi Arabia;
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Bakhsh A, Moyes D, Proctor G, Mannocci F, Niazi SA. The impact of apical periodontitis, non-surgical root canal retreatment and periapical surgery on serum inflammatory biomarkers. Int Endod J 2022; 55:923-937. [PMID: 35707939 PMCID: PMC9540413 DOI: 10.1111/iej.13786] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023]
Abstract
AIM The aim of the study was to measure serum levels of molecular markers of inflammation in patients undergoing non-surgical root canal retreatment (Re-RCT) and periapical surgery (PS) for the treatment of apical periodontitis and to establish if such levels are influenced by the size of apical radiolucencies at baseline and by the treatment outcome. METHODOLOGY A total of 115 participants were recruited (n = 50 Controls, n = 35 Re-RCT, n = 30 PS). Preoperative periapical radiographs and cone beam CT (CBCT) scans of teeth were taken. Blood was collected from treatment groups at baseline, 3-, 6-, and 12-month post-treatment and from controls at baseline and 12 months. Serum levels of IL-1β, IL-6, IL-8, TNF-α, Pentraxin 3, ICAM-1, VCAM-1, hs-CRP, FGF-23, MMP-2, MMP-8, MMP-9, C3 and ADMA were analysed using multiplex immunoassay and enzyme-linked immunosorbent assay. Different time points within the same group were compared using Wilcoxon signed-rank test, and differences between groups were analysed using the Mann-Whitney test. Non-linear association between different factors was assessed using Spearman's correlation. RESULTS Preoperative serum levels of FGF-23, IL-1β, hs-CRP and ADMA were significantly higher in the diseased groups compared with controls (p < .001; p = .008; p < .001; p = .013, respectively). The preoperative size of the radiolucency was associated with increased levels of FGF-23, IL-1β and IL-6. At 3-months following treatment, IL-1β, IL-8, hs-CRP, C3, MMP-2 and MMP-9 levels increased compared with baseline in treatment groups. IL-1β and IL-8 further increased at 6 months, whereas FGF-23, hs-CRP, C3, MMP2 and MMP-9 decreased. One-year post-treatment, FGF-23, pentraxin-3 and ADMA were significantly reduced below baseline levels. At the 1-year review, CBCT revealed that 25.9% of treated cases completely healed, while 63% were healing, and 11.1% failed. Treatment outcome was found to be influenced by preoperative levels of ADMA and IL-8 levels at 6 months. CONCLUSIONS Both symptomatic and asymptomatic apical periodontitis (AP) can contribute to increased levels of molecular markers of inflammation. A further transient inflammatory markers rise after root canal retreatment and apical surgery were demonstrated. Successful endodontic treatment and periapical surgery result in a long-term reduction in inflammatory marker levels.
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Affiliation(s)
- Abdulaziz Bakhsh
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre of Oral Clinical & Translational Sciences, Guy's Dental Hospital, King's College London, London, UK.,Department of Restorative Dentistry, Division of Endodontics, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - David Moyes
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, Guy's Dental Hospital, King's College London, London, UK
| | - Gordon Proctor
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, Guy's Dental Hospital, King's College London, London, UK
| | - Francesco Mannocci
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre of Oral Clinical & Translational Sciences, Guy's Dental Hospital, King's College London, London, UK
| | - Sadia Ambreen Niazi
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre of Oral Clinical & Translational Sciences, Guy's Dental Hospital, King's College London, London, UK
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Leão TSS, Tomasi GH, Conzatti LP, Marrone LCP, Reynolds MA, Gomes MS. Oral inflammatory burden and carotid atherosclerosis among stroke patients. J Endod 2022; 48:597-605. [PMID: 35143813 DOI: 10.1016/j.joen.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This study aimed to test the hypothesis that oral inflammatory burden (OIB) is independently associated with the carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA). METHODS This cross-sectional observational study included 240 hospital patients with the diagnosis of IS or TIA. The main exposures were apical periodontitis (AP), root canal treatment (RCT), and crestal alveolar (periodontal) bone loss (BL), and the main outcome was the CAB. Exposure and outcome variables were measured through a head and neck multidetector computed tomography angiography and CAB was dichotomized in <50% and ≥50% vessel occlusion. OIB scored as a composite measure of the endodontic and periodontal disease exposure. Hospital health records provided information on socio-demographic and medical covariates. Prevalence ratios (PR) were calculated through Poisson regression models, estimating the relationship between the oral exposures and CAB, with =5%. RESULTS Mean age was 62.15 ± 13.1 years, with 56.7% males. Univariate analyses showed that AP≥2 (PR=1.83,95%CI=1.05-3.17) and endodontic burden (EB) (AP &/or RCT≥2) (PR=1.98,95%CI=1.13-3.47) were associated with CAB ≥50%. Multivariate models, adjusted for socio-demographic and medical covariates, revealed that pooled periodontal and endodontic parameters (OIB= BL ≥5mm & EB ≥2) was independently associated with CAB ≥50% (PR=2.47,95%CI= 1.04-5.87). CONCLUSION A higher OIB was independently associated with increased levels of CAB among IS or TIA hospital patients. The combination of endodontic and periodontal parameters strengthened the observed association and should be evaluated in future studies on the relationship between oral health and cardiovascular outcomes.
