Elsevier

Journal of Endodontics

Volume 37, Issue 12, December 2011, Pages 1624-1629
Journal of Endodontics

Clinical Research
Association of Endodontic Infection with Detection of an Initial Lesion to the Cardiovascular System

https://doi.org/10.1016/j.joen.2011.09.006Get rights and content

Abstract

Introduction

Dental infections might predispose toward the onset of cardiovascular disease (CVD). To date, only a few studies, yielding inconclusive findings, have investigated the potential correlation between apical periodontitis (AP) and CVD. The aim of this study (as the first part of a prospective study) was to evaluate, in the absence of CV risk factors, whether subjects with AP were more exposed to the pathogenetic indices of an atherosclerotic lesion.

Methods

Forty men between the ages of 20 and 40 years who were free from periodontal disease, CVD, and traditional CV risk factors were enrolled in the study; 20 subjects had AP, and 20 acted as controls. All subjects underwent dental examination and complete cardiac assessment: physical examination, electrocardiogram, conventional and tissue Doppler echocardiography, and measurement of endothelial flow reserve (EFR). The following laboratory parameters were tested: interleukins -1, -2, and -6 (IL-1, IL-2, IL-6), tumor necrosis factor alpha, and asymmetrical dimethylarginine (ADMA). Data were analyzed by using the 2-tailed Student's t test, Pearson t test (or Spearman t test for nonparametric variables), and multivariate linear regression analysis.

Results

Echocardiography revealed no abnormalities in any of the subjects studied. ADMA levels were inversely correlated with EFR (P < .05) and directly correlated with IL-2 (P < .001). Patients with AP presented with significantly greater blood concentrations of IL-1 (P < .05), IL-2 (P < .01), IL-6 (P < .05), and ADMA (P < .05) and a significant reduction of EFR (P < .05).

Conclusions

Increased ADMA levels and their relationship with poor EFR and increased IL-2 might suggest the existence of an early endothelial dysfunction in young adults with AP.

Section snippets

Study Design and Patient Population

The present study represents the first part of an observational cross-sectional trial conducted on young men observed at the Diagnostic Section of the Dental Clinic at the University of Cagliari during 2009. Subjects were divided into 2 groups, patients affected by AP and healthy controls. The study protocol was approved by the Institutional Ethics Committee (Azienda Ospedaliero-Universitaria, University of Cagliari). Written informed consent was obtained from all subjects.

Inclusion criteria

Results

Table 1 summarizes the basic dental features of the patients in the study group (AP).

In case of multirooted teeth, they were simply classified as having AP whether they exhibited 1 or more periapical lesions. There were no appreciable differences in anthropometric, clinical, and chemical parameters between AP subjects and controls. All patients in the study sample presented at least 1 lesion of endodontic origin. Neither electrocardiogram nor standard and TDI echocardiographic examinations

Discussion

In this study we found (1) a direct correlation between IL-2 and ADMA increases; (2) an inverse correlation between ADMA and EFR; (3) a significant increase in serum levels of IL-1, IL-2, IL-6, and ADMA in patients with AP; and (4) EFR values in the lower limit of normal in AP group, significantly reduced when compared with healthy controls. Both groups featured a lack of clinical and preclinical cardiac injury, as evidenced by normal parameters observed at conventional and TDI echocardiography.

Acknowledgments

The authors deny any conflicts of interest related to this study.

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