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Ideo F, Niazi S, Chessa L, Miglianti M, Bardini G, Mannocci F, Cotti E. Prevalence of Apical Periodontitis in Patients with Autoimmune Liver Diseases on Immune Suppressants and Immune Modulators: A Cross-sectional Study. J Endod 2024; 50:784-791. [PMID: 38527610 DOI: 10.1016/j.joen.2024.02.026] [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: 09/05/2023] [Revised: 01/28/2024] [Accepted: 02/11/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Autoimmune liver diseases (ALDs) are chronic conditions generated by an immune-mediated autoaggressive inflammatory reaction in genetically susceptible individuals. The purpose of this study was to evaluate the prevalence of apical periodontitis (AP) in patients suffering from ALDs undergoing treatment with the immune suppressants glucocorticoids, azathioprine, and/or ursodeoxycholic acid. METHODS The ALD group included 46 patients (11 men and 35 women, average age = 57.9 ± 11.8 years) and 1186 teeth. The control group included 50 healthy patients not taking any medications (15 men and 35 women, average age = 58.6 ± 10.4 years) and 1251 teeth. Demographic data and medical, pharmacologic, and dental history were recorded. Dental and radiographic examinations were performed. The presence of AP; the periapical index score; decayed, missing, and filled teeth; quality of restoration, and root canal treatment were evaluated. The influence of the medications the patients were taking on the prevalence of AP was also tested. RESULTS The prevalence of AP was significantly lower in ALDs than in the control group at the patient (P = .019) and tooth level (P = .014). Smoking and age were associated with a significant increase in AP in cases and controls (P = .045 and P = .001, respectively). In both groups, endodontically treated teeth showed a higher prevalence of AP. CONCLUSIONS Considering the limitations because of the observational nature of the study, the patients affected by ALDs liver diseases and undergoing treatment with immune suppressors (often associated with immune modulators) were found to exhibit a lower prevalence of AP.
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Affiliation(s)
- Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
| | - Sadia Niazi
- Department of Endodontology, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College, Guy's Hospital, London, United Kingdom
| | - Luchino Chessa
- Liver Unit, Department of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Michela Miglianti
- Liver Unit, Department of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Giulia Bardini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Francesco Mannocci
- Department of Endodontology, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College, Guy's Hospital, London, United Kingdom
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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Ferreira RDO, Pereira MS, Souza-Monteiro D, Frazão DR, de Moura JDM, Baia-da-Silva DC, Bittencourt LO, Balbinot GDS, Collares FM, Lima MLDS, de Araújo AA, Lima RR. Physical training attenuates systemic cytokine response and tissue damage triggered by apical periodontitis. Sci Rep 2024; 14:8030. [PMID: 38580668 PMCID: PMC10997662 DOI: 10.1038/s41598-024-58384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
Apical periodontitis (AP) is a condition characterized by inflammatory and infectious components in the tooth canal. AP affects periradicular tissues and has systemic repercussions. Physical exercise is a structured activity that requires cardiorespiratory function, and can modulate the inflammatory profile in pathological conditions. As a result, this study aimed to determine the effects of aerobic physical training (PT) on the alveolar bone with and without AP, and its systemic inflammatory repercussions. AP was induced in the mandibular first molars, and PT was performed on a treadmill for five consecutive days over four weeks, with progressive increases in speed and activity time. Blood samples were collected to determine serum cytokine levels using immunoassays, and alveolar bone samples were collected for histopathological evaluation, lesion volume and microarchitecture assessment using computed microtomography. Animals with AP had increased pro-inflammatory cytokines levels compared to those without AP; however, these levels were attenuated or restored by PT. Compared to the AP group, the AP + PT group had a smaller lesion volume and greater preservation of the bone trabeculae in the remaining alveolar bone surrounding the lesion. In overall, PT minimized the severity of AP proving to be a valid strategy for individuals undergoing endodontic treatment.
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Affiliation(s)
- Railson de Oliveira Ferreira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Matheus Soares Pereira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Deiweson Souza-Monteiro
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Deborah Ribeiro Frazão
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - João Daniel Mendonça de Moura
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Daiane Claydes Baia-da-Silva
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Leonardo Oliveira Bittencourt
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Gabriela de Souza Balbinot
- Dental Materials Laboratory, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabrício Mezzomo Collares
- Dental Materials Laboratory, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Laura de Souza Lima
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Aurigena Antunes de Araújo
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil.