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Affiliation(s)
- T S S Leão
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil;; Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - G H Tomasi
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L P Conzatti
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L C P Marrone
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - M A Reynolds
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - M S Gomes
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil;; Medical and Dental Center of the Military Police of Rio Grande do Sul, Brazil
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11
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Milojevic Samanovic A, Jakovljevic V, Vasovic M, Mitrovic S, Rankovic M, Mihajlovic K, Bolevich S, Zivkovic V. Cardiac, biochemical and histopathological analysis reveals impaired heart function in hypertensive rats with apical periodontitis. Int Endod J 2021; 54:1581-1596. [PMID: 33987853 DOI: 10.1111/iej.13562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
AIM To investigate the association between experimentally induced apical periodontitis (AP) and heart function in hypertensive rats. METHODOLOGY Forty-eight normotensive Wistar albino and spontaneously hypertensive (SHR) rats were divided into four equal groups: control (C), normotensive with AP (AP), SHR and SHR with AP (SHR + AP). AP was induced on the first right mandibular molars by exposing the pulp chambers to the oral environment for four weeks and confirmed radiographically. Thereafter, the animals were sacrificed by cervical dislocation, whilst hearts were isolated and perfused according to the Langendorff technique gradually increasing coronary perfusion pressures 40-120 cmH2 O. The hemimandibles were analysed radiographically (mm2 and pixels) to verify the presence of AP. Biomarkers of cardiac oxidative stress (OS) were determined in coronary venous effluent and cardiac tissue homogenate. Cardiac tissue was analysed histopathologically for signs of heart damage (oedema, fibrosis and necrosis). All data were analysed by Kruskal-Wallis and one-way anova tests (p < .05). RESULTS The levels of the maximum left ventricular pressure development rate of the SHR + AP group were significantly increased compared to the AP and C groups, and of the SHR group compared with the C group (p < .05). The levels of the minimum left ventricular pressure development rate of the SHR + AP group were significantly decreased compared to the AP, SHR and C groups, and of the SHR group compared to the C group (p < .05). The radiographic AP area was significantly larger in the SHR + AP group than in the AP group (p < .01). The levels of superoxide anion were significantly higher in the SHR + AP group than in the AP, SHR and C groups (p < .05). The activities of superoxide dismutase in cardiac tissue homogenate were significantly lower in the SHR + AP and AP groups compared with the SHR and C groups (p < .05). CONCLUSIONS In rats, AP was associated with impaired cardiodynamics, disturbed cardiac OS, antioxidant defence and cardiac pathologic changes in hypertensive conditions. Hypertension was associated with an increase in the AP radiographic area. Further studies should confirm whether root canal treatment can have a cardioprotective effect and reduce cardiac OS in hypertensive conditions.
