Introduction:
In recent years, an intriguing connection has emerged between dental health and cardiovascular well-being, shedding light on the intricate interplay between oral and systemic health. Among the dental conditions garnering attention is apical periodontitis (AP), a form of inflammation affecting the dental or alveolar bone surrounding the root apex of teeth. While traditionally viewed as a localized dental issue, mounting evidence suggests that AP may exert systemic implications, particularly concerning cardiovascular disease (CVD). This intriguing possibility has sparked considerable interest and investigation within the medical and dental communities, prompting a deeper exploration into the potential link between AP and CVD. By dealing with this relationship, it aims to uncover the underlying mechanisms and implications for both dental and cardiovascular health, ultimately shaping the understanding of holistic approaches to patient care.
Is Apical Periodontitis Linked to Cardiovascular Disease?
Apical periodontitis (AP) represents a significant form of inflammation affecting the dental or alveolar bone surrounding the root apex of teeth. It falls under the broader category of perio-endo lesions. Globally, it affects approximately 52 percent of individuals at the individual level, accounting for around five percent of tooth-borne diseases worldwide. Apart from its local impact on the tooth and gingival tissues, AP can also trigger low-grade systemic inflammation, potentially posing risks to long-term systemic health. Numerous medical and dental studies have established connections between periodontal and endodontic diseases and systemic conditions.
Despite numerous research efforts aiming to establish a definitive link between apical periodontitis (AP) and conditions such as cardiovascular disease (CVD) or type 2 diabetes, the findings have been inconsistent, leading to ongoing debate. However, recent dental research has been accumulating evidence suggesting a potential association between AP and systemic conditions, particularly diabetes and CVD. Given that CVDs stand as the primary cause of mortality worldwide, followed closely by a range of other significant medical conditions including cerebrovascular diseases (stroke), coronary heart diseases(heart disease), congenital heart diseases(birth defects involving the heart), peripheral arterial diseases(poor blood flow to limbs), deep vein thrombosis(blood clot in deep veins), and pulmonary embolism(blood clot in lungs), according to the World Health Organization (2017), understanding any potential links between AP and CVD is crucial.
How Can Cardiovascular Disease Occur Because of Tooth Bound Periapical Infections?
Most cardiovascular diseases (CVDs) stem from endothelial dysfunction, leading to the formation of atherosclerotic plaque in the heart. This plaque buildup, driven by the accumulation of unhealthy fat tissue or lipids and connective tissue inflammation, significantly slows down metabolism in individuals affected by CVD. In research comparing healthy young adults with apical periodontitis to control groups without any periodontal or period-endo disease, clear signs of endothelial dysfunction and elevated levels of inflammatory bioactive molecules were observed in those with AP. These findings suggest that AP may indeed increase the long-term risk of developing CVD. Moreover, even after undergoing effective dental surgical treatments, there appears to be a temporary period of systemic inflammatory response in the body, as highlighted by the research. Over time, the temporary phase of inflammation typically resolves in healthy individuals. However, for those at an increased risk of cardiovascular events, this temporary inflammation could pose concerns. It is crucial to recognize that unless the clinical symptoms of apical periodontitis are addressed through endodontic treatment or periapical surgery by a dental surgeon, localized inflammation cannot be effectively relieved. Therefore, it underscores the importance for most individuals with apical periodontitis (AP) to undergo routine endodontic procedures to manage the condition effectively.
What Is the Research Based Evidence to Systemic Inflammation?
Detailed research investigations have revealed that patients with apical periodontitis (AP) exhibit a significantly higher systemic inflammatory burden compared to healthy control subjects. Specifically, young adults with AP displayed increased inflammatory markers such as IL-1β(Interleukin-1 beta), hs-CRP(high-sensitivity C-reactive protein), and FGF-23(Fibroblast Growth Factor 23). Moreover, the severity of AP, indicated by larger apical radiolucencies or dental periapical lesions, correlated with even higher levels of IL-1β and FGF-23. These findings align with other medical studies indicating that dental lesions can have inflammatory effects on systemic health. Raised levels of systemic inflammatory mediators, including ADMA(Asymmetric Dimethylarginine), hs-CRP(high-sensitivity C-reactive protein), IL-1β(Interleukin-1 beta), IL-6(Interleukin-6), MMP-8(Matrix Metalloproteinase-8), and E-selectin have similarly been observed in patients with AP or apical periodontitis. Following treatment of apical periodontitis, levels of inflammatory mediators such as IL-1β, IL-8, CPR, C3, MMP-2, and MMP-9 were significantly elevated within the first 3 to 6 months. These findings suggest the presence of a transient inflammatory period that persists even after endodontic or apical surgery treatment.
What Are the Contraindications?
Recent dental research demonstrates that one year after endodontic or periapical surgical treatment, inflammatory mediators such as FGF-23, pentraxin-3, and ADMA levels were significantly reduced, even falling below baseline levels. This highlights the temporary increase in systemic inflammatory markers induced by invasive dental procedures. Consequently, individuals with pre-existing cardiovascular risks, such as heart patients, are often considered contraindicated cases for apical surgery or re-root canal treatment, as suggested by some dental experts and researchers.
Why Is Dental Treatment or Periapical Surgery Mandatory in Healthy Individuals?
For healthy individuals, undergoing endodontic treatment or apical surgery is crucial to effectively eradicate the infection associated with apical periodontitis. It's important to note that while there may be a temporary increase in inflammatory mediators in the body following such interventions, the long-term systemic inflammation rate is typically low after endodontic intervention. Therefore, this short-lived phase of inflammatory mediator elevation should not deter individuals from pursuing the recommended local treatment protocol or endodontic intervention administered by their dentist or endodontist. These procedures are essential for not only alleviating local symptoms but also for preventing the spread of infection and preserving overall dental and systemic health.
Conclusion:
As it recognizes the mouth as a reflection of overall health, dental diseases have significant implications for long-term systemic health. Research has now firmly established a direct association between dental apical periodontitis (AP) and increased levels of systemic inflammatory markers, elevating the risk of cardiovascular disease and type two diabetes. While healthy individuals can undergo endodontic intervention or apical surgery without significant dental risks, vulnerable patients with cardiac diseases should avoid these local dental treatments due to the transient increase in inflammatory markers immediately afterward. Overall, maintaining good dental health is crucial for sustaining optimal cardiovascular and multi-organ health, underscoring the importance of regular dental check-ups, treatments, and follow-ups.