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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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Ideo F, Manca MF, Niazi S, Mannocci F, Bardini G, Cotti E. The role of systemic statins in the inception and healing of apical periodontitis: a systematic review. BMC Oral Health 2023; 23:730. [PMID: 37805447 PMCID: PMC10560424 DOI: 10.1186/s12903-023-03472-3] [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: 06/19/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVES Statins are a category of medications widely used to reduce plasma LDL-cholesterol levels, that also possess antibacterial, anti-inflammatory, and immunomodulatory action. The aim of this systematic review was to explore the effects of systemic statins therapy on the development and treatment of apical periodontitis (AP) on humans and animals. MATERIAL AND METHODS Three electronic databases (PubMed, Web of Science, and Scopus) and grey literature were searched from their inception until February, 20 2023 (PROSPERO CRD42021246231). For the quality assessment and risk of bias, different guidelines were used according to the typology of the studies considered (Animal Research Reporting of In Vivo Experiments, Newcastle-Ottawa Quality Assessment Form for Cohort Studies, Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool and Tool to assess risk of bias in cohort studies of CLARITY Group). RESULTS Seven hundred eleven records were screened, and six articles were included for this qualitative review. The eligible studies showed a moderate overall quality and risk of bias. Human patients in treatment with statins exhibited a higher healing rate of AP following root canal treatment. In experimental animal models, statins had a beneficial effect on the development of AP. CONCLUSIONS Despite the limited number of studies and considering that most of them are on animals, our findings suggest that systemically administered statins make a positive contribution to prevent the development and help healing of AP. CLINICAL RELEVANCE There is an increased evidence that a pharmacologic adjunct to endodontic treatment may be considered to enhance healing of AP. Among other medications, statins seem to have a positive impact on the disease.
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Affiliation(s)
- Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Matteo Francesco Manca
- Department of Conservative Dentistry and Endodontics, 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 London, Guy's Hospital, London, UK
| | - Francesco Mannocci
- Department of Endodontology, Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Giulia Bardini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
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Khoshbin E, Salehi R, Behroozi R, Sadr S, Zamani A, Farhadian M, Karkehabadi H. The effect of low-dose aspirin on aspirin triggered lipoxin, interleukin 1 beta, and prostaglandin E2 levels in periapical fluid: a double-blind randomized clinical trial. BMC Oral Health 2023; 23:530. [PMID: 37525211 PMCID: PMC10388445 DOI: 10.1186/s12903-023-03243-0] [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: 04/14/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The role of pro-resolving mediators in inflammation is a new concern in research. The effect of low-dose aspirin on production of a special kind of these mediators named aspirin triggered lipoxin (ATL) has been studied on different tissues. This randomized clinical trial evaluated the effect of low-dose aspirin on ATL and pro-inflammatory mediators' level in periapical fluid of necrotic teeth with large lesions. METHODS Twenty-four patients with necrotic pulp and periapical lesion were randomly assigned to low-dose aspirin and placebo groups. In the first appointment, canals were shaped up to F3 size and #40 K-file and cleaned with 10 milliliters 2.5% sodium hypochlorite and 17% Ethylenediaminetetraacetic acid. Periapical fluid was sampled by a paper cone. The tooth was temporized without any intracanal medication. Tablets were administered for 7 days, then the teeth were re-opened and the sampling were repeated. Interleukin-1 beta (IL-1β), prostaglandin E2 (PGE2) and ATL were analyzed by enzyme-linked immunosorbent assay. Data were analyzed with paired t-test using SPSS statistical software, version 21 (α = 0.05). RESULTS A significant reduction in PGE2 and IL-1β was noted in the aspirin-treated group while an increase in ATL was observed (P < 0.001). There was no significant difference in the mediator scores before and after in the placebo-treated group (P > 0.05). CONCLUSION Low-dose aspirin can influence the inflammatory process by reducing pro-inflammatory mediators such as PGE2 and IL-1β, as well as increasing the pro-resolving mediators such as ATL. TRIAL REGISTRATION IRCT20191211045702N1.
