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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] [MESH Headings] [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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Wu H, Wang L, Qiu C. Causal relationship, shared genes between rheumatoid arthritis and pulp and periapical disease: evidence from GWAS and transcriptome data. Front Immunol 2024; 15:1440753. [PMID: 39346909 PMCID: PMC11427265 DOI: 10.3389/fimmu.2024.1440753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/27/2024] [Indexed: 10/01/2024] Open
Abstract
Objective Patients with rheumatoid arthritis (RA) have an increased risk of developing pulp and periapical disease (PAP), but the causal relationship and shared genetic factors between these conditions have not been explored. This study aimed to investigate the bidirectional causal relationship between RA and PAP and to analyze shared genes and pathogenic pathways. Methods We utilized GWAS data from the IEU Open GWAS Project and employed five Mendelian randomization methods (MR Egger, weighted median, inverse variance weighted, simple mode, and weighted mode) to investigate the bidirectional causal relationship between RA and PAP. Transcriptome data for RA and irreversible pulpitis (IRP) were obtained from the GEO database. Hub genes were identified through differential analysis, CytoHubba, machine learning (ML), and other methods. The immune infiltration of both diseases was analyzed using the ssGSEA method. Finally, we constructed a regulatory network for miRNAs, transcription factors, chemicals, diseases, and RNA-binding proteins based on the identified hub genes. Results RA was significantly associated with an increased risk of PAP (OR = 1.1284, 95% CI 1.0674-1.1929, p < 0.001). However, there was insufficient evidence to support the hypothesis that PAP increased the risk of RA. Integrating datasets and differential analysis identified 84 shared genes primarily involved in immune and inflammatory pathways, including the IL-17 signaling pathway, Th17 cell differentiation, and TNF signaling pathway. Using CytoHubba and three ML methods, we identified three hub genes (HLA-DRA, ITGAX, and PTPRC) that are significantly correlated and valuable for diagnosing RA and IRP. We then constructed a comprehensive regulatory network using the miRDB, miRWalk, ChipBase, hTFtarget, CTD, MalaCards, DisGeNET, and ENCORI databases. Conclusion RA may increase the risk of PAP. The three key genes, HLA-DRA, ITGAX, and PTPRC, have significant diagnostic value for both RA and IRP.
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Affiliation(s)
- Huili Wu
- Department of Endodontics, Changzhou Stomatological Hospital,
Changzhou, China
| | - Lijuan Wang
- Department of Endodontics, Changzhou Stomatological Hospital,
Changzhou, China
| | - Chenjie Qiu
- Department of General Surgery, Changzhou Hospital of Traditional Chinese
Medicine, Changzhou, China
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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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Hayashi R, Yamazaki S, Mutoh N, Hashimoto T, Ohshima H, Tani-Ishii N. Influence of IgA nephropathy on the progression of pulpitis and apical periodontitis in HIGA mice. J Oral Biosci 2024; 66:98-104. [PMID: 37979655 DOI: 10.1016/j.job.2023.11.003] [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: 10/03/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Immunoglobulin (Ig)A nephropathy has been associated with oral infections such as periodontitis, but its pathogenesis is not fully understood; no treatments exist. This study analyzes the influence of IgA nephropathy, an autoimmune disease, on the pathogenesis of pulpitis and apical periodontitis. METHODS Two groups of mice were used in pulp infection experiments: high serum IgA nephropathy model mice (HIGA) and control mice (BALB/c). Histologic analyses of the pulp and apical periodontal tissues were performed on days 3, 5, 7, 14, and 28 following oral bacterial infection. The dynamics of odontoblasts, apoptotic cells, and IgA expression were analyzed using anti-Nestin, TUNEL, and anti-IgA staining, respectively. RESULTS Inflammatory cells infiltrated the exposed pulp at day three in both groups and by 14 days, these cells had infiltrated from the pulp to the apical periodontal tissue. The area of necrotic pulp tissue increased significantly in the control group at seven days. Odontoblasts decreased from day three onwards and disappeared by 28 days in both groups. The number of apoptotic cells in the pulp and apical periodontal tissues was significantly higher in the experimental group at day 28. The experimental group exhibited a significant increase in IgA production in the pulp after 14 days. Bone resorption in the apical periodontal tissue was significantly decreased in the experimental group at day 28. CONCLUSIONS The results of this study suggest that IgA nephropathy may modulate the inflammatory response and sustain long-term biological defense responses in pulpitis and apical periodontitis in HIGA mice.
