Apical Periodontitis Significantly Associated With Cardiovascular Diseases

MedicalResearch.com Interview with:

John Liljestrand, DDS Department of Oral and Maxillofacial Diseases University of Helsinki

Dr. John Liljestrand

John Liljestrand, DDS
Department of Oral and Maxillofacial Diseases
University of Helsinki

MedicalResearch.com: What is the background for this study?

Response: There is an increased amount of evidence supporting the hypothesis that oral inflammations increase the risk for cardiovascular diseases (CVDs). The association between marginal periodontitis, a common inflammatory disease in the tooth supporting tissues, and CVDs is well established. The link is thought to depend on transient but repeated bacteremia, endotoxemia and an increased systemic inflammatory burden.

Apical periodontitis is a common manifestation of an endodontic infection, most often caused by dental caries. It is an inflammatory reaction surrounding the root tip of a tooth and it restrains the dental infection from spreading into the bone. Apical periodontitis is similar to marginal periodontitis regarding its microbial profile and ability to increase systemic inflammatory markers. Therefore, it is justified to suggest that apical periodontitis might also increase the risk for CVDs. There is only a minor amount of publications on this topic and further research is still needed. 

MedicalResearch.com: What are the main findings?

Response: For this study, we used a Finnish cohort of 508 patients in a cross-sectional setup. The status of coronary artery disease was determined by coronary angiography and periapical lesions were determined from panoramic tomographies. We analyzed the association between apical periodontitis and cardiovascular diseases; stable coronary artery disease and acute coronary syndrome to be precise. We also examined subgingival levels of P. endodontalis, a common oral pathogen, and its corresponding serum antibodies as potential mediators of the disease.

As many as 58 per cent were found to be suffering from one or more periapical lesions. We found that having apical periodontitis significantly associated with cardiovascular diseases, especially acute coronary syndrome, even after extensive adjustment for confounders. Interestingly the OR-values were highest for those who had apical periodontitis in teeth without past root canal treatment (OR=2.72, 95% CI= 1.16 to 6.40, p=0.022). Furthermore, high levels of P. endodontalis and corresponding serum antibodies associated with apical periodontitis, indicating that oral infections result in a systemic immunologic response.

MedicalResearch.com: What should readers take away from your report?

Response: Our study further consolidates the current concept that oral inflammations have an exacerbating effect on cardiovascular diseases. The most common oral inflammatory diseases are often asymptomatic and they are largely preventable by appropriate oral hygiene routines. Therefore it is highly important for anyone to regularly visit a dental office for examination.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Regarding the field of oral inflammations and chronic non-communicable diseases, marginal periodontitis has received a lot more attention than apical periodontitis. Therefore, we encourage the scientific community to acknowledge also other sources of chronic inflammation, e.g. apical periodontitis, pericoronitis or oral ulcers. The total impact of oral inflammation on CVDs is still under debate, but unravelling these associations are of great interest from a public health perspective, considering the high prevalence of these diseases.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


J Dent Res. 2016 Jul 27. pii: 0022034516660509. [Epub ahead of print]

Association of Endodontic Lesions with Coronary Artery Disease.

Liljestrand JM1, Mäntylä P2, Paju S2, Buhlin K3, Kopra KA2, Persson GR4, Hernandez M5, Nieminen MS6, Sinisalo J6, Tjäderhane L7, Pussinen PJ2.

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