Endodontic lesions linked to heart disease

heart diseaseNew research has linked endodontic lesions to cardiovascular disease.

The study, published online ahead of print in the Journal of Dental Research, found that the more apical rarefactions a person has, the more likely they are to have coronary artery disease.

‘Our study further consolidates the current concept that oral inflammations have an exacerbating effect on CVDs [cardiovascular diseases],’ said lead author John Liljestrand, DDS, a doctoral candidate at the University of Helsinki.

Research has already established that inflammation, particularly periodontitis, is linked with an increased risk of cardiovascular diseases. Because endodontic lesions and periodontal disease have similar properties, Dr Liljestrand and colleagues wanted to see if apical periodontitis and heart disease were associated as well.

‘Apical periodontitis is similar to marginal periodontitis regarding its microbial profile and ability to increase systemic inflammatory markers,’ he said. ‘Therefore, it is justified to suggest that apical periodontitis might also increase the risk for CVDs.’

For the study, a random sample of 508 adult patients in Finland who underwent coronary angiography, a test that measures plaque in the coronary arteries, from 2006 to 2008 were recruited. The researchers then divided the patients into groups by the severity of their disease:

  • 123 people with no significant coronary artery disease
  • 184 people with stable coronary artery disease
  • 169 people with acute coronary syndrome (ACS), putting them at risk for a heart attack
  • 32 with ACS-like symptoms but no coronary artery disease.

A dental expert who was blinded to the patients’ coronary diagnoses also took radiographs, blood samples, and bacteria samples from the 476 patients who still had teeth. The researchers once again divided the patients into groups, this time based on the prevalence of endodontic lesions:

  • 210 patients, including 32 edentulous patients, with no endodontic lesions
  • 222 patients with a widened periapical space and/or one apical rarefaction
  • 76 patients with two or more apical rarefactions.

Once the data were collected, the researchers compared the lesion results with coronary artery disease information using three separate models, each accounting for various factors, such as age, body mass index, and bone loss.

All three models showed a statistically significant correlation between having at least one widened periapical space and having stable coronary artery disease. The models also found that having at least one apical rarefaction in teeth without a root canal filling was significantly associated with having acute coronary syndrome.

‘Interestingly, the OR values were highest for those who had apical periodontitis in teeth without past root canal treatment, suggesting that root canal treatment might have an attenuating effect on the studied association with CVDs,’ said Dr Liljestrand. ‘However, this needs to be further studied before making such conclusions.’

Furthermore, the more lesions a person had, the more likely they were to have Porphyromonas endodontalis, which has previously been linked to coronary artery disease, as it is able to invade smooth muscle cells and vascular walls.

Despite not including a healthy population for reference, by comparing those who underwent coronary angiography, the results of the study were significant and suggested that, like periodontitis, inflammation around roots also may be linked to heart disease.

Studies are now needed to further explore the relationship between endodontic lesions and heart disease, including whether performing root canal treatments can minimise or mitigate coronary artery disease risk.

The article can be viewed here.

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