Pulpal Inflammation and Incidence of Coronary Heart Disease

Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Journal of Endodontics (Impact Factor: 3.38). 03/2006; 32(2):99-103. DOI: 10.1016/j.joen.2005.10.039
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Pulpal inflammation is primarily caused by coronal caries, and leads to root canal therapy (RCT). Chronic inflammation has been associated with various cardiovascular diseases. This study evaluates the association between pulpal inflammation (using RCT as a surrogate) and incident coronary heart disease (CHD). We report results among males from the Health Professionals Follow-Up Study (HPFS), excluding participants with prior cardiovascular disease or diabetes. We obtained RCT data from the HPFS cohort (n = 34,683). Compared to men without RCT, those with >/=1 RCT had a multivariate RR of 1.21 (95% CI 1.05-1.40) for CHD. The association was limited to dentists (RR = 1.38; 95% CI 1.14-1.67). There was no association among nondentists (RR = 1.03). Dental caries was not associated with CHD. The results suggest a possible modest association between pulpal inflammation and CHD.

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Available from: Kaumudi J Joshipura, May 14, 2015
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    • "With this in mind, endodontic treatment was used as a surrogate parameter for the presence of endodontic disease in the retrospective analysis of the data from the Atherosclerosis Risk in Communities study to investigate the correlation with coronary heart disease, although endodontic therapy represents treatment of endodontic disease more than being a manifestation of disease itself [16]. In the Health Professionals Follow-Up Study, endodontic treatment was used in conjunction with CAP as an indication of the presence of pulpal infection, so the effect of CAP on the probability of coronary heart disease, with an odds ratio of 1.21, was probably underestimated in this study [17]. The suspicion that CAP treatment already carried out due to pulpal inflammation may have hindered the detection of the correlation with coronary heart disease was first expressed after the retrospective analysis of the data from the VA Dental Longitudinal Study and the Normative Aging Study [15] and was confirmed in our study. "
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    ABSTRACT: Chronic apical periodontitis (CAP) appears to be a risk factor for coronary heart disease. The aims of the study were to estimate the significance of AP for the atherosclerotic burden and to examine the potential effect of endodontic treatment. The whole-body computed tomography (CT) examinations of 531 patients with a mean age of 50 ± 15.7 years were evaluated retrospectively. The atherosclerotic burden of the abdominal aorta was quantified using a calcium scoring method. The parameters of periodontitis were measured using the CT scan. The patients had a total of 11,191 teeth. The volume of the aortic atherosclerotic burden for patients with at least one CAP lesion was 0.32 ± 0.92 ml, higher than for patients with no CAP (0.17 ± 0.51 ml; p < 0.05). The atherosclerotic burden increased with age and number of CAP lesions without root canal treatment, but not with number of CAP lesions with endodontic treatments (p < 0.05 each). In logistic regression models, age (Wald 90.8), CAP without endodontic treatment (Wald 39.9), male gender (Wald 9.8), and caries per tooth (Wald 9.0) correlated positively and the number of fillings (Wald 11) correlated negatively with the atherosclerotic burden (p < 0.05 each). Apical radiolucencies in teeth with endodontic treatment were irrelevant with respect to atherosclerosis. CAP correlated positively with the aortic atherosclerotic burden. In regression models, CAP without endodontic treatment was found to be an important factor, not however apical radiolucencies in teeth with endodontic treatment. Further research is needed to clarify the possible clinical significance of these associations.
    Clinical Oral Investigations 12/2013; 18(7). DOI:10.1007/s00784-013-1156-3 · 2.35 Impact Factor
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    • "However, a direct causative relationship has not been established (28). Although the role of chronic apical periodontitis and endodontic therapy in the development of adverse systemic outcomes has not been thoroughly explored, several investigations suggest their association with type II diabetes (19,29) and coronary heart disease (30,31). Among the multiple causes of post-transplantation infection that are cited in the literature, however, dental sources have rarely been implicated (32,33). "
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    ABSTRACT: Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects. Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression. Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects. Key words:Apical periodontitis, endodontics, hepatic cirrhosis, liver disease, liver transplant, oral health, root-canal treatment.
    Medicina oral, patologia oral y cirugia bucal 05/2013; DOI:10.4317/medoral.19148 · 1.17 Impact Factor
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    • "ces in oral health ( mainly antemortem tooth loss and caries ) of the Spanish adult population in two different historical periods in an attempt to determine : ( a ) Whether the transition from Middle to Modern Ages has affected the dental health of the popula - tion [ which is also a good indicator of the general health status of the population ; Joshipura et al . , 2006 ; Misra et al . , 2007 ; Ylöstalo et al . , 2006 ] . ( b ) Whether the effects of this transition were uniform or whether they showed some evidence of sex - bias ."
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    ABSTRACT: The aim of this study is to present, discuss and compare the results of pathological conditions in teeth from skeletal remains found in the northern part of the Iberian Peninsula (Spain) in four Medieval cemeteries (late 15th century) and three cemeteries from the Modern Age (late 18th century). The final objective was to evaluate the impact of socioeconomic and cultural changes that took place during the early Modern Age in Spain, on oral health. Dental caries and antemortem tooth loss were considered as indicators of dental disease. A significant increase of both dental caries and antemortem tooth loss occurred in Modern Age individuals when compared to Medieval values, as reported for other regions. Increased trade with other continents may explain this deterioration of dental health, as food exchanges (mainly with America) contributed to diet changes for the overall population, including higher carbohydrate consumption (introduction of potatoes) at the expense of other vegetables. A sex-specific increase of dental disease with age, and a significantly higher prevalence of carious lesions in Modern Age females than in males, were also found. These changes can be explained by women having had limited access to dental care after the Middle-Modern Age transition, as a consequence of socio-cultural and political changes. In these changes, an increasing influence of the Catholic Church in Spanish society has to be noted, as it can contribute to the explanation of the unequal dental health of men and women. Women were socially excluded from dental care by regulations inspired by religious precepts.
    Homo: internationale Zeitschrift fur die vergleichende Forschung am Menschen 02/2012; 63(1):21-42. DOI:10.1016/j.jchb.2011.12.001 · 0.96 Impact Factor
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