The Association between Endodontic Pathosis and Cardiovascular Disease: A Systematic Review and Feasibility Study

Abstract

Introduction: There have been many reports in the literature showing a potential relationship of periodontal disease and cardiovascular disease. The aim of this study was to evaluate the association of endodontic pathosis with cardiovascular disease by means of systematic review of the literature. Methods: A literature search was conducted on MEDLINE via OVID using the following MeSH terms: Periapical diseases, Endodontics and Cardiovascular diseases. Hand searching was performed through 3 endodontic textbooks. A strict inclusion criteria was used. The sample size for each category of exposure and outcome was estimated using data from the articles. Results: The search identified a total of 190 published articles. A total of five articles met all the inclusion criteria. According to the Strength of Recommendation Taxonomy (SORT) grading system recently recommended by the Journal of Evidence Based Dental Practice, all five studies were classified as Level 2: limited-quality evidence. The results of this review showed substantial variations in methods and findings, which posed a problem in performing a meta- analysis. Four of the five studies found a significant association between endodontic pathosis and cardiovascular disease. The fifth study found a similar significant association before performing a multivariate analysis. The prevalence of CHD was significantly higher in groups of 2 and greater than or equal to 3 periapical lesions when compared to no periapical lesions. Conclusions: The findings of this study show an important association that deserves to have additional study.