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Affiliation(s)
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Department of Human Pathology, 1st Moscow State Medical, University IM Sechenov, Moscow, Russia
| | - Miroslav Vasovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodanka Mitrovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Rankovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina Mihajlovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sergey Bolevich
- Department of Human Pathology, 1st Moscow State Medical, University IM Sechenov, Moscow, Russia
| | - Vladimir Zivkovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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12
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Georgiou AC, Cornejo Ulloa P, Van Kessel GMH, Crielaard W, Van der Waal SV. Reactive oxygen species can be traced locally and systemically in apical periodontitis: A systematic review. Arch Oral Biol 2021; 129:105167. [PMID: 34126418 DOI: 10.1016/j.archoralbio.2021.105167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this systematic review was to summarize the existing evidence on the local production and systemic traces of reactive oxygen species (ROS) in apical periodontitis (AP). DESIGN A search of MEDLINE-PubMed and EMBASE was conducted up to January 12 of 2021 to identify studies in 6 different languages. Eligibility was evaluated and data were extracted from the eligible studies following the predefined objective. The Newcastle-Ottawa Scale was used for quality assessment of the included studies. RESULTS After screening, 21 papers met the inclusion criteria. Six studies were about systemic oxidative stress, 14 studies examined local production of reactive oxygen species and one studied both. ROS modulate cell signalling and cause oxidant imbalance locally at the site of AP. Cell signalling leads to a pro-inflammatory response, activation of MMPs and formation and progression of the AP lesion. Simultaneously, these oxidative stress biomarkers are also found in blood and saliva of subjects with AP. CONCLUSIONS Understanding the mechanism of ROS generation, involved in chronic inflammation, can provide us with important information to enhance local and systemic healing and possibly improve diagnostic tools. Future research considerations would be to use antioxidants to accelerate the return to oxidative balance.
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Affiliation(s)
- A C Georgiou
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.
| | - P Cornejo Ulloa
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - G M H Van Kessel
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - W Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - S V Van der Waal
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands; Department of Endodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
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13
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Chen S, Ma D, Xiao S, Li P, Lei H, Huang X. Effects of chronic apical periodontitis on the inflammatory response of the aorta in hyperlipemic rats. Clin Oral Investig 2021; 25:3845-3852. [PMID: 33404761 DOI: 10.1007/s00784-020-03714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the effects of chronic apical periodontitis (CAP) on the inflammatory response and initial lesion of aorta in hyperlipemic rats. MATERIALS AND METHODS Sprague-Dawley (SD) rats aged 14 weeks were randomly divided into 4 experimental groups (n = 8), namely, normal diet (ND), high-fat diet (HFD), CAP, and HFD + CAP. The rats were raised under controlled conditions and fed with diet specified for each group. All subjects were euthanatized after 14 weeks for histopathological analysis. Serum cytokines were analyzed to assess changes in gene and protein expression of aorta via enzyme-linked immunosorbent assay and real-time polymerase chain reaction. Results were analyzed by one-way ANOVA. RESULTS Low-density lipoprotein cholesterol levels in rats in HFD + CAP group were significantly higher than those in other groups. By comparison, low-density lipoprotein cholesterol levels in rats in both the HFD and HFD + CAP groups were significantly lower than those in the other groups. No significant difference among all groups was observed in terms of CRP level. However, levels of IL-2, IL-6, and IL-10 increased in the experimental CAP rats compared with the control rats. mRNA expression levels of MCP-1, TLR-4, and NF-κB p65 were markedly elevated in rats in the HFD group compared with those in rats in the ND group. TLR-4 mRNA expression was significantly higher in rats in the HFD + CAP group than that in rats in the HFD group. CONCLUSIONS CAP mediated the high expression of cytokines and induced the initial inflammatory response in the aorta. Apical periodontitis may affect the level of inflammatory cytokines (IL-2, IL-6, and IL-10) depending on the immune response. CLINICAL RELEVANCE CAP may trigger a systemic inflammatory response and affect the aorta of patients.
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Affiliation(s)
- Shuai Chen
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.,Institute of Stomatology and Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Dianfu Ma
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.,Stomatological Hospital of Xiamen Medical College, Xiamen, 361008, China
| | - Suli Xiao
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.,Stomatological Hospital of Xiamen Medical College, Xiamen, 361008, China
| | - Pingping Li
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.,Stomatological Hospital of Xiamen Medical College, Xiamen, 361008, China
| | - Huaxiang Lei
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.,Institute of Stomatology and Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Xiaojing Huang
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China. .,Institute of Stomatology and Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.