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Affiliation(s)
- Reona Hayashi
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, Japan
| | - Shiori Yamazaki
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, Japan
| | - Noriko Mutoh
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, Japan
| | - Tatsuo Hashimoto
- Department of Internal Medicine, Graduate School of Dentistry, Kanagawa Dental University, Japan
| | - Hayato Ohshima
- Division of Anatomy and Cell Biology of the Hard Tissue, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Nobuyuki Tani-Ishii
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, Japan.
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de Araujo BMDM, de Miranda BM, Kowaltschuk TC, Gonçalves FM, Schroder AGD, Kuchler EC, Guariza-Filho O, Carneiro E, de Araujo CM, Xavier da Silva-Neto U. Impact of chronic diseases on the periapical health of endodontically treated teeth: A systematic review and meta-analysis. PLoS One 2024; 19:e0297020. [PMID: 38358980 PMCID: PMC10868775 DOI: 10.1371/journal.pone.0297020] [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: 11/10/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Systemic diseases affecting the immune system can influence the body's response time to endodontic treatment, potentially necessitating a longer duration for the complete resolution of existing infections when compared to healthy controls. This systematic review aims to evaluate the association between the presence of chronic diseases and periapical status after endodontic treatment through a systematic and comprehensive assessment of existing literature on this topic. The search strategy covered seven electronic databases and grey literature, encompassing articles published until October 2023. Two reviewers independently assessed potentially eligible studies based on the following criteria: Included were studies involving populations exposed to pre-existing chronic diseases who underwent endodontic treatment in permanent teeth. These studies evaluated periapical health status, making comparisons with healthy individuals. There were no language or publication date restrictions. Additionally, two reviewers independently extracted data regarding the characteristics of the included studies. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Meta-analysis was conducted using random effects models. The certainty of evidence was assessed using the GRADE tool. Twenty-three studies were included in the synthesis. Patients with diabetes were found to have about half the odds of having periapical health compared to non-diabetic patients (OR = 0.46; 95% CI = 0.30-0.70%; I2 = 58%) in teeth that underwent endodontic treatment. On the other hand, other systemic diseases like HIV, cardiovascular disease, and rheumatoid arthritis did not demonstrate significant differences concerning the outcome. In conclusion, diabetic patients showed a lower likelihood of maintaining periapical health. Conversely, patients with HIV, cardiovascular disease, and rheumatoid arthritis did not exhibit significant differences, although the existing evidence is still considered limited. It is crucial to manage these patients in a multidisciplinary manner to provide appropriate care for this population.
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Affiliation(s)
- Bianca Marques de Mattos de Araujo
- Postgraduate Program in Dentistry, Department of Endodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
| | - Bruna Marlene de Miranda
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
- Postgraduate Program in Dentistry, Department of Endodontics, Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Tatiana Carvalho Kowaltschuk
- Postgraduate Program in Dentistry, Department of Endodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
| | - Flávio Magno Gonçalves
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
| | - Angela Graciela Deliga Schroder
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
- Postgraduate Program in Dentistry, Department of Endodontics, Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Erika Calvano Kuchler
- Postgraduate Program in Dentistry, Department of Endodontics, Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Odilon Guariza-Filho
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
- Postgraduate Program in Dentistry, Department of Orthodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Everdan Carneiro
- Postgraduate Program in Dentistry, Department of Endodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Cristiano Miranda de Araujo
- Center for Advanced Studies in Systematic Review and Meta-Analysis – NARSM, Curitiba, Paraná, Brazil
- Postgraduate Program in Dentistry, Department of Endodontics, Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva-Neto
- Postgraduate Program in Dentistry, Department of Endodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Karataş E, Kul A, Camilleri J, Yonel Z. Association between rheumatoid arthritis and pulpal-periapical pathology: a systematic review. Clin Oral Investig 2023; 27:7019-7028. [PMID: 37828236 PMCID: PMC10713683 DOI: 10.1007/s00784-023-05305-7] [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: 08/18/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a debilitating disease where numerous pro-inflammatory cytokines have a proven role in its pathology. These cytokines are also involved in the pathogenesis of apical periodontitis (AP) where they have a pro-inflammatory role and induce bone resorption. Patients with RA may therefore be more prone to develop pulpal-periapical pathology (PPP). This study systematically reviewed the existing literature evaluating the association between RA and PPP. MATERIALS AND METHODS Studies including human participants with both RA and PPP were included. The search was performed in PubMed, Web of Science, and The Cochrane Library databases using keywords and Medical Subject Headings (MeSH) search terms. The risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale. The following parameters were extracted and analyzed by the reviewers; author, journal, year, design of the study, diagnostic criteria for periapical pathology, the association between rheumatoid arthritis and periapical pathology, and the evidence level. RESULTS The search identified 142 records. Inclusion criteria were as follows; studies in the English language, including human participants only, including patients with RA and PPP, cohort studies, cross-sectional studies, clinical trials, and case-control studies. According to the inclusion criteria, 5 studies were included in this systematic review. Three of the five studies reported significant association between RA and PPP. CONCLUSIONS Existing evidence suggests there may be an association between RA and PPP. CLINICAL RELEVANCE Clinicians should be aware that RA patients can be more prone to develop PPP which may result in a reduced quality of life.
