Prevalence of Apical Periodontitis in Patients with Autoimmune Liver Diseases on Immune Suppressants and Immune Modulators: A Cross-sectional Study.

INTRODUCTION: Autoimmune liver diseases (ALDs) are chronic conditions generated by an immune-mediated autoaggressive inflammatory reaction in genetically susceptible individuals. The purpose of this study was to evaluate the prevalence of apical periodontitis (AP) in patients suffering from ALDs undergoing treatment with the immune suppressants glucocorticoids, azathioprine, and/or ursodeoxycholic acid. METHODS: The ALD group included 46 patients (11 men and 35 women, average age = 57.9 ± 11.8 years) and 1186 teeth. The control group included 50 healthy patients not taking any medications (15 men and 35 women, average age = 58.6 ± 10.4 years) and 1251 teeth. Demographic data and medical, pharmacologic, and dental history were recorded. Dental and radiographic examinations were performed. The presence of AP; the periapical index score; decayed, missing, and filled teeth; quality of restoration, and root canal treatment were evaluated. The influence of the medications the patients were taking on the prevalence of AP was also tested. RESULTS: The prevalence of AP was significantly lower in ALDs than in the control group at the patient (P = .019) and tooth level (P = .014). Smoking and age were associated with a significant increase in AP in cases and controls (P = .045 and P = .001, respectively). In both groups, endodontically treated teeth showed a higher prevalence of AP. CONCLUSIONS: Considering the limitations because of the observational nature of the study, the patients affected by ALDs liver diseases and undergoing treatment with immune suppressors (often associated with immune modulators) were found to exhibit a lower prevalence of AP.

Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study.

OBJECTIVE: To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population. MATERIALS AND METHODS: Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP. RESULTS: Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007). CONCLUSION: The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population. CLINICAL RELEVANCE: The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Periapical Lesions Associated with Demographic Variables, Dental Conditions, Systemic Diseases, and Habits.

AIM AND BACKGROUND: The aim of this study was to analyze the prevalence of periapical lesions and possible associations with demographic, dental conditions, systemic diseases, and habit variables in patients from a private Brazilian university. MATERIALS AND METHODS: Data from 452 patients of both sexes, aged 18-78 years, from a Brazilian university were evaluated. Panoramic radiographs were analyzed, and the presence of periapical lesions was recorded. In these cases, the dental condition was assessed for the presence or absence of endodontic treatment. Medical records provide information related to general health (diabetes, cardiovascular diseases, altered cholesterol, autoimmune diseases, gallstones, or kidney stones) and habits (smoking or alcoholism). The data were descriptively analyzed, and then logistic regression and the Wald test were performed in Stata/SE v.14.1. RESULTS: A rate of 58.4% of participants were women, and the mean age was 36.4 (±14.6) years. Periapical lesions prevailed in 193 (42.7%) patients, and 281 (72.4%) teeth were not previously endodontically treated. Mandibular first molars (19%) and men (48.9%) were the most affected. The adjusted model showed that the age group of 26-45 years was 5 times more likely [odds ratio (OR) = 5.01; 95% confidence interval (CI): 2.85-8.82] to have lesions than those aged ≤25 years. Participants aged above 46 years were 19.1 times more prone (OR = 19.1; 95% CI: 10.2-36.0) to morbidity than younger ones (≤25 years). CONCLUSION: The studied sample showed that periapical lesions were more prevalent in males, in mandibular molars, and without prior endodontic treatment. There was no observed association between periapical lesions and comorbidities or habits; however, a significant correlation occurred with advancing age. CLINICAL SIGNIFICANCE: Comorbidities and habits were not associated with the presence of periapical lesions. However, aging has been identified as a significant risk factor for the development of periapical lesions. This finding is clinically relevant as it highlights the importance of monitoring and maintaining oral health in patients with advanced age. How to cite this article: dos Santos VC, de Oliveira Kublitski PM, Marques da Silva B, et al. Periapical Lesions Associated with Demographic Variables, Dental Conditions, Systemic Diseases, and Habits. J Contemp Dent Pract 2023;24(11):864-870.

