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

      Seltzer, Jared Ian; Fouad, Ashraf F. (2012)
      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.
    • The Effects of Local Antibiotic Administration on Endodontic Treatment Outcomes

      Bennett, Ian G.; Fouad, Ashraf F. (2011)
      Teeth with periapical radiolucency have a lower prognosis than those without radiolucency and may take up to 4 years for complete healing after primary endodontic treatment. Local delivery of a non-toxic substance with antimicrobial and anti-inflammatory properties may improve the healing of apical periodontitis. The study was a randomized clinical trial to evaluate the effects of local administration of doxycycline or saline at the periapex of teeth with periapical lesions. The primary aim was to compare the change from baseline to 4 months in periapical radiolucency area between doxycyline and saline groups. The secondary aims were to compare the percentage of healed cases (no detectable periapical radiolucency) at 4 months between doxycycline and saline groups and to compare the post-obturation pain experience between doxycycline and saline groups. 20 single-rooted teeth with pulpal necrosis and periapical radiolucency ≥ 3mm were treated endodontically in two visits. Prior to obturation, doxycycline or saline was delivered through the apical foramen into the periapical tissues. Cone-beam computed tomography (CBCT) imaging of the tooth and periapical tissues was performed post-op and at 4 month recall. All patients reported their post-obturation pain experience using a Visual Analogue Scale (VAS). There was no significant difference when comparing the change from baseline to 4 months in periapical radiolucency area between doxycycline and saline groups (p = 0.36, One-Way ANOVA). There was no difference when comparing the percentage of healed cases (no detectable periapical radiolucency) at 4 months between groups. All patients had mild (<30/100 VAS) to no pain that uniformly resolved within 7 days. There was no significant difference when comparing VAS scores between groups (p > 0.05, One-Way ANOVA controlling for level of pre-op pain using a linear regression model). The local administration of doxycycline at the periapex of teeth with periapical lesions did not significantly improve healing of periapical radiolucencies at 4-months. It did, however, show potential as a clinically important adjunct that warrants future research. Doxycycline did not appear to have any deleterious effects upon healing of periapical lesions and it was not associated with significant increases in post-operative pain.