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Affiliation(s)
- Elham Khoshbin
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Razieh Salehi
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Endodontics, School of dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rooholah Behroozi
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soroush Sadr
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Zamani
- Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamed Karkehabadi
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran.
- Department of Endodontics, Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Allihaibi M, Niazi SA, Farzadi S, Austin R, Ideo F, Cotti E, Mannocci F. Prevalence of apical periodontitis in patients with autoimmune diseases: A case-control study. Int Endod J 2023; 56:573-583. [PMID: 36747086 DOI: 10.1111/iej.13902] [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: 04/13/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
AIM The purpose of this case-control study was to compare the prevalence of apical periodontitis (AP) in patients affected by autoimmune disorders (AD) (inflammatory bowel disease [IBD], rheumatoid arthritis [RA] and psoriasis [Ps]) with the prevalence of AP in subjects without AD. The prevalences of AP in patients taking biologic medications, conventional medications and no medication were also compared. METHODOLOGY Eighty-nine patients (2145 teeth) with AD were investigated and the control group included 89 patients (2329 teeth) with no systemic diseases. Full dental panoramic tomograms were used to determine the periapical status of the teeth. Additional variables investigated included patient's socio-demographic characteristics, medications taken by AD patients, the decayed, missing and filled teeth (DMFT) index. The chi-square test and logistic regression analysis were used to evaluate the correlation between AD and AP. p-Values lower than .05 were considered to be statistically significant. RESULTS The prevalence of AP was 89.9% in AD patients and 74.2% in control subjects (odds ratio [OR] = 3.75, p = .015). The DMFT score was found to be significantly higher in the AD group (p = .004). Patients with RA had the highest risk of being affected by AP, whereas those with IBD had the lowest risk. Multiple binary logistic regression analysis indicated that the teeth of AD patients who were not taking any medication or were being treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) had a higher risk of being affected by AP than did the teeth of the control subjects (OR = 1.42 and OR = 2.03, respectively; p = .010). The teeth of patients taking conventional DMARDs (cDMARDs) were less affected by AP compared with those of patients taking bDMARDs. CONCLUSIONS Patients with AD, whether treated or not with biologic medications, showed a higher prevalence of AP than did those in the control group. The DMFT index score, which was higher in AD patients compared with controls was identified as a significant predictor of AP prevalence.
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Affiliation(s)
- Marwa Allihaibi
- Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Department of Endodontics, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Sadia Ambreen Niazi
- Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Samira Farzadi
- Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Rupert Austin
- Department of Prosthodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Francesco Mannocci
- Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Segura-Egea JJ, Cabanillas-Balsera D, Martín-González J, Cintra LTA. Impact of systemic health on treatment outcomes in endodontics. Int Endod J 2023; 56 Suppl 2:219-235. [PMID: 35752972 DOI: 10.1111/iej.13789] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth. OBJECTIVE To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved. METHODS The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models. RESULTS Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT. DISCUSSION Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region. CONCLUSIONS The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.
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Affiliation(s)
- Juan J Segura-Egea
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Daniel Cabanillas-Balsera
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Jenifer Martín-González
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Luciano T A Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), São Paulo, Brazil
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Newman KL, Kamada N. Pathogenic associations between oral and gastrointestinal diseases. Trends Mol Med 2022; 28:1030-1039. [PMID: 35691866 PMCID: PMC9691515 DOI: 10.1016/j.molmed.2022.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
Both periodontitis and inflammatory bowel disease (IBD) are complex chronic conditions characterized by aberrant host immune response and dysregulated microbiota. Emerging data show an association between periodontitis and IBD, including direct and indirect mechanistic links between oral and intestinal inflammation. Direct pathways include translocation of proinflammatory microbes from the oral cavity to the gut and immune priming. Indirect pathways involve systemic immune activation with possible nonspecific effects on the gut. There are limited data on the effects of periodontal disease treatment on IBD course and vice versa, but early reports suggest that treatment of periodontitis decreases systemic immune activation and that treatment of IBD is associated with periodontitis healing, underscoring the importance of recognizing and treating both conditions.