Lesiones perirradiculares asociadas a primeros molares superiores tratados endodónticamente: estudio a través de tomografías computadas / Periradicular lesions associated with endodontically treated maxillary first molars: study through computed tomography

Objetivos: Estudiar con tomografías computadas de haz cónico (CBCT) las lesiones perirradiculares de primeros molares superiores tratados endodónticamente; evaluar la lo- calización y, en los que tenían lesión en la raíz mesiovestibu- lar (MV), evaluar la frecuencia del conducto MV2. Materiales y métodos: A partir de una muestra de 179 tomografías, que incluían primeros molares superiores, se seleccionaron y analizaron aquellas en las cuales estos ha- bían recibido un tratamiento endodóntico previo, presentaban lesiones perirradiculares y conservaban una restauración co- ronaria. Las variables analizadas fueron: la localización de áreas radiolúcidas compatibles con lesiones perirradiculares de origen endodóntico y la correlación entre diferentes loca- lizaciones y la calidad del tratamiento realizado (adecuado, defectuoso o sin tratamiento). Los datos fueron analizados mediante la prueba de chi-cuadrado y la prueba de Spearman. Resultados: De las 179 CBCT que incluían primeros molares superiores, 90 reunían las condiciones requeridas. La frecuencia de las lesiones perirradiculares fue significativa- mente mayor en la raíz MV al compararla con las raíces disto- vestibular y palatina (p<0,05). El conducto MV1 presentó un tratamiento adecuado en todos los casos. El conducto MV2 recibió un tratamiento adecuado en 4 casos (4,44%), defec- tuoso en 4 casos (4,44%) y no tratado en 82 casos (91,1%); con una diferencia estadísticamente significativa (p<0,05). Conclusiones: En la muestra analizada, la localización de lesiones perirradiculares postratamiento endodóntico en primeros molares superiores se encontró con mayor frecuencia asociada a la raíz mesiovestibular, donde en la mayoría de los casos el con- ducto MB2 no fue tratado o presentó un tratamiento defectuoso (AU)

Aim: To study with cone-beam computed tomography (CBCT) the periradicular lesions of maxillary first molars with endodontical treatment; to evaluate its localization and, in those with a mesiobuccal root (MB) injury, assess the fre- quency of the MB2 root canal. Materials and methods: From a sample of 179 tomog- raphies (CBCT) that included maxillary first molars, those in which they had received previous endodontic treatment, pre- sented periradicular lesions and had a coronary restoration were selected and analyzed. The analyzed variables were: localization of radiolucent areas compatible with periradic- ular lesions of endodontic origin and the correlation between different localizations and quality of the performed treatment (adequate, defective, or untreated). Data were analyzed by the chi-square test and the Spearman test. Results: Of the 179 CBCT that included maxillary first molars, 90 met the required conditions. The frequency of periradicular lesions was significantly higher in the MB root when compared with distobuccal and palatal roots (P<0,05). The MB1 canal presented an adequate treatment in all cas- es. The MB2 canal received adequate treatment in 4 cases (4.44%), a defective one in 4 cases (4.44%) and was untreated in 82 cases (91.1%). The differences among these frequencies were statistically significant (P<0.05). Conclusions: In the analyzed sample, the localization of periradicular lesions after endodontic treatment in maxillary first molars was associated more frequently with the mesio- buccal root in which in the majority of cases the MB2 canal was untreated or presented a defective treatment

Periapical and endodontic status among 65-year-old Oslo-citizens.

