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Camponogara JG, de Ferreira TGM, Pelissari TR, Anversa AM, Moreira CHC, Bier CAS. Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study. Clin Oral Investig 2023; 27:7319-7325. [PMID: 37857733 DOI: 10.1007/s00784-023-05322-6] [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: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population. MATERIALS AND METHODS Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP. RESULTS Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007). CONCLUSION The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population. CLINICAL RELEVANCE The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.
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Affiliation(s)
- Jeanni Gonçalves Camponogara
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Ticiane Góes Mário de Ferreira
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Thayná Regina Pelissari
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Alessandro Meneghetti Anversa
- Graduate Program in Health Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26A (Medicina), Santa Maria, RS, 97105-900, Brazil
| | - Carlos Heitor Cunha Moreira
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil
| | - Carlos Alexandre Souza Bier
- Graduate Program in Dental Science, Federal University of Santa Maria, Avenida Roraima, 1000, Bairro Camobi, Prédio 26F (Odontologia), Santa Maria, RS, 97105-900, Brazil.
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Martinho JP, Coelho A, Oliveiros B, Pires S, Abrantes AM, Paulo S, Carvalho AC, Carrilho E, Paula A, Carvalho L, Seiça R, Botelho MF, Marto CM, Spagnuolo G, Matafome P, Ferreira MM. Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus. Int Endod J 2021; 54:1687-1698. [PMID: 33999433 DOI: 10.1111/iej.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. METHODOLOGY A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto-Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. RESULTS The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p < .001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p < .001) and triglycerides levels (p < .05) and area under the curve (AUC) during the insulin tolerance test at t21 (p < .001). AP area was significantly greater in GK rats (p < .05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21 days after AP induction (p < .08; p < .07). GK rats had intrinsically lower levels of VEGF than control rats (p < .05), which did not change after AP. CONCLUSION Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.
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Affiliation(s)
- José P Martinho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Coelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bárbara Oliveiros
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Salomé Pires
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Margarida Abrantes
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Siri Paulo
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Catarina Carvalho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Eunice Carrilho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Anabela Paula
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Anatomical and Molecular Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raquel Seiça
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Filomena Botelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos Miguel Marto
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - Paulo Matafome
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Complementary Sciences, Instituto Politécnico de Coimbra, Coimbra Health School (ESTeSC), Coimbra, Portugal
| | - Manuel Marques Ferreira
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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