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
Source: PubMed


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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    • "Serum levels of inflammatory markers are known to predict CVD risk (Blake & Ridker 2002). Thus, AP may also represent a risk factor for CVD; however, few epidemiological studies have examined this potential association (Frisk et al. 2003, Caplan et al. 2006, Joshipura et al. 2006, Cotti et al. 2011a, Pasqualini et al. 2012, Willershausen et al. 2014). One longitudinal investigation found a relationship between incident AP and time to coronary heart disease diagnosis, especially amongst young men (Caplan et al. 2006). "
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    ABSTRACT: To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Aging (BLSA). This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. Total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was, incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean=17.4±11.1 years) following dental examination. Relative Risks (RR) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE. Mean age at baseline was 55.0±16.8 years and 51.4% were men. Sixty two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age≥60 years (RR=3.07, 95%CI=1.68-5.62), hypertension (RR=2.0, 95%CI=1.16-3.46) and EB≥3 (RR=1.77, 95%CI=1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to non-significance after adjustments (RR=1.97, 95%CI=0.83-4.70). EB in mid-life was an independent predictor of CVE among community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · May 2015 · International Endodontic Journal
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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.
    Full-text · Article · Dec 2013 · Clinical Oral Investigations
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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.
    Full-text · Article · May 2013 · Medicina oral, patologia oral y cirugia bucal
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