Association of tobacco use and periapical pathosis - a systematic review
Department of Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland Department of Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, UK. International Endodontic Journal
(Impact Factor: 2.97).
04/2012; 45(12). DOI: 10.1111/j.1365-2591.2012.02072.x
Walter C, Rodriguez FR, Taner B, Hecker H, Weiger R. Association of tobacco use and periapical pathosis - a systematic review. International Endodontic Journal. ABSTRACT: The aim was to review the current evidence regarding an association between tobacco use, that is, cigarette smoking, and periapical pathosis. A systematic MEDLINE search of articles published prior to October 2011 (4th) was conducted using the keywords 'smoking and endodontics OR smoking and periapical index'. The study selection, data preparation and validity assessment were conducted by two reviewers. Nine studies fulfilled the inclusion criteria and represented data from 3008 individuals. The studies differed with respect to (i) study design, (ii) radiographic techniques, (iii) assessment of periapical pathosis, (iv) classification of smoking characteristics and/or (v) potential confounders accounted for in the analyses. Five of six cross-sectional studies revealed a significant positive association (OR 1.35-16.8) between periapical pathosis and current cigarette smoking. One of three longitudinal studies indicated an increased risk (OR 1.7) of root treated teeth for current smokers. The substantial heterogeneity of the included studies limited their interpretation. Further, well-designed studies are required to investigate the association between tobacco use and periapical pathosis.
Available from: Juan Jose Segura-Egea
- "The lack of scientific studies on this topic might be masking the potential risk of retaining teeth with chronic AP and the real importance and health advantages of endodontic treatments to patients, doctors and dentists (Segura-Egea et al. 2012). On the other hand, the impact of systemic diseases and some general habits, such as smoking, on pulp and periapical health also needs to be further investigated (Walter et al. 2012a). Strindberg (1956), in his classic study, did not find the general health status of the patient as a significant factor affecting periapical health. "
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ABSTRACT: The prevalence of apical periodontitis (AP) in Europe has been reported to affect 61% of individuals and 14% of teeth, and increase with age. Likewise, the prevalence of root canal treatment (RCT) in Europe is estimated to be around 30-50% of individuals and 2-9% of teeth with radiographic evidence of chronic persistent apical periodontitis in 30-65% of root filled teeth. Apical periodontitis is not only a local phenomenon and for some time the medical and dental scientific community have analysed the possible connection between apical periodontits and systemic health. Endodontic medicine has developed, with increasing numbers of reports describing the association between periapical inflammation and systemic diseases. The results of studies carried out both in animal models and humans are not conclusive, but suggest an association between endodontic variables, i.e. apical periodontitis and root canal treatment, and diabetes mellitus (DM), tobacco smoking, coronary heart disease, and other systemic diseases. Several studies have reported a higher prevalence of periapical lesions, delayed periapical repair, greater size of osteolityc lesions, greater likelihood of asymptomatic infections and poorer prognosis for root filled teeth in diabetic patients. On the other hand, recent studies have found that a poorer periapical status correlates with higher HbA1c levels and poor glycaemic control in type 2 diabetic patients. However, there is no scientific evidence supporting a causal effect of periapical inflammation on diabetes metabolic control. The possible association between smoking habits and endodontic infection has also been investigated, with controversial results. The aim of this paper is to review the literature on the association between endodontic variables and systemic health (especially diabetes mellitus and smoking habits). This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Available from: PubMed Central
- "Local,12 acquired and environmental factors, as tobacco use,13 diabetes14 and vascular problems15 are connected to the apical periodontal disease. Important to mention that many aspects are still unknown in the pathogenesis of this disease.16 "
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The Calcium Hydroxide has been widely used as an intracanal dressing and in combination with restorative and endodontic materials and its main goal is the tissue reparation. However, when the patient has chronic stress, the immunological response and tissue repair decreases in both the epithelial and connective tissue. Therefore, the aim was to analyze the effect of chronic stress on the tissue response in rats exposed to calcium hydroxide (CH).
Materials and Methods:
A total of 60 wistar rats were anesthetized, and a polyethylene tube containing CH was inserted under the skin. After 24 h, they were divided into two groups: Calcium hydroxide + stress (CHSG) n = 30 and calcium hydroxide (CHG) n = 30. They were stressed by physical restraint, for 12 h each day for periods of 7, 15 and 30 days when 10 animals from each group were euthanized. The tissues surrounding the polyethylene tubes were removed, and slides were prepared and stained with hematoxylin and eosin. The analysis was performed with an optical microscope with magnification of 4-400 times by a blinded senior examiner. The sample slides were classified according to the following scores 0 - absent/1 - present/2 - infiltrate to: Inflammatory infiltrate containing fibrous condensation, lymphocytes, plasmacytes, macrophages, neutrophils, and eosinophils. The data were statistically analyzed using the Student’s t-test (P < 0.05) for paired samples.
The exposure time of 7 days elicited no statistical difference between groups (P > 0.05). The 15 days exposure group had higher averages for CHG to eosinophils and inflammatory infiltrate (P < 0.05). In 30 days, CHG showed higher averages to inflammatory infiltrate and lower averages to FC (P < 0.05).
Some modified patterns of responses in the CHSG were observed at 15 days and 30 days.
Available from: Clemens Walter
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To evaluate the association between cigarette smoking and the frequency of apical periodontitis in female and male patients seeking treatment at the University of Basel (KREBS Project).
Materials and methods
This cohort study included full-mouth periapical radiographs of 161 subjects, including 66 current smokers, 26 former smokers and 69 individuals who had never smoked. The periapical region of all teeth was radiographically evaluated using the Periapical Index (PAI) score. Generalised linear mixed-effects models using the logit link were performed.
The frequency of apical periodontitis differed based on gender and smoking status. Current male cigarette smokers with <10 or ≥10 pack years showed frequencies of apical periodontitis of 12 % and 5.5 %, respectively, compared to 3.8 % in individuals who had never smoked. The corresponding data for female smokers were 5.7 % and 7.2 % in smokers with <10 or ≥10 pack years, respectively, versus 5.2 % in individuals who had never smoked. The factors “prevalent coronal restoration” (p < 0.001), “prevalent root canal treatment” (p < 0.001) and “quality of root canal filling” (p < 0.001) were significant predictors for apical periodontitis. After adjustment for quality of root canal filling cigarette smoking was not associated with apical periodontitis in current female and male smokers with <10 or ≥10 pack years (p > 0.05).
Smoking status did not predict apical periodontitis in females and males in this sample group.
With respect to quality of root canal filling, tobacco use may not be a significant predictor for apical periodontitis.
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