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Affiliation(s)
- Ertugrul Karataş
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ayhan Kul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Josette Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Zehra Yonel
- Periodontology Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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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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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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Nagendrababu V, Duncan HF, Fouad AF, Kirkevang LL, Parashos P, Pigg M, Vaeth M, Jayaraman J, Suresh N, Jakovljevic A, Dummer PMH. PROBE 2023 guidelines for reporting observational studies in endodontics: Explanation and elaboration. Int Endod J 2023; 56:652-685. [PMID: 36851874 DOI: 10.1111/iej.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health-related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team has developed and published new reporting guidelines for observational-based studies called the 'Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023' guidelines. The PROBE 2023 guidelines were developed exclusively for the speciality of Endodontics by integrating and adapting the 'STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)' checklist and the 'Clinical and Laboratory Images in Publications (CLIP)' principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the PRIDE website (http://pride-endodonticguidelines.org/probe/).
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Affiliation(s)
| | - Henry F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Peter Parashos
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Michael Vaeth
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jayakumar Jayaraman
- Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nandini Suresh
- Faculty of Dentistry, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER), Chennai, India
| | - Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Cotti E, Schirru E. Present status and future directions: Imaging techniques for the detection of periapical lesions. Int Endod J 2022; 55 Suppl 4:1085-1099. [PMID: 36059089 DOI: 10.1111/iej.13828] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Diagnosing and treating apical periodontitis (AP) in an attempt to preserve the natural dentition, and to prevent the direct and indirect systemic effects of this condition, is the major goal in endodontics. Considering that AP is frequently asymptomatic, and is most often associated with a lesion in the periapex of the affected tooth, within the maxillary bones, imaging becomes of paramount importance for the diagnosis of the disease. The aim of this narrative review was to investigate the most relevant classic and current literature to describe which are, to date, the diagnostic imaging systems most reliable and advanced to achieve the early and predictable detection of AP, the best measures of the lesions and the disclosure of the different features of the disease. Dental panoramic tomography (DPT) is a classic exam, considered still useful to provide the basic diagnosis of AP in certain districts of the maxillary bones. Periapical radiographs (PRs) represent a valid routine examination, with few, known limitations. Cone-beam computed tomography (CBCT) is the only system that ensures the early and predictable detection of all periapical lesions in the jaws, with the minor risk of false positives. These techniques can be successfully implemented, with ultrasounds (USI) or magnetic resonance (MRI) imaging, exams that do not use ionising radiations. MRI and USI provide information on specific features of the lesions, like the presence and amount of vascular supply, their content and their relationship with the surrounding soft tissues, leading to differential diagnoses. Further, all the three-dimensional systems (CBCT, USI and MRI) allow the volumetric assessment of AP. Pioneering research on artificial intelligence is slowly progressing in the detection of periapical radiolucencies on DPTs, PRs and CBCTs, however, with promising results. Finally, it is established that all imaging techniques have to be associated with a thorough clinical examination and a good degree of calibration of the operator.
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Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Elia Schirru
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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12
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Niazi SA, Bakhsh A. Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:931. [PMID: 35888650 PMCID: PMC9319780 DOI: 10.3390/medicina58070931] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
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
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah 24381, Saudi Arabia;
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