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14
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Aminoshariae A, Kulild J, Fouad AF. The impact of cardiovascular disease and endodontic outcome: a systematic review of longitudinal studies. Clin Oral Investig 2020; 24:3813-3819. [PMID: 32965589 DOI: 10.1007/s00784-020-03596-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/15/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To date, the relationship between cardiovascular disease (CVD) and endodontic treatment outcomes remains elusive with mixed reports. Thus, the purpose of this systematic review of longitudinal cohort studies was to evaluate whether CVD was a risk factor for endodontic outcome. MATERIALS AND METHODS Two reviewers independently conducted a comprehensive electronic database search to July 2020. The bibliographies of all relevant articles, textbooks, and gray literature were manually searched. The methodological quality of evidence was appraised by the Newcastle-Ottawa Scale and GRADE. The authors considered any publication on CVD and endodontic outcome. Endodontic outcome referred to either healing or survival of endodontically treated tooth. Risk ratio (RR) with 95% confidence interval (CI) was used. RESULTS Three articles met the inclusion criteria with a low risk of bias. Patients with CVD demonstrated a 67% higher risk for negative endodontic outcomes compared with patients who were healthy (RR = 1.67, P = 0.001, 95% confidence interval 1.53-1.81). CONCLUSION With the limitations of this systematic review, the overall confidence by GRADE was moderate suggesting that CVD might be a risk factor for endodontic outcomes. CLINICAL RELEVANCE The results support an association between CVD and endodontic outcomes.
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Affiliation(s)
- Anita Aminoshariae
- Department of Endodontics, Case School of Dental Medicine, 2123 Abington Road, A 280, Cleveland, OH, 44106, USA.
| | - J Kulild
- Department of Endodontics, UMKC School of Dentistry, Kansas City, MO, USA
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, University of North Carolina, 1098 First Dental Building, CB #7450, Chapel Hill, NC, 27599, USA
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15
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Conti LC, Segura-Egea JJ, Cardoso CBM, Benetti F, Azuma MM, Oliveira PHC, Bomfim SRM, Cintra LTA. Relationship between apical periodontitis and atherosclerosis in rats: lipid profile and histological study. Int Endod J 2020; 53:1387-1397. [PMID: 32573791 DOI: 10.1111/iej.13350] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
AIM To investigate the relationship between apical periodontitis and atherosclerosis in rats by lipid profile and carotid artery intima tunic measurement, and histological and histometric evaluation of periapical lesions. METHODOLOGY Forty male Wistar rats were allocated into four groups: control (C), with apical periodontitis (AP), with atherosclerosis (AT) and with AP and AT (AP + AT). Atherosclerosis was induced using a high-lipid diet associated with a surgical ligature in the carotid artery and a super dosage of vitamin D3 . AP was induced via pulp exposure to the oral environment. At 45 and 75 days, serum levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured. The maxillary and mandibular jaws and carotid artery were collected and processed for histological analysis. The Kruskal-Wallis or Mann-Whitney test was performed for nonparametric data, and the Tukey's or Student's t-test was performed for parametric data (P < 0.05). RESULTS In nonatherosclerotic animals, the induction of apical periodontitis increased TG levels significantly, from 63.1 ± 11.4 mg dL-1 in group C to 88.2 ± 7.9 mg dL-1 in the AP group (P < 0.05). The induction of AP was associated with a trend for higher TC and LDL-C levels in atherosclerotic animals (P > 0.05); however, it only significantly increased TG levels, from 93.2 ± 18.0 mg dL-1 in AT group to 121.9 ± 14.5 mg dL-1 in the AP + AT group (P < 0.05). Animals in the AP + AT group had a 36.5% increase in the thickness of the carotid intima tunic when compared with the AT group (P < 0.05). The intensity of the inflammatory infiltrate was significantly larger in the AP + AT group when compared with AP group (P < 0.05). The AP + AT group exhibited significantly greater alveolar bone loss, with a periapical lesion size of 206.4 ± 56.3 × 104 μm2 , compared with 151.4 ± 49.1 × 104 μm2 in the AP group (P < 0.05). CONCLUSION Apical periodontitis influenced triglyceride levels, increasing them even in the absence of atherosclerosis, and influenced the increase in the thickness of the carotid artery intima tunic in the presence of atherosclerosis. Atherosclerosis intensified the inflammatory reaction and increased bone resorption in periapical lesions.