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Affiliation(s)
- Kira L Newman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Alghofaily M, Fouad AF. Association of Chronic Systemic Medications with the Incidence, Prevalence, or Healing of Endodontic Disease: A Systematic Review. J Endod 2022; 48:1458-1467. [DOI: 10.1016/j.joen.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
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Li C, Wu Y, Xie Y, Zhang Y, Jiang S, Wang J, Luo X, Chen Q. Oral manifestations serve as potential signs of ulcerative colitis: A review. Front Immunol 2022; 13:1013900. [PMID: 36248861 PMCID: PMC9559187 DOI: 10.3389/fimmu.2022.1013900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
As an immune dysregulation-related disease, although ulcerative colitis (UC) primarily affects the intestinal tract, extraintestinal manifestations of the disease are evident, particularly in the oral cavity. Herein, we have reviewed the various oral presentations, potential pathogenesis, and treatment of oral lesions related to UC. The oral manifestations of UC include specific and nonspecific manifestations, with the former including pyostomatitis vegetans and the latter encompassing recurrent aphthous ulcers, atrophic glossitis, burning mouth syndrome, angular cheilitis, dry mouth, taste change, halitosis, and periodontitis. Although the aetiology of UC has not been fully determined, the factors leading to its development include immune system dysregulation, dysbiosis, and malnutrition. The principle of treating oral lesions in UC is to relieve pain, accelerate the healing of lesions, and prevent secondary infection, and the primary procedure is to control intestinal diseases. Systemic corticosteroids are the preferred treatment options, besides, topical and systemic administration combined with dietary guidance can also be applied. Oral manifestations of UC might accompany or precede the diagnosis of UC, albeit with the absence of intestinal symptoms; therefore, oral lesions, especially pyostomatitis vegetans, recurrent aphthous ulcer and periodontitis, could be used as good mucocutaneous signs to judge the occurrence and severity of UC, thus facilitating the early diagnosis and treatment of UC and avoiding severe consequences, such as colon cancer.
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Affiliation(s)
| | | | | | | | | | | | - Xiaobo Luo
- *Correspondence: Qianming Chen, ; Xiaobo Luo,
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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: 18] [Impact Index Per Article: 9.0] [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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Ordinola-Zapata R, Noblett C, Perez-Ron A, Ye Z, Vera J. Present status and future directions of intracanal medicaments. Int Endod J 2022; 55 Suppl 3:613-636. [PMID: 35322427 PMCID: PMC9321724 DOI: 10.1111/iej.13731] [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: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.
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Affiliation(s)
- R Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Noblett
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | | | - Z Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB), School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J Vera
- Division of Endodontics, School of Dentistry, University of Missouri, Kansas City, MO, USA
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13
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Ideo F, Niazi S, Mezzena S, Mannocci F, Cotti E. Prevalence of Apical Periodontitis in Patients with Autoimmune Diseases under Immunomodulators: A Retrospective Cohort Study. J Endod 2022; 48:722-729. [DOI: 10.1016/j.joen.2022.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/06/2022] [Accepted: 02/16/2022] [Indexed: 12/23/2022]
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14
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Liu X, Li H. A Systematic Review and Meta-Analysis on Multiple Cytokine Gene Polymorphisms in the Pathogenesis of Periodontitis. Front Immunol 2022; 12:713198. [PMID: 35046930 PMCID: PMC8761621 DOI: 10.3389/fimmu.2021.713198] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022] Open
Abstract
Aim Periodontitis is an inflammatory disease that destroys both soft and hard periodontal tissues. However, a complex periodontal cytokine network remains unclear. This systematic review explored multiple cytokine gene polymorphisms in the pathogenesis of periodontitis. Material and Methods A systematic search was performed using the databases from previous publications, which indicated the association between cytokine polymorphisms and periodontitis pathogenesis. Meta-analysis was conducted using fixed or randomized models to calculate the significance of multiple cytokine polymorphisms. A total of 147 articles were analyzed with polymorphisms in 12 interleukins [Th1 (IL-2, IFN-γ, and TNF-α), Th2 (IL-4 and IL-13), Th17 (IL-1α, IL-1β, IL-6, and IL-17), and Treg cytokines (IL-10 and TGF-β)]. Doi plot was used to probe the occurrence of publication bias. Results The polymorphisms of IL-2 and TNF-α of Th1 cytokine family may be associated with the pathogenesis or the prevention of periodontitis risk, while the polymorphism of IFN-γ is not related to periodontitis risk. The polymorphisms for IL-4 and IL-13 of Th2 cytokine family are not found to be associated with the pathogenesis of periodontitis. For the polymorphisms of the members of Th17 cytokine family, different IL-1α polymorphisms may have inverse actions in the pathogenesis of periodontitis. IL-1β is a noteworthy cytokine biomarker in periodontitis development and progression. IL-6 may have a protective function in the inflammatory responses of periodontitis, and IL-17 has a weak relationship the inflammatory responses. The polymorphisms for the members of Treg cell cytokines may have a protective function against periodontitis risk. LFK indexes show the major asymmetry due to publication bias. Conclusion IL-1β is a notable cytokine biomarker in periodontitis risk. Treg cytokines favor an anti-inflammatory and protective environment. Further data are needed to confirm the present conclusion due to publication bias.