AIM: This cross-sectional study aimed to investigate the prevalence of apical periodontitis (AP) and root-filled teeth in a 65-year-old population in Oslo, Norway, and to investigate associations of pathosis and endodontic treatment with selected individual risk indicators and technical quality of root fillings. MATERIAL AND METHODS: A random sample of 450 65-year-olds in Oslo answered a questionnaire and underwent a clinical and radiological examination (52% men and 48% women). Periapical radiographs were taken of all root-filled teeth and of teeth with apical radiolucency, and periapical status was evaluated using the Periapical Index. Apex-to-filling distance and homogeneity were assessed for all root fillings. Analyses on individual level and tooth level were performed. The outcome variables were 'non-root-filled tooth with AP' ('untreated AP'), 'root-filled tooth', and 'root-filled tooth with AP'. The explanatory variables were gender, education, dental attendance pattern, smoking, remaining teeth (n), tooth group, and root filling quality. Chi-square test and logistic regression analyses were used to assess the associations between outcome variables and explanatory variables. The level of significance was set to p < 0.05. RESULTS: The mean number of remaining teeth was 26 (SD: 4). AP was present in 45% of the individuals. Sixteen percent of the individuals had untreated AP and 38% had at least one root-filled tooth with AP. Sixty-six percent of the individuals had one or more root-filled teeth. Untreated AP was significantly associated with a decreasing number of remaining teeth and smoking. All the outcome variables were significantly more prevalent in molars compared with premolars and anterior teeth. Thirty-five percent of the root-filled teeth had AP, and AP was more prevalent in teeth with too short apex-to-filling distance (53%) or unsatisfactory homogeneity (46%). CONCLUSIONS: The remaining number of teeth was high, and AP and root-filled teeth were prevalent in the present young-elderly population. A notable amount of untreated AP was observed, especially in smokers. The findings in the present study indicate a substantial need for dental care associated with endodontic conditions in the future elderly.

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

AIM: Crohn's disease (CD) and ulcerative colitis (UC) are two chronic recurrent inflammatory processes of the gastrointestinal tract, grouped under the name inflammatory bowel disease (IBD), causing clinical episodes of intestinal inflammation. The aim of this study was to investigate the possible association between IBD and the prevalence of apical periodontitis (AP) and root canal treatment. METHODOLOGY: A case-control study design matched to age and sex was used. The study group (SG) included 28 patients with IBD (13 with CD, 15 with UC). Another 28 healthy subjects, without IBD and age- and sex-matched, were included in the control group (CG). Radiographic records were analysed and AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score. Student's t-test, χ2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: In the CG, only 17 subjects (61%) had at least one tooth with AP, whilst in the SG group they were 23 patients (82%; OR = 2.98; 95% CI = 0.87-10.87; p = .08). The number of subjects with one or more root filled teeth (RFT) in the CG was 14 (50%), whilst in the SG they were 22 (79%; OR = 3.67; 95% CI = 1.14-11.79; p = .026). At least one RFT with AP was evident in three subjects (10.7%) in the CG, whilst in the SG 15 patients (53.6%) showed RFT with AP (OR = 9.60; 95% CI = 2.35-39.35; p = .001). In the multivariate logistic regression analysis, only endodontic status was found to be associated with IBD (OR = 1.86; 95% CI = 1.24-2.80; p = .003). CONCLUSION: IBD, UC and Crohn's disease are associated with higher prevalence of RFT and higher percentage of RFT with periapical lesions. Dentists should consider these findings when caring for IBD patients by monitoring the evolution of periapical lesions of endodontically treated teeth.

Prevalence of Apical Periodontitis in Patients with Autoimmune Diseases under Immunomodulators: A Retrospective Cohort Study.

INTRODUCTION: The aim of this retrospective cohort study was to investigate the prevalence of apical periodontitis (AP) in patients affected by autoimmune diseases (ADs) taking biologic medications (BMs). METHODS: Ninety-nine patients (2440 teeth) with ADs referred to the university clinic for dental evaluation were investigated. The controls included 99 patients (2655 teeth) with no systemic diseases and taking no medications. The patients underwent a complete oral, dental, and radiographic examination for the presence of AP. The periapical index and the status of endodontic and restorative treatments were obtained. Statistics were based on descriptive analysis and continuous variables for the total sample and by subgroups. Adjusted odds ratios and 95% confidence intervals were calculated. RESULTS: The prevalence of AP was 65.7% in the autoimmune diseases group (AI) and 46.5% in the controls (P ≤ .05). The association between smoking and AP was significant (P ≤ .05). Among the AI subgroups, rheumatoid arthritis patients at the tooth level had a lower probability of developing AP than patients with inflammatory bowel disease (P ≤ .05). Furthermore, each additional year of age implied a +1% risk of AP; women had a lower periapical index than men in both groups (P ≤ .05), and tocilizumab was associated with a reduced risk of AP compared with infliximab (P ≤ .05). CONCLUSIONS: Patients with ADs taking BMs had a higher prevalence of AP. These results indicate that the status of the patients' immune system may have an effect on the development and prevalence of AP.

