Lesions of endodontic origin: An emerging risk factor for coronary heart diseases

Abstract

A high inflammatory state, such as atherosclerosis, is a major underlying cause of coronary heart diseases (CHDs). Inflammatory mediators are known to lead to endothelial dysfunction and play a key role in initiation, progression, and rupture of atherothrombotic plaque. Chronic inflammatory dental infections such as periodontitis and lesions of endodontic origin or chronic apical periodontitis (CAP) may provide an environment conducive for such events. Atherosclerosis has shown to share a common spectrum of inflammatory markers with apical periodontitis. The possible correlation between CHD and CAP is emerging at microbiological, clinical, inflammatory, and molecular levels. This less recognized fact should be discussed more among the dental and medical fraternity so that more awareness and positive approach toward oral health can be created among patients and health-care providers.

Oral Health and Cardiovascular Disorders

“…A positive association between apical periodontitis and cardiovascular disease was also demonstrated [56]. Apical periodontitis, the inflammatory injury around the apex of a tooth due to gram-negative bacteria, may also cause systemic effects due to cytokines (interleukin 1 beta, interleukins 2, 6, 8, and 17, TNF alpha), reactive oxygen species, and matrix metalloproteinase, similar to chronic periodontitis [18,21]. Interleukin 1 (IL-1) level, the predominant form of interleukin found in endodontic injuries, is involved in the formation, growth, and destabilization of the atherosclerotic plaque [18].…”

“…Atherosclerosis is a high inflammatory state, and inflammatory mediators can cause endothelial dysfunction, a proatherogenic and prothrombotic effect, and are involved in the development and evolution of the atherosclerotic plaque [18,21]. The same inflammatory markers are involved in both atherosclerosis and periodontitis [21]. Periodontitis impairs endothelial function and is also associated with oxidative stress [13].…”

“…Periodontitis was associated with several cardiovascular risk factors, especially hypertension, diabetes mellitus, dyslipidemia, and smoking [21].…”

“…Dental caries and chronic apical periodontitis are different stages of the same inflammatory condition, and the focal infection theory has gained again attention [18,21].…”

“…Streptococcus mutans, the bacteria commonly associated with dental caries, was identified also in the atherosclerotic plaque, suggesting a proatherogenic potential of dental caries, and may also cause bacterial endocarditis [21,55]. It takes less than 1 minute after an oral intervention for the oral bacteria to reach the heart or the peripheral capillaries [21]. Normally, microorganisms are eliminated within minutes, but in patients with valvular heart disease, bacteremia may cause infective endocarditis [18].…”