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Affiliation(s)
- Xin Liu
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Li
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
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15
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Biological Anti-TNF- α Therapy and Markers of Oxidative and Carbonyl Stress in Patients with Rheumatoid Arthritis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2021:5575479. [PMID: 34976302 PMCID: PMC8716244 DOI: 10.1155/2021/5575479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 12/04/2022]
Abstract
Rheumatoid arthritis (RA) as a chronic inflammatory disease is associated with oxidative stress. Drugs targeting tumor necrosis factor-alpha (TNF-α) ameliorate inflammation and symptoms of RA in most patients. Whether markers of oxidative stress can be used for monitoring of treatment effects is unknown. The aim of our study was to analyze the effects of anti-TNF-α treatment on oxidative stress in plasma and saliva of patients with RA. Samples were collected from 26 patients with RA at baseline as well as 3 and 6 months after starting the anti-TNF-α treatment. Thiobarbituric acid-reacting substances (TBARS), advanced oxidation protein products (AOPP), advanced glycation end products (AGEs), and fructosamine were quantified using spectrophotometry and spectrofluorometry in plasma. TBARS were measured also in saliva. The disease activity score (DAS28) was used to assess the clinical status of patients. No significant dynamic changes were found except plasma TBARS that decreased continuously. At 6 months after starting the treatment, plasma TBARS were lower by 39% in comparison to baseline (p = 0.006). Salivary concentrations of TBARS did not reflect the dynamics in plasma. Although a trend was observed (r = 0.33), a significant correlation between plasma TBARS and DAS28 was not found. Our results indicate that anti-TNF-α treatment decreases plasma TBARS as a marker of lipid peroxidation. However, the lack of a significant correlation with DAS28 suggests that it cannot be used for monitoring of treatment. Other markers of oxidative stress and antioxidant capacity with lower biological variability should be tested in future studies.
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16
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Association between Pulpal-Periapical Pathology and Autoimmune Diseases: A Systematic Review. J Clin Med 2021; 10:jcm10214886. [PMID: 34768405 PMCID: PMC8584450 DOI: 10.3390/jcm10214886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 12/30/2022] Open
Abstract
Several studies have linked apical periodontitis and systemic diseases. The aim of this study is to present a systematic review of the available literature investigating whether there is an association between pulpal-periapical pathology and autoimmune disease. The review was conducted following the PRISMA statement. A literature search was performed in five databases. Studies involving patients with pulpal-periapical pathology and autoimmune diseases were included in the review. Based on the PICO model, the research question aimed to assess whether there is an increased risk of developing pulpal-periapical pathology in patients with autoimmune disease. Article selection, data extraction, and quality assessment were performed using an adapted version of the STROBE guidelines. A total of seven studies were included in our review. The types of articles were five case-control and two cross-sectional studies. Periapical pathologies were associated to three autoimmune diseases (diabetes mellitus I, rheumatoid arthritis, and inflammatory bowel disease). Among the included studies, four show a low risk of bias, while three present a moderate risk. There could be an association between apical periodontitis and autoimmune diseases, although most studies report statistically non-significant associations.