Endodontic inflammatory disease: A risk indicator for a first myocardial infarction.

AIM: To study the association between endodontic inflammatory disease and a first myocardial infarction (MI). METHODOLOGY: The study comprised 805 patients with recent experience of a first MI, each gender, age and geographically matched with a control. Panoramic radiographs were available for 797 patients and 796 controls. Endodontic inflammatory disease was assessed radiographically. The sum of decayed, missing and filled teeth (DMFT) was calculated, and the number of root filled teeth and teeth with periapical lesions were recorded. The associated risk of a first MI was expressed as odds ratios (OR) with 95% confidence intervals (CI), unadjusted and adjusted for confounders (family history of cardiovascular disease, smoking habits, marital status, education and diabetes). RESULTS: Patients who had suffered a first MI had higher DMFT (mean 22.5 vs. 21.9, p = .013) and more missing teeth (mean 7.5 vs. 6.3; p < .0001) than the healthy controls. The number of missing teeth was associated with an increased risk of a first MI (adjusted OR 1.04; CI 1.02-1.06). Conversely, decay-free, filled teeth were associated with decreased risk (adjusted OR 0.98; CI 0.96-1.00). Analysis based on age disclosed the following variables to be associated with an increased risk of a first MI: number of decayed teeth (adjusted OR 1.18; CI 1.02-1.37, in patients <60 years), any primary periapical lesion (adjusted OR 1.57; CI 1.08-2.29, in patients <65 years) and the proportion of root filled teeth (adjusted OR 1.18; CI 1.03-1.36, in patients ≥65 years). CONCLUSIONS: More missing teeth was independently associated with an increased risk of a first MI. In addition, endodontic inflammatory disease may contribute as an independent risk factor to cardiovascular disease since untreated caries, periapical lesions and root fillings, depending on age, were significantly associated with a first MI.

The association of apical periodontitis and type 2 diabetes mellitus: A large hospital network cross-sectional case-controlled study.

BACKGROUND: The relationship of apical periodontitis (AP) and type 2 diabetes mellitus (T2DM) is poorly studied in large populations. The aims of this study were to determine if there is an independent association between AP and T2DM in a large hospital network after controlling for confounding variables, as well as to determine if glycated hemoglobin levels were independently associated with AP. METHODS: An initial search of the Carolina Data Warehouse for Health yielded 5,995,011 patients, of whom 7,749 were diagnosed with AP in 2015 through 2018. Patients' demographics, T2DM status, HbA1c, periodontal disease, oral cellulitis, hypertension, atherosclerosis, kidney disease, smoking, body mass index, the use of metformin or statins, and hospital inpatient status were collected from their most recent visit. A control group of 7,749 patients without AP were sampled and matched according to the age, race, and sex of each patient with AP. Multiple logistic regression was used to determine the association between T2DM and AP, as well as between HbA1c and AP after controlling for the effects of the aforementioned confounding variables, using a matched cohort design. RESULTS: T2DM was independently associated with significantly greater prevalence of AP (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.73 to 2.43). The use of metformin (OR, 0.82; 95% CI, 0.69 to 0.98) or statins (OR, 0.70; 95% CI, 0.62 to 0.78) was independently associated with significantly lower prevalence of AP. HbA1c greater than 8.0 (OR, 2.46; 95% CI, 1.83 to 3.35) was significantly associated with greater prevalence of AP. CONCLUSIONS: T2DM and poorly controlled glycemia were significantly associated with AP. Metformin and statin use were associated with lower prevalence of AP. PRACTICAL IMPLICATIONS: This study provides evidence linking T2DM and the level of glycemia to the increased prevalence of AP. Statins and metformin use may be protective in this relationship.

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis.

BACKGROUND: Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). MATERIAL AND METHODS: A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, 2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome "periapical status" (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 - 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 - 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 - 472.15; p = 0.002), regardless of IBD type. CONCLUSIONS: The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment.

