Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Abstract

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

Chronic apical periodontitis exacerbates atherosclerosis in apolipoprotein E‐deficient mice and leads to changes in the diversity of gut microbiota

“…A retrospective evaluation of the CT scans of 531 patients reported that CAP was positively correlated with atherosclerotic lesions (Petersen et al, 2014 ). The number of teeth affected by CAP is significantly associated with cardiovascular events (Gonzalez‐Navarro et al, 2020 ). In a cross‐sectional study that included 120 men between the ages of 20 and 40 who did not have CVD, periodontal disease, traditional cardiovascular risk factors and impaired flow‐mediated dilatation, elevated carotid intima‐media thickness was found in subjects with CAP, which indicates a possible association between dental pulp infection and CVD (Chauhan et al, 2019 ).…”

Periapical and endodontic status of patients with inflammatory bowel disease: Age‐ and sex‐matched case–control study

“…The objectives of this study are part of the growing interest in research on the possible relationship of endodontic pathology with systemic diseases. The results of epidemiological studies carried out in the last years suggest a link between AP and some systemic diseases, such as diabetes mellitus (López‐López et al, 2011; Sánchez‐Domínguez et al, 2015), cardiovascular diseases (Cotti & Mercuro, 2015), atherosclerosis (Berlin‐Broner et al, 2017), tobacco smoking (López‐López et al, 2012; Pinto et al, 2020), metabolic syndrome (González‐Navarro et al, 2020), osteoporosis (López‐López et al, 2015), inherited coagulation disorders (Castellanos‐Cosano et al, 2013), and others (Segura‐Egea et al, 2015). The results of these studies are already notable for the simple fact that they draw the attention of physicians and dentists to the interrelation between oral inflammatory pathology and systemic health status.…”

Present status and future directions: Microbiology of endodontic infections

“…There is a low‐to‐moderate evidence in the literature that apical periodontitis can exert systemic effects in the host and predispose to systemic diseases (Berlin‐Broner et al, 2017; Caplan et al, 2006; Cotti et al, 2011; Cotti & Mercuro, 2015; Garrido et al, 2019; Gonzalez‐Navarro et al, 2020; Joshipura et al, 2006; Pasqualini et al, 2012; Segura‐Egea et al, 2015). So far, there is no scientific reason to regard endodontic infections as segregate events that have no effects on other body sites.…”