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Affiliation(s)
- L C Conti
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - J J Segura-Egea
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - C B M Cardoso
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - F Benetti
- Endodontic Section, Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - M M Azuma
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan, Ann Arbor, MI, USA
| | - P H C Oliveira
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - S R M Bomfim
- Department Clinic and Surgery and Animal Reproduction, Araçatuba Veterinary Medicine, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - L T A Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
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16
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Georgiou AC, Crielaard W, Armenis I, de Vries R, van der Waal SV. Apical Periodontitis Is Associated with Elevated Concentrations of Inflammatory Mediators in Peripheral Blood: A Systematic Review and Meta-analysis. J Endod 2019; 45:1279-1295.e3. [PMID: 31542282 DOI: 10.1016/j.joen.2019.07.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/18/2019] [Accepted: 07/28/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Apical periodontitis (AP), except for the local known consequences, may also be a systemic burden. Circulating inflammatory mediators that are released to sustain the AP lesion can in theory harm other bodily tissues. The aim of this systematic review was to summarize the existing evidence on the influence of AP on the peripheral blood levels of inflammatory mediators and markers of systemic stress. METHODS A search of MEDLINE-PubMed, Embase, and Cochrane was conducted up to and including February 2019 to identify studies in 5 different languages. The Newcastle-Ottawa Scale was used for quality assessment of the included studies. RESULTS Twelve of the 20 included studies were case-control studies, and 8 were intervention studies. The data of all the included studies were analyzed descriptively, whereas the data of 11 studies were available for meta-analyses. The study designs were heterogeneous. Nevertheless, the meta-analyses revealed statistically significant differences in C-reactive protein, interleukin 6, and asymmetric dimethylarginine levels between AP subjects and controls in peripheral blood. In addition, the concentration of C3 complement fragment in peripheral blood was significantly lower after the treatment and resolution of AP than before. CONCLUSIONS The existing literature indicates that AP adds on to systemic inflammation by elevating C-reactive protein, interleukin 6, asymmetric dimethylarginine, and C3 levels. In order to overcome the issue of large variation between study designs, future studies should have clear inclusion criteria, preferably larger cohorts, adequate follow-up of all subjects, and a thorough presentation of the data to enable further exploration of the possible burden of AP on general human health. Nevertheless, there is now stronger evidence that AP contributes to low-grade systemic inflammation.
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Affiliation(s)
- Athina Christina Georgiou
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands.
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Iakovos Armenis
- Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece; Department of Internal Medicine, "Laiko" Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Suzette V van der Waal
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands; Department of Endodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
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17
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Garrido M, Cárdenas AM, Astorga J, Quinlan F, Valdés M, Chaparro A, Carvajal P, Pussinen P, Huamán-Chipana P, Jalil JE, Hernández M. Elevated Systemic Inflammatory Burden and Cardiovascular Risk in Young Adults with Endodontic Apical Lesions. J Endod 2019; 45:111-115. [PMID: 30711165 DOI: 10.1016/j.joen.2018.11.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim of this study was to assess whether apical lesions are associated with inflammatory serum markers of cardiovascular risk, especially high-sensitivity C-reactive protein (hsCRP), in young adults. METHODS In this cross-sectional study, otherwise healthy individuals with apical lesions of endodontic origin (ALEOs) and a clinical diagnosis of asymptomatic apical periodontitis and controls aged between 18 and 40 years were included. Patients' sociodemographic characteristics, medical history, and classic cardiovascular risk factors were recorded, and the pathobiological determinants of atherosclerosis in youth score was calculated. Oral clinical and radiographic examinations were performed. Blood samples were collected to determine the lipid profile, glycated hemoglobin, hsCRP, immunoglobulin G, interleukin (IL)-6, IL-10, IL-12p70, matrix metalloproteinase 8, soluble vascular cellular adhesion molecule-1, soluble intercellular adhesion molecule-1, and soluble