Association of ankylosing spondylitis with radiographically and clinically diagnosed apical periodontitis: A cross-sectional study.

BACKGROUND: There are no studies evaluating the possible association between ankylosing spondylitis (AS) and apical periodontitis (AP). OBJECTIVES: The aim of the present cross-sectional study was to investigate the possible association between AS and AP. MATERIAL AND METHODS: Fifty patients diagnosed with AS, receiving treatment at the Rheumatology Clinic in Erzurum, Turkey, were included in the experimental group. Another 50 ageand gender-matched individuals without any history of systemic disease were included in the study as the control group. All patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients: the smoking habit, the number of teeth present, the number of teeth with AP, the number of root canal-treated (RCT) teeth, and the number of RCT teeth with AP. RESULTS: There were 1,283 teeth in the AS group and 1,305 in the control group. There was a significant association between teeth with AP and AS, as the prevalence of teeth with AP was significantly lower in the control group (1.3%) than in the AS group (2.9%) (OR (odds ratio) = 2.250; p = 0.005). There was no statistically significant difference between the groups in terms of the number of RCT teeth and RCT teeth with AP (p > 0.05). CONCLUSIONS: Ankylosing spondylitis is significantly associated with an increased prevalence of AP. It can be concluded that patients with AS can be more prone to develop AP. However, AS does not reduce the success rate of endodontic treatment, because there was no significant difference between the AS and control groups in terms of RCT teeth with AP.

The influence of tobacco smoking on dental periapical condition in a sample of an adult population of the Lódz region, Poland.

OBJECTIVES: Epidemiological studies show that apical periodontitis (AP), alongside tooth decay, is the most common oral disease. The aim of the study was to evaluate the influence of smoking on the prevalence of AP in the population of the Lódz region, Poland. MATERIAL AND METHODS: The study involved 815 first-time, randomly selected patients reporting to the Central Teaching Hospital of the Medical University of Lodz. The studied group was a systematic sample of the population admitted for treatment in 2016. The study consisted of a questionnaire and a radiological part. Each patient filled out a questionnaire containing demographic data, and an interview regarding smoking and diabetes. The radiological part of the study included the analysis of panoramic radiographs which showed the periapical status, and the presence and quality of root canal treatment. RESULTS: Teeth with AP were observed more frequently in patients addicted to tobacco either at the time of the study or in the past (group 1) - 7.2% than in people who had never smoked (group 2) - 5.2% (p < 0.0005). In the teeth without root canal treatment, AP was observed more frequently in group 1 - 3.5% than in group 2 - 1.9% (p < 0.0005). A statistically significant difference was found in the percentage of endodontically treated teeth between group 1 and group 2 (10.7% vs. 9.6%) (p = 0.017). However, no difference was observed in the frequency of AP in the endodontically treated teeth in both groups (37.6% vs. 35.8%) (p = 0.451). CONCLUSIONS: Smokers are a group facing an increased risk of AP and, therefore, there is a need for an early detection and treatment of caries and its complications in this group of patients. The multifactorial etiology of AP indicates the necessity to undertake further studies on the effect of smoking on the periapical status. Int J Occup Med Environ Health. 2020;33(1):45-57.

Presença de cárie e periodontite apical em pacientes portadores de doença renal crônica com necessidade de transplante renal / Presence of caries and apical periodontitis in patients with chronic kidney disease requiring kidney transplantation

