Prevalence and Quality of Endodontic Treatment in Patients with Cardiovascular Disease and Associated Risk Factors

Abstract

This study aimed to determine the prevalence and quality of endodontic treatment, by radiographically assessing the periapical periodontitis and endodontic treatment status in patients with cardiovascular disease (CVD) and cardiovascular risk (CVR) factors. Patients who visited the Out Patient Department of Institute of Dental Sciences and Department of Cardiology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, from August 2021 to February 2022, for a check-up or dental problem were considered as participants in this study. After obtaining informed consent, the participants were enrolled on the Oral Infections and Vascular Disease Epidemiology Study (INVEST) IDS, BHUBANESWAR. After testing negative for COVID-19, patients’ demographic details, such as age and gender were recorded, followed by a panoramic radiographic examination (OPG). A total sample of 408 patients were divided into three groups: Group 1/control (without any cardiovascular manifestation) consisting of 102 samples, group 2 of 222 CVR patients, and group 3 of 84 CVD cases. The CVR and CVD groups had a preponderance of elderly age groups between 60 to 70 years, with a significantly higher proportion of males. Co-morbidities such as diabetes mellitus, hypertension, and dyslipidemia were significantly associated with the CVR and CVD groups. From OPG interpretation, it was observed that the periapical radiolucency was greater in the CVR and CVD groups than in the control group (p = 0.009). The prevalence of endodontically treated teeth was higher in CVR and CVD than in the control group (p = 0.028). A high prevalence of dental caries, about 70%, was reported in all three groups (p = 0.356). The presence of dental restoration among all the groups was low (p = 0.079). The proportion of periodontal bone loss in the control group was significantly lower than CVR and CVD (p = 0.000). There was a strong association between periapical radiolucency, endodontically treated teeth, and periodontal bone loss in CVR and CVD patients. Notably, the associations reported herein do not reflect a cause-effect relationship; however, individuals with endodontic pathologies may accumulate additional risk factors predisposing them to hypertension or other CVDs. The results emphasize that eliminating local infections may decrease the systemic infection burden.

Prevalence of Patients with Comorbidities at the Undergraduate Clinic of Piracicaba Dental School – Brazil

“…The higher prevalence of systemic alterations in females may be attributed to their increased health awareness and higher utilization of medical and dental care. 20 A higher prevalence of comorbidities in males was found in patients undergoing endodontic treatment 22 and periodontal treatment 23 , likely due to the inclusion of elderly patients.…”

Expert consensus on endodontic therapy for patients with systemic conditions

“…Consequently, systemic diseases linked to inflammation may impair crucial immune factors involved in the pathogenesis of apical periodontitis, 27 potentially impacting the outcome of the treatment. Most acquired CVD are associated with increased systemic inflammatory burdens, which can lead to adverse outcomes in endodontic therapy, 28,29 and may be a risk factor for treatment failure. 30 However, Laukkanen et al 31 found that CVD did not have a significant effect on the success rate of endodontic therapy.…”

Influencia de las enfermedades sistémicas en la reparación postendodóntica

“…La ECV engloba trastornos que afectan el corazón y el sistema vascular, abarcando diversas condiciones como la cardiopatía coronaria (CHD), la enfermedad arterial periférica y la enfermedad cerebrovascular (Segura-Egea et al, 2023). Entre las afecciones cardiovasculares más frecuentes en pacientes que buscan atención dental se encuentran la ECV, la hipertensión (HTA), las arritmias, la endocarditis infecciosa y la insuficiencia cardíaca (Dash et al, 2022).…”

“…Las enfermedades sistémicas más comunes a nivel global incluyen la diabetes mellitus (DM), la hipertensión arterial, las enfermedades cardiovasculares, los accidentes cerebrovasculares, las enfermedades autoinmunitarias y el hábito de fumar (Dash et al, 2022). Los pacientes con enfermedades sistémicas crónicas se asocian con frecuencia a problemas y enfermedades de la salud oral, provocando alteraciones en las células sanguíneas y los mediadores de la inflamación, lo cual afecta a la respuesta reparadora del tejido e incluso puede mantener el proceso inflamatorio y la resorción ósea periapical después de haber finalizado el tratamiento de conducto (RCT) (Michael & Edgar, 2012b) .…”