E-selectin. Bivariate and multivariate analyses adjusting for oral and classic cardiovascular risk factors were performed. RESULTS hsCRP levels were significantly higher in ALEO patients versus controls (median = 2.54 vs 0.78), whereas the pathobiological determinants of atherosclerosis in youth score was comparable among the groups. Also, the levels of IL-6, matrix metalloproteinase 8, and soluble E-selectin were significantly higher in ALEO patients. hsCRP, IL-6, and IL-12 correlated with soluble adhesion molecules. Bivariate analysis based on hsCRP serum concentrations ≥1 mg/L showed an odds ratio (OR) = 6.8, and the risk increased 3.3 times for an additional ALEO. In multivariate analysis, ALEO was significantly associated with hsCRP levels ≥1 mg/L (OR = 5.1-12.8) independently of the adjustment model. ALEO also associated with CRP levels >3 mg/L, which was significant after the adjustment for covariates (OR = 4.0). CONCLUSIONS ALEO is associated with the systemic inflammatory burden and cardiovascular risk determined by hsCRP, supporting a mechanistic link for cardiovascular diseases in young adults.
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Affiliation(s)
- Mauricio Garrido
- Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Angélica M Cárdenas
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile; Health Sciences Division, Faculty of Dentistry, Universidad Santo Tomás, Bucaramanga, Colombia
| | - Jessica Astorga
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Francisca Quinlan
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Macarena Valdés
- Epidemiology Program, Public Health School, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Alejandra Chaparro
- Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Paola Carvajal
- Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patricia Huamán-Chipana
- Department of Periodontology, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Jorge E Jalil
- Division of Cardiovascular Diseases, School of Medicine, Pontifical Universidad Católica de Chile, Santiago, Chile
| | - Marcela Hernández
- Laboratory of Periodontal Biology, Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile; Dentistry Unit, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile.
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18
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Chauhan N, Mittal S, Tewari S, Sen J, Laller K. Association of Apical Periodontitis with Cardiovascular Disease via Noninvasive Assessment of Endothelial Function and Subclinical Atherosclerosis. J Endod 2019; 45:681-690. [PMID: 31030979 DOI: 10.1016/j.joen.2019.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic infections of endodontic origin might predispose to the onset of cardiovascular disease (CVD). The studies depicting the link between apical periodontitis (AP) and CVD are few, and the association is very controversial; also, the markers used are expensive, which makes them difficult to use in general practice. The purpose of this study was to investigate whether an association exists between AP and CVD using noninvasive methods (ie, flow-mediated dilatation [FMD] and carotid intima-media thickness [c-IMT]). METHODS This cross-sectional study included 120 men between 20 and 40 years old free from periodontal disease, CVD, and traditional cardiovascular risk factors; 60 subjects had AP, and 60 acted as controls. All subjects underwent complete physical and dental examination, echocardiography, ultrasound assessment of FMD of the right brachial artery, and c-IMT. Data were analyzed using the Mann-Whitney U test and the Spearman rank correlation (rs) test. RESULTS FMD was found to be significantly impaired in patients with AP (mean = 4.9% ± 2.05%) compared with healthy controls (mean = 9.74% ± 2.59%, P = .000). The study also depicts statistically significant differences between c-IMT of the AP (mean = 0.64 ± 0.12 mm) and control (mean = 0.54 ± 0.08 mm) groups (P = .000). A significant inverse correlation between c-IMT and FMD was observed (rs = -0.381, P = .000). CONCLUSIONS Impaired FMD and greater c-IMT in subjects with AP suggests a potential association between endodontic infection and CVD.
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Affiliation(s)
- Nishant Chauhan
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Shweta Mittal
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Jyotsana Sen
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kuldip Laller
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Sirin DA, Ozcelik F, Uzun C, Ersahan S, Yesilbas S. Association between C-reactive protein, neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study. Acta Odontol Scand 2019; 77:142-149. [PMID: 30394169 DOI: 10.1080/00016357.2018.1522447] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels. MATERIAL AND METHODS Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers. RESULTS The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p < .05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p < .05). CONCLUSIONS hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.