A doença renal crônica (DRC) é caracterizada pela alteração progressiva e irreversível da função dos rins. A presença de lesões cariosas e da periodontite apical exercem influência na saúde sistêmica dos pacientes com DRC. O objetivo do presente estudo foi avaliar a presença de cáries e periodontites apicais em pacientes que estão em tratamento de hemodiálise e na lista de espera para transplante renal. Vinte e seis pacientes aceitaram participar do estudo, porém as informações de um foram excluídas por se enquadrarem nos critérios de exclusão. Então, foi realizado exame clínico e radiográfico periapical em 25 pacientes, onde o índice CPO-D foi determinado considerando as faixas etárias, assim como, foi verificado a presença de periodontites apicais e a sua indicação para tratamento endodôntico ou extração dentária. Os pacientes também relataram práticas de saúde bucal e presença de sintomatologia durante a anamnese. Em 12 pacientes foi detectado pelo menos um dente com lesão cariosa e a média de dentes com lesões de cárie por paciente foi de 2,64. O índice CPO-D foi de 12,66 para pacientes com idade entre 23 e 34 anos, índice considerado moderado pela OMS; CPO-D de 15,71 para pacientes na faixa etária dos 35 à 44 anos e de 17,16 para pacientes entre 45 e 64 anos, índices considerados como "alto" pela OMS. Foi observado a presença de periodontite apical em 32% dos pacientes e a média de lesões por paciente foi de 2,37. Do total de periodontites apicais presentes 7 foram indicadas ao tratamento endodôntico e 6 à extração dentária. Foi observado ausência de cárie e/ou periodontite apical em 10 dos 25 pacientes avaliados. Conclui-se que os pacientes portadores de doença renal crônica possuem alta incidência de lesões de cáries e alta prevalência de periodontites apicais(AU)

Chronic kidney disease (CKD) is characterized by the progressive and irreversible alteration of the function of the kidneys. The presence o f carious lesions and periapical periodontitis have an influence on the systemic health of patients with CKD. The aim of the present study was to evaluate the presence of dental caries and periapical periodontitis in patients undergoing hemodialysis treatm ent and on the kidney transplant. Twentysix patients agreed to participate in the study waiting list of . Because of the inclusion criteria, one of them had to be excluded . Then, a clinical and periapical radiographic examination was performed in 25 patien ts, where the DMFT index was determined considering the age groups, as well as the presence of apical periodontitis and the indication of endodontic treatment or tooth extraction. Patients also reported oral health practices and symptomatology during anamn esis. In 12 patients less than one tooth with dental carie was detected and the average of teeth with dental caries per patient was 2.64. The DMFT index was 12.66 for patients aged 23 to 34 years, a rate considered moderate by the WHO; DMFT of 15.71 for pa tients aged 35 to 44 years and 17.16 for patients aged 45 to 64 years, rates considered "high" by the WHO. Apical periodontitis was observed in 32% of patients and the average of lesions per patient was 2.37. The total apical periodontitis presents 7 indic ators of endodontic treatment and 6 of tooth extraction. Absence of caries and / or apical periodontics was observed in only 10 of 25 patients. It was concluded that patients with chronic kidney disease suffer a high incidence of dental caries and a high p revalence of periapical periodontitis(AU)

Associação entre a periodontite apical e o diabetes mellitus: uma revisão da literatura / Association between apical periodontitis and diabetes mellitus: a literature review

Objetivo: realizar uma revisão de literatura para verificar a relação entre o diabetes mellitus e a periodontite apical (PA). Revisão da literatura: a PA caracteriza-se por uma perda óssea na região do ápice dental, que decorre principalmente da contaminação do sistema de canais radiculares. Embora a PA seja um processo inflamatório local, na região do periápice radicular, sua progressão pode ser influenciada por patologias sistêmicas, como o diabetes. O diabetes melittus é uma patologia crônica na qual há alteração na produção de insulina ou resistência à ação desta, esse hormônio auxilia a manter a concentração normal de glicose sanguínea. O quadro de hiperglicemia crônica presente no paciente diabético descompensado ocasiona alterações fisiológicas, que permitem suspeitar de uma relação entre o diabetes e a progressão de lesões periapicais. Considerações finais: a literatura estudada sugere uma associação positiva entre a presença do diabetes e a progressão de lesões periapicais. Porém, apesar de os estudos apontarem que existe uma maior prevalência de periodontite apical em diabéticos, ainda são poucas as evidências científicas sobre o assunto. (AU)