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17
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Cai Z, Zhu T, Liu F, Zhuang Z, Zhao L. Co-pathogens in Periodontitis and Inflammatory Bowel Disease. Front Med (Lausanne) 2021; 8:723719. [PMID: 34616755 PMCID: PMC8488124 DOI: 10.3389/fmed.2021.723719] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023] Open
Abstract
Localized inflammatory lesions in one area of the body may affect other distant organs through various modes of transmission thus initiating secondary inflammatory infections. Periodontal disease (PD) and inflammatory bowel disease (IBD) have been shown to coexist. Periodontitis is a multifactorial inflammatory disease, and dental plaque is considered to be the initial risk factor. Individuals with genetic susceptibility are more likely to develop periodontitis when exposed to external stimuli. IBD is affected by host genetics, immunoregulation, daily diet, and the gut microbiota, and its risk factors appear to be shared with those of PD. However, the key etiologies of both diseases remain unclear, thus hindering the exploration of possible links between IBD and PD. Recent studies and systematic reviews have focused on evidence-based statistics of the prevalence and clinical manifestations of both diseases, but discussions of the microbial etiological correlation between periodontitis and intestinal inflammation are scarce. Here, we summarize the potential common pathogenic microorganisms that may serve as bridges between the two diseases. Studies have shown that invasive microorganisms such as Porphyromonas gingivalis, Fusobacterium nucleatum, Klebsiella spp. and Campylobacter spp. play key roles in the comorbidity of PD and IBD.
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Affiliation(s)
- Zhengwen Cai
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Tao Zhu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Fengshuo Liu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Zixuan Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Zhao
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China.,Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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18
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Agossa K, Roman L, Gosset M, Yzet C, Fumery M. Periodontal and dental health in inflammatory bowel diseases: a systematic review. Expert Rev Gastroenterol Hepatol 2021:1-15. [PMID: 34227446 DOI: 10.1080/17474124.2021.1952866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022]
Abstract
Introduction: An increased risk of dental caries and periodontal diseases has been reported for inflammatory bowel disease (IBD) patients and are challenging conditions to manage.Areas covered: The authors searched international databases to find all studies assessing dental/periodontal outcomes in patients with IBD and other immune-mediated inflammatory disease (IMID), as well as the association between IMID medications and dental/periodontal status.Expert opinion: IBD are associated with a higher risk of both periodontitis and caries. Some evidence from rheumatoid arthritis suggests that periodontitis may be associated with a lower response to anti-TNF. There is no reliable evidence that IBD patients may be at greater risk of complications during routine dental care. On the basis of current data, guidelines can be proposed for the dental management focusing on the detection and eradication of infectious foci prior to the implementation of immunosuppressants/biologics and modified dental treatment protocol for invasive dental procedures that includes antibiotic prophylaxis.
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Affiliation(s)
- Kevimy Agossa
- Univ. Lille, Inserm, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France
- Department of Periodontology, Faculty of Dentistry, University of Lille, Place De Verdun, Lille, France
| | - Lidia Roman
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille France
| | - Marjolaine Gosset
- Department of Odontology, Assistance Publique-Hôpitaux De Paris, Hôpital Charles Foix, Hôpitaux Universitaires La Pitié Salpétrière - Charles Foix Ivry-sur-SeineFaculty of Dental Surgery, University Paris Descartes PRES Sorbonne Paris Cité, University of Paris, EA 2496
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France
- Department of Gastroenterology, PériTox Laboratory, Périnatalité & Risques Toxiques, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France
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19
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Poyato-Borrego M, Segura-Egea JJ, Martín-González J, Jiménez-Sánchez MC, Cabanillas-Balsera D, Areal-Quecuty V, Segura-Sampedro JJ. Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis. Med Oral Patol Oral Cir Bucal 2021; 26:e208-e215. [PMID: 32851982 PMCID: PMC7980298 DOI: 10.4317/medoral.24135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). MATERIAL AND METHODS A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, 2 test and multivariate logistic regression were used in the statistical analysis. RESULTS Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome "periapical status" (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 - 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 - 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 - 472.15; p = 0.002), regardless of IBD type. CONCLUSIONS The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment.