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Affiliation(s)
- DA Sirin
- Department of Endodontics, Faculty of Dentistry, University of Health Sciences, Istanbul, Turkey
| | - F Ozcelik
- Medical Biochemistry Department, Sultan Abdülhamid Han Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - C Uzun
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, University of Health Sciences, Istanbul, Turkey
| | - S Ersahan
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - S Yesilbas
- Medical Biochemistry Department, Sultan Abdülhamid Han Training Hospital, University of Health Sciences, Istanbul, Turkey
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20
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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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Aminoshariae A, Kulild JC, Fouad AF. The Impact of Endodontic Infections on the Pathogenesis of Cardiovascular Disease(s): A Systematic Review with Meta-analysis Using GRADE. J Endod 2018; 44:1361-1366.e3. [DOI: 10.1016/j.joen.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022]
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Vázquez-Martínez ER, García-Gómez E, Camacho-Arroyo I, González-Pedrajo B. Sexual dimorphism in bacterial infections. Biol Sex Differ 2018; 9:27. [PMID: 29925409 PMCID: PMC6011518 DOI: 10.1186/s13293-018-0187-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences are important epidemiological factors that impact in the frequency and severity of infectious diseases. A clear sexual dimorphism in bacterial infections has been reported in both humans and animal models. Nevertheless, the molecular mechanisms involved in this gender bias are just starting to be elucidated. In the present article, we aim to review the available data in the literature that report bacterial infections presenting a clear sexual dimorphism, without considering behavioral and social factors. Main body The sexual dimorphism in bacterial infections has been mainly attributed to the differential levels of sex hormones between males and females, as well as to genetic factors. In general, males are more susceptible to gastrointestinal and respiratory bacterial diseases and sepsis, while females are more susceptible to genitourinary tract bacterial infections. However, these incidences depend on the population evaluated, animal model and the bacterial species. Female protection against bacterial infections and the associated complications is assumed to be due to the pro-inflammatory effect of estradiol, while male susceptibility to those infections is associated with the testosterone-mediated immune suppression, probably via their specific receptors. Recent studies indicate that the protective effect of estradiol depends on the estrogen receptor subtype and the specific tissue compartment involved in the bacterial insult, suggesting that tissue-specific expression of particular sex steroid receptors contributes to the susceptibility to bacterial infections. Furthermore, this gender bias also depends on the effects of sex hormones on specific bacterial species. Finally, since a large number of genes related to immune functions are located on the X chromosome, X-linked mosaicism confers a highly polymorphic gene expression program that allows women to respond with a more expanded immune repertoire as compared with men. Conclusion Notwithstanding there is increasing evidence that confirms the sexual dimorphism in certain bacterial infections and the molecular mechanisms associated, further studies are required to clarify conflicting data and to determine the role of specific hormone receptors involved in the gender bias of bacterial infections, as well as their potential as therapeutic targets.
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Affiliation(s)
- Edgar Ricardo Vázquez-Martínez
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Elizabeth García-Gómez
- Unidad de Investigación en Reproducción Humana, Consejo Nacional de Ciencia y Tecnología (CONACyT)-Instituto Nacional de Perinatología, Ciudad de México, Mexico
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Bertha González-Pedrajo
- Departamento de Genética Molecular, Instituto de Fisiología Celular, UNAM, Ciudad Universitaria, Av. Universidad 3000, Coyoacán, 04510, Ciudad de México, Mexico.
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Bacterial DNA detected on pathologically changed heart valves using 16S rRNA gene amplification. Folia Microbiol (Praha) 2018; 63:707-711. [DOI: 10.1007/s12223-018-0611-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022]
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24
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Association between Systemic Diseases and Endodontic Outcome: A Systematic Review. J Endod 2017; 43:514-519. [PMID: 28190585 DOI: 10.1016/j.joen.2016.11.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. METHODS Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. CONCLUSIONS Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.