Objective: the present study aims to review the lit-erature to verify the relationship between diabetes mellitus and apical periodontitis (AP). Literature Review: the AP is characterized by bone loss in the tooth apex region, mainly resulting from the contamination of the root canal system. Although AP is a local inflammatory process in the root peri-apex region, its development may be affected by systemic pathologies such as diabetes. Diabetes mellitus is a chronic condition that causes chang-es in insulin production or the resistance to its action, considering this hormone helps maintain-ing the normal concentration of blood glucose. The chronic hyperglycemia condition in decom-pensated diabetic patients causes physiological changes that allow establishing a relationship be-tween diabetes and the development of the peri-apical lesions. Final considerations: the literature studied suggests a positive association between the presence of diabetes and the development of periapical lesions. However, although studies in-dicate a higher prevalence of apical periodontitis in diabetics, there is still little scientific evidence on the subject. (AU)

Investigating Potential Correlations between Endodontic Pathology and Cardiovascular Diseases Using Epidemiological and Genetic Approaches.

INTRODUCTION: Apical periodontitis (AP) and cardiovascular diseases (CVDs) are chronic conditions triggered by an inflammatory process and sharing similar pathogeneses and molecular players. Previous studies have suggested that AP may perpetuate a systemic inflammation state and, in turn, contribute to CVD. In this study, we investigated the potential association between endodontic pathology and CVD using epidemiological and genetic approaches. METHODS: Epidemiologic analysis was performed by querying the medical and dental records of >2 million patients. We retrieved information on positive/negative history for endodontic pathologies and CVDs using diagnostic and treatment codes from a dental school-based and a hospital-based patient electronic health record system. A case-control genetic association study was also performed; 10 single nucleotide polymorphisms in genes identified as strongly associated with CVDs were genotyped in 195 cases with AP and 189 control individuals without AP. Data analyses were performed using the chi-square and Fisher exact tests. P ≤.05 indicates significant difference between groups. RESULTS: Significant associations were found between the presence of endodontic pathology and a history of hypertension, myocardial infarction, cerebrovascular accident, pacemaker, congestive heart failure, heart block, deep vein thrombosis, and cardiac surgery (0.0001 ≤ P ≤ .008). A modest association was found for heart murmur and atrial fibrillation (P = .04). A trend toward positive association (P = .05) was also found between AP and a single nucleotide polymorphism in KCNK3, a gene known to be involved in increased susceptibility to hypertension. CONCLUSIONS: Significant associations were found between endodontic pathology and various CVDs and CVD-related risk factors, particularly hypertension. A trend toward a positive association was also found between AP and KCNK3, suggesting that common genetic variations may underlie different diseases. Additional studies with larger sample sizes have the potential to elucidate common mechanisms underlying AP and CVD.

Socio-economic and health status as a predictor of apical periodontitis in adult patients in Croatia.

OBJECTIVE: A few studies focused on determinants of apical periodontitis other than technical or biological factors. This research aimed to investigate to what extent socio-economic and health status can predict apical periodontitis in adult patients. SUBJECTS AND METHODS: The cross-sectional study included 599 adult patients. Medical history, health habits and socio-economic status of each participant were recorded using a self-administered structured questionnaire. For caries detection, the World Health Organization diagnostic thresholds were used, and oral hygiene level was estimated using plaque index. Periapical index system was used to analyse the periapical status of all teeth. Dental, socio-economic and health-related variables were tested against dependent variable (periapical disease ratio) in a multiple linear regression analysis. RESULTS: Dental independent variables explained 71.7% of the observed variation in periapical disease ratio (R2  = 0.717; p < 0.001). Periapical disease ratio increased with the increase in number of carious teeth, plaque index and number of root-filled teeth, but also with decrease in number of coronal fillings (all p < 0.001). Socio-economic and health-related variables accounted for lower portion of variability, 15.5% and 12.9%, respectively (both p < 0.001). CONCLUSIONS: Dental variables are more important predictors of periapical status than socio-economic and health-related variables.

