Apical Periodontitis Is Associated with Elevated Concentrations of Inflammatory Mediators in Peripheral Blood: A Systematic Review and Meta-analysis

Georgiou, Athina Christina; Crielaard, Wim; Armenis, Iakovos; Vries, Ralph de; Waal, Suzette V. van der

doi:10.1016/j.joen.2019.07.017

Cited by 83 publications

(80 citation statements)

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“…According to recent studies, the molecules can reach the general circulation, eliciting a low-grade inflammatory response. 25,38,39 The results of the present study can be explained by the circulatory mechanism proposed by Baeza et al, which, in turn, can serve as an underlying mechanisms of the systemic response to periapical disease. AAP can, therefore, be a potential risk factor for inflammatory systemic diseases such as cardiovascular diseases or depression.…”

Section: Discussionsupporting

confidence: 69%

Biomarker for Asymptomatic Apical Periodontitis in Gingival Crevicular Fluid: aMMP-8

Karteva

Manchorova

2020

Eur J Dent

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Objectives Asymptomatic apical periodontitis (AAP) is one of the most widespread chronic inflammatory diseases in the field of dental medicine. Active matrix metalloproteinase (aMMP-8) previously demonstrated diagnostic potential as a biomarker for AAP in gingival crevicular fluid (GCF). The aim of this study was to determine the levels and diagnostic accuracy of aMMP-8 in GCF from teeth with AAP. Materials and Methods In this cross-sectional study, GCF samples were obtained from teeth with AAP (sample group, n = 31) and their contralateral teeth (control group, n = 31). Clinical and cone beam computed tomography (CBCT) parameters were used for the diagnosis and assessment of AAP and the determination of clinically healthy marginal periodontal tissues. One pool GCF sample per tooth was obtained from the whole crevice’s perimeter. aMMP-8 levels were determined by enzyme-linked immunosorbent assay (ELISA). Statistical Analysis Wilcoxon signed ranks test and Spearman rank correlation coefficient (rs) were used as statistical tools. The significance level was set at p < .05. Results The two groups demonstrated biomarker levels corresponding to a healthy marginal periodontal tissue. aMMP-8 levels were statistically and significantly higher in the samples collected from teeth with AAP. Lesions with greater volume showed correspondingly larger diameters. No statistically significant correlation between aMMP-8 levels and lesions’ volume or diameter was discovered. Conclusion GCF composition is modified by AAP only to a minimal extent. Further research is needed to substantiate the utilization of aMMP-8 as a potential biomarker for the diagnosis of the disease as well as to explore its relationship with other biomarkers.

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Section: Discussionsupporting

confidence: 69%

Biomarker for Asymptomatic Apical Periodontitis in Gingival Crevicular Fluid: aMMP-8

Karteva

Manchorova

2020

Eur J Dent

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“…2013, Georgiou et al . 2019). The increase of circulating inflammatory markers may be the consequence of oral infection spreading through the blood system and activation of the systemic immune response, which could lead to the development of generalized low‐grade inflammation in the human body.…”

Section: Discussionmentioning

confidence: 99%

“…2005) and consequent low‐grade systemic inflammation (Georgiou et al . 2019) caused by persistent AP may be a trigger for the development of CVDs.…”

Section: Introductionmentioning

confidence: 99%

Association between cardiovascular diseases and apical periodontitis: an umbrella review

et al. 2020

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Background The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive. Objective To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults. Methods The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics’ Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta‐analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of ‘high’, ‘moderate’, ‘low’ or ‘critically low’ quality. Results Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as ‘moderate’ quality, whereas one review was graded as ‘critically low’ quality. Discussion Only one systematic review included a meta‐analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis. Conclusions From the limited ‘moderate’ to ‘critically low’ quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well‐designed, longitudinal clinical studies with long‐term follow‐up are required.

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“…However, an inactive process or a "scar" might still have caused an inflammatory process in another part of the body [34]. Previous studies in which they found a relation between (peri-apical) periodontal disease and cardiovascular diseases used clinical information [9,13].…”

Section: Discussionmentioning

confidence: 99%

Elevated Coronary Artery Calcium scores are associated with tooth loss

et al. 2020

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Aim This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph–OPG). Materials and methods In this retrospective cross-sectional study, data was collected from three hospitals spread in the Netherlands. Patients were included when a CAC score and an OPG were available, both recorded within a maximum period of 365 days from 2009–2017. The CAC score was measured on a CT scan, using the Agatston method. To assess dental pathology, the number of missing teeth, the number of dental implants, alveolar bone loss, caries, endodontic treatments, peri-apical radiolucencies, bone loss at implants, impacted teeth and dental cysts, were determined on the OPG. All observers were calibrated. The electronic health records provided information about: gender, age, smoking, Diabetes Mellitus, hypercholesterolemia, hypertension and Body Mass Index (BMI). Results 212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, sex, and other well-known risk factors for cardiovascular disease, the significant correlation was no longer present after multivariate correction. Furthermore, the results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores. Conclusion This study showed that being edentulous or missing teeth is correlated to higher CAC scores however failed to be an independent predictor of atherosclerotic cardiovascular diseases. The number of (missing) teeth is an easily accessible marker and could be used as a marker for atherosclerotic cardiovascular disease (ACVD) risk by almost any healthcare worker. The current study needs to be considered as an explorative pilot study and could contribute to the design of further (prospective) studies on the relationship between dental pathology and coronary artery calcification by adding clinical information and extra cardiovascular biomarkers.

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Apical Periodontitis Is Associated with Elevated Concentrations of Inflammatory Mediators in Peripheral Blood: A Systematic Review and Meta-analysis

Cited by 83 publications

References 84 publications

Biomarker for Asymptomatic Apical Periodontitis in Gingival Crevicular Fluid: aMMP-8

Biomarker for Asymptomatic Apical Periodontitis in Gingival Crevicular Fluid: aMMP-8

Association between cardiovascular diseases and apical periodontitis: an umbrella review

Elevated Coronary Artery Calcium scores are associated with tooth loss

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