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Berlin-Broner Y, Febbraio M, Levin L. Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature. Int Endod J 2016; 50:847-859. [DOI: 10.1111/iej.12710] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/18/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Y. Berlin-Broner
- Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - M. Febbraio
- Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
| | - L. Levin
- Faculty of Medicine and Dentistry; University of Alberta; Edmonton AB Canada
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Al-Harbi NO, Nadeem A, Al-Harbi MM, Zoheir KMA, Ansari MA, El-Sherbeeny AM, Alanazi KM, Alotaibi MR, Ahmad SF. Psoriatic inflammation causes hepatic inflammation with concomitant dysregulation in hepatic metabolism via IL-17A/IL-17 receptor signaling in a murine model. Immunobiology 2016; 222:128-136. [PMID: 27773660 DOI: 10.1016/j.imbio.2016.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/15/2016] [Indexed: 02/07/2023]
Abstract
Psoriatic inflammation has been shown to be associated with cardiovascular dysfunction and systemic inflammation. Recently, psoriasis has also been linked to hepatic disorders, however underlying mechanism connecting the two are unknown. IL-17A being a central pro-inflammatory cytokine in the pathogenesis of psoriasis may be involved in hepatic inflammation through its receptor and downward signaling; however so far no study has investigated IL-17A related signaling in the liver during psoriasis in a murine model. Therefore, this study explored psoriasis-induced hepatic inflammation and concurrent metabolic changes. Mice were applied topically imiquimod (IMQ) to develop psoriatic inflammation. Additionally mice were also treated either with IL-17A or anti-IL17A antibody to explore the role of IL-17 related signaling in liver. Mice were then assessed for hepatic inflammation through assessment of inflammatory/oxidative stress markers (IL-17RC, NFκB, IL-6, MCP-1, IL-1β, GM-CSF, ICAM-1, iNOS, lipid peroxides and myeloperoxidase activity) as well as hepatic injury (alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase) and protein/lipid metabolic biomarkers (total proteins, albumin, total bilirubin, triglycerides, HDL cholesterol, and total cholesterol). IMQ treatment led to hepatic inflammation as evidenced by increased pro-inflammatory cytokines and oxidative stress with concomitant dysregulation in hepatic protein/lipid metabolism. Treatment with IL-17A further aggravated, whereas treatment with anti-IL17A antibody ameliorated IMQ-induced changes in hepatic injury/inflammation and protein/lipid metabolism. Our study shows for the first time that psoriatic inflammation leads to hepatic inflammation which results in dysregulated protein/lipid metabolism through IL-17RC/NFκB signaling. This could result in increased risk of cardiovascular dysfunction in patients with psoriasis.
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Affiliation(s)
- Naif O Al-Harbi
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - Ahmed Nadeem
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia.
| | - Mohammed M Al-Harbi
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - Khairy M A Zoheir
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - Mushtaq A Ansari
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | | | - Khalid M Alanazi
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Moureq R Alotaibi
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - Sheikh F Ahmad
- Department of Pharmacology & Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
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Sebring D, Dimenäs H, Engstrand S, Kvist T. Characteristics of teeth referred to a public dental specialist clinic in endodontics. Int Endod J 2016; 50:629-635. [DOI: 10.1111/iej.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/14/2016] [Indexed: 01/09/2023]
Affiliation(s)
- D. Sebring
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - H. Dimenäs
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S. Engstrand
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - T. Kvist
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Association between Systemic Diseases and Apical Periodontitis. J Endod 2016; 42:1427-34. [DOI: 10.1016/j.joen.2016.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022]
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Pussinen PJ, Könönen E. Oral health: A modifiable risk factor for cardiovascular diseases or a confounded association? Eur J Prev Cardiol 2016; 23:834-8. [PMID: 26915578 DOI: 10.1177/2047487316636506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku and City of Turku, Welfare Division, Turku, Finland
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Cotti E, Mercuro G. Apical periodontitis and cardiovascular diseases: previous findings and ongoing research. Int Endod J 2015; 48:926-32. [DOI: 10.1111/iej.12506] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Sardinia Italy
| | - G. Mercuro
- Department of Medical Sciences; University of Cagliari; Sardinia Italy
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