Periapicopatias inflamatórias de origem endodôntica: estudo multicêntrico na população brasileira / Endodontic periapical lesions: A multicenter study in the Brazilian population

Introdução: as periapicopatias inflamatórias de origem endodôntica são as doenças mais frequentes dos ossos maxilares e ocorrem principalmente como consequência da disseminação da infecção endodôntica. Apesar de vários estudos, não existem dados recentes sobre as características epidemiológicas e clínicas dessas lesões envolvendo uma amostra tão grande da população. Objetivo: Investigar as características epidemiológicas e clínicas das periapicopatias inflamatórias de origem endodôntica, incluindo o granuloma periapical, o cisto radicular e o abscesso periapical. Metodologia: foi realizado um estudo retrospectivo e multicêntrico em quatro instituições com centros de referência em diagnóstico oral no Brasil. Todos os registros histopatológicos foram revisados e foram incluídos todos os casos diagnosticados microscopicamente como granuloma periapical, cisto radicular e abscesso periapical. Foram coletados os seguintes dados demográficos e clínicos: sexo, idade e cor da pele dos pacientes, sintomas, duração, tamanho e localização das lesões e concordância entre o diagnóstico clínico e histopatológico. Análises estatísticas descritivas e bivariadas, utilizando o teste Qui-quadrado de Pearson, foram realizadas. Em casos de variáveis com mais de duas categorias, utilizou-se o teste Z para comparação das proporções de colunas e a correção de Bonferroni. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: foram encontrados 10.381 casos de lesões periapicais entre 74.931 espécimes arquivados (13,8%) em 65 anos. Os cistos radiculares foram as lesões mais comuns (59,9%). As lesões periapicais acometeram principalmente mulheres (56,1%), com média de idade de 37,01 anos (13 a 100 ± 14,42 anos) e cor de pele branca (59,2%). As lesões eram geralmente assintomáticas (28,1%), persistindo por mais de um ano (13,3%), com tamanho de até 10 mm (25,2%) e localizadas na maxila (60,1%) e região posterior (49,8%). Os cistos radiculares foram maiores (p < 0,001), com maior ocorrência de sintomatologia (p < 0,027) e maior frequência na região posterior (p < 0,001) em relação aos granulomas periapicais. A possibilidade de discordância entre o diagnóstico clínico e histopatológico foi maior nos granulomas periapicais (p < 0,001). Conclusões: as periapicopatias inflamatórias de origem endodôntica foram comuns em serviços de Patologia Bucomaxilofacial, acometendo principalmente adultos. Isso deve ser uma consequência da carga de cáries não tratadas em dentes permanentes. As mulheres são mais afetadas e o cisto radicular é a lesão mais comum.

Introduction: Inflammatory periapical lesions are the most frequent diseases of maxillary bones and occur mainly as a consequence of the dissemination of endodontic infection. Despite several studies, there are no recent data on the epidemiological and clinical characteristics of these lesions involving such a large sample. Objective: To investigate the epidemiological and clinical characteristics of periapical lesions, including periapical granuloma, radicular cyst and periapical abscess. Methodology: A multicenter retrospective study was realized in four institutional reference centers in oral diagnosis in Brazil. Histopathological records were reviewed and included all cases diagnosed microscopically as periapical granuloma, radicular cyst and periapical abscess. Data on patient sex, age, skin color, symptoms, lesion duration, lesion size, lesion location and concordance between clinical and histopathological diagnosis were collected. Descriptive statistics and bivariate analyses using Pearson's Chi-square test were done. A z-test, to compare the column proportions, and Bonferroni correction were used, in the case of variables with more than two categories. P values < 0.05 were considered statistically significant. Results: Were found 10,381 cases of periapical lesions among 74,931 archived specimens (13.8%) in 65 years. Radicular cysts were the most common lesions (59.9%). Periapical lesions affected mainly women (56.1%), with a mean age of 37,01 years (range 13 to 100 ± 14,42) and white-skinned (59.2%). The lesions were generally asymptomatic (28.1%), persisting for more than one year (13.3%), size up to 10 mm (25.2%) and located in the maxilla (60.1%) and posterior region (49.8%). The radicular cysts were larger (p < 0.001), with a higher occurrence of symptomatology (p < 0.027) and higher frequency in the posterior region (p < 0.001) compared to periapical granulomas. The possibility of disagreement between clinical and histopathological diagnosis was higher in periapical granulomas (p < 0.001) than radicular cyst. Conclusions: Endodontic periapical lesions were common in the Bucomaxillofacial Pathology services affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst is the most common lesion.