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Affiliation(s)
- M Poyato-Borrego
- Son Espases University Hospital School of Medicine, University of Balearic Islands Health Research Institute of Balearic Islands Palma de Mallorca, Spain
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20
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Cotti E, Ideo F, Pedrazzini A, Bardini G, Musu D, Kantarci A. Proresolving Mediators in Endodontics: A Systematic Review. J Endod 2021; 47:711-720. [PMID: 33548330 DOI: 10.1016/j.joen.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/29/2020] [Accepted: 01/22/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of this study was to investigate the scientific literature to assess the potential of SPMs as an adjunct in the treatment of endodontic infection. METHODS Three electronic databases (PubMed, Web of Science, and Scopus) were searched from their inception until February 2020 (PROSPERO CRD42020164743). Supplemental research was performed by screening the references of the relevant studies eligible for inclusion. A quality assessment of animal studies was performed using the Animal Research: Reporting of In Vivo Experiments guidelines, whereas the Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool was used to assess the risk of bias. RESULTS A total of 3295 records were screened, and 8 articles meeting the criteria were included for this qualitative review. The eligible studies showed a high to moderate overall quality and a low to moderate risk of bias. SPMs positively affected the development of pulpitis and apical periodontitis in experimental animal models. The early treatment of pulpitis with the topical application of SPMs was beneficial to control inflammation within 24 hours from contamination. In addition, SPMs delivered within the root canals after disinfection were found effective in promoting periapical healing. CONCLUSIONS Our findings suggest that SPMs may play a role in the inception and treatment of pulpal-periapical diseases, and they should be considered for future research for developing new therapeutics as an adjunct to endodontic treatment.
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Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Alessandro Pedrazzini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Giulia Bardini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Davide Musu
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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21
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Barta Z. Apical Periodontitis in Patients With Inflammatory Bowel Disease: A Puppet Master? Inflamm Bowel Dis 2020; 26:280-282. [PMID: 31247090 DOI: 10.1093/ibd/izz129] [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: 06/04/2019] [Indexed: 12/09/2022]
Abstract
Focal infection theory posits that periodontal pathobionts play a causal role in initiating or exacerbating diseases. Periodontal disease is a common inflammatory, multifactorial disease of the periodontal tissues. The main factor for inflammation is mature dental plaque with the presence of pathogens in the microbial biofilm. Disturbances of the systemic and/or mucosal immune system, antibiotic treatments, immunosuppressants, and biologic therapies all increase the chance of infections and inflammatory processes (ie, apical periodontitis). The pathogenesis of Crohn's disease and ulcerative colitis, the 2 main forms of inflammatory bowel disease (IBD), is still unclear, but both autoimmune and immune-mediated phenomena are involved. It is a global disease with a prevalence of 0.3% and an incidence of 280-320 per 100,000 people in North America. According to the literature, there is a negative association between poor oral health and risk of IBD, and this protective effect increases with the severity of poor dental hygiene. On the other hand, existing IBD seems to be associated with an increased risk of periodontal disease and worse oral health compared with other diseases. The nature of these associations is unclear, but it is unquestionable that all have an effect on the others. Additional studies are needed to confirm if there is a causal relationship between dental status and IBD. Apical periodontitis in patients affected by Crohn's disease or ulcerative colitis needs to be considered carefully, and it is important to treat the disease.
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Affiliation(s)
- Zsolt Barta
- Department of Gastroenterology, Institute of Medicine, and Department of Infectology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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22
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Poyato-Borrego M, Segura-Sampedro JJ, Martín-González J, Torres-Domínguez Y, Velasco-Ortega E, Segura-Egea JJ. High Prevalence of Apical Periodontitis in Patients With Inflammatory Bowel Disease: An Age- and Gender- matched Case-control Study. Inflamm Bowel Dis 2020; 26:273-279. [PMID: 31247107 DOI: 10.1093/ibd/izz128] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Deep carious lesions cause pulpitis, pulpal necrosis and, finally, apical periodontitis (AP). Root canal treatment (RCT) is the treatment of choice for AP, changing the tooth into a root-filled tooth (RFT). Several studies have linked AP and RFT to systemic diseases. Likewise, previous studies have also found an association among inflammatory bowel disease (IBD) and periodontal disease. This study aims to analyze the frequency of AP and RCT in IBD patients and healthy control subjects. METHODS An age- and gender-matched case-control study design was used. The study group (SG) included 54 IBD patients (28 with Crohn´s disease, 26 with ulcerative colitis). Another 54 healthy subjects without IBD and age- and gender-matched were included in the control group (CG). The radiographic records were analyzed, and periapical radiolucencies were diagnosed as AP, using the periapical index (PAI). The statistical analysis was carried out using the Student t test, χ 2 test, and multivariate logistic regression. RESULTS The presence of 1 or more teeth with radiolucent periapical lesions (RPLs) was found in 19 patients (35.2%) in the study group and in 9 subjects (16.7%) in the control group (P = 0.03). No differences were found among the 2 groups neither in the amount of teeth with AP nor in the number of RFTs (P > 0.05). However, multivariate logistic regression analysis adjusting for number of teeth and number of RFTs showed that patients with IBD have RPLs with higher likelihood than control patients (odds ratio, 5.7; confidence interval 95%, 1.7-19.1; P = 0.0048). CONCLUSIONS Subjects with inflammatory bowel disease have higher prevalence of apical periodontitis. An oral health protocol should be established to address the higher prevalence of inflammatory oral processes.
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Affiliation(s)
| | - Juan J Segura-Sampedro
- General & Digestive Surgery Unit, Hospital Universitario Son Espases, School of Medicine, University of Balearic Islands, Health Research Institute of Balearic Islands, Palma de Mallorca, Spain
| | - Jenifer Martín-González
- Department of Stomatology, School of Dentistry, University of Sevilla, Calle Avicena s/n, Sevilla, Spain
| | | | - Eugenio Velasco-Ortega
- Department of Stomatology, School of Dentistry, University of Sevilla, Calle Avicena s/n, Sevilla, Spain
| | - Juan J Segura-Egea
- Department of Stomatology, School of Dentistry, University of Sevilla, Calle Avicena s/n, Sevilla, Spain
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23
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Wang HW, Lai EHH, Yang CN, Lin SK, Hong CY, Yang H, Chang JZC, Kok SH. Intracanal Metformin Promotes Healing of Apical Periodontitis via Suppressing Inducible Nitric Oxide Synthase Expression and Monocyte Recruitment. J Endod 2019; 46:65-73. [PMID: 31753516 DOI: 10.1016/j.joen.2019.10.001] [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: 05/30/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We have previously shown that intracanal metformin ameliorates apical periodontitis, partially by modulation of osteoblast apoptosis. The action of metformin on other cell types pertinent to the development of apical periodontitis needs to be examined. In the present study, we aimed to analyze whether its effects on the expression of inducible nitric oxide synthase (iNOS) and monocyte recruitment contribute to the therapeutic effect on apical periodontitis. METHODS Lipopolysaccharide (LPS)-induced expression of iNOS in a human monocytic cell line, Mono-Mac-6, was assessed by Western blot. The amount of nitrite in culture medium was assessed to quantify nitric oxide (NO) production. C-C motif chemokine ligand-2 (CCL-2) synthesis was measured by enzyme-linked immunosorbent assay. Experimental apical periodontitis in rats was treated with root canal debridement with or without intracanal metformin medication. Lesion progression was assessed by conventional radiography and micro-computed tomographic imaging. Cellular expression of iNOS and the number of monocytes/macrophages were assessed by immunohistochemistry. RESULTS Metformin suppressed LPS-induced iNOS and NO production by monocytes. More importantly, metformin inhibited LPS-enhanced CCL-2 synthesis through modulation of the iNOS/NO pathway. Intracanal metformin reduced bone resorption associated with apical periodontitis and suppressed iNOS expression and monocyte recruitment. CONCLUSIONS Our results confirmed the therapeutic efficacy of intracanal metformin for apical periodontitis. Suppression of monocyte recruitment through modulation of iNOS expression and NO production is an important mechanism underlying the beneficial effect of metformin.
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Affiliation(s)
- Han-Wei Wang
- Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Eddie Hsiang-Hua Lai
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Ning Yang
- Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sze-Kwan Lin
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Yuan Hong
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan; College of Bio-Resources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Hsiang Yang
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sang-Heng Kok
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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