Endodontic Inflammatory Disease and Future Cardiovascular Events and Mortality: A Report from the PAROKRANK Study.

Prospective studies assessing the relation between endodontic inflammatory disease and subsequent cardiovascular events are few. The present aim was to explore associations between endodontic variables and future cardiovascular events in patients with myocardial infarction and matched controls participating in the PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study. Eight-hundred five patients hospitalized for a first myocardial infarction and 805 controls were recruited between 2010 and 2014. Signs of endodontic inflammatory disease were assessed in panoramic radiographs taken at baseline. Mortality and morbidity data during the approximately 8 years of follow up were obtained from national registries. The risk for future cardiovascular events (first of mortality and nonfatal myocardial infarction, stroke, or hospitalization for heart failure) was analyzed with the log-rank test and Cox proportional hazards regression adjusted for the following confounders: sex, age, smoking, myocardial infarction, diabetes, education, marital status, family history of cardiovascular disease, and marginal periodontitis. In total, 285 future events were observed during the follow-up period. Unadjusted analyses revealed that ≥1 root-filled tooth increased the risk of a future event. After adjustment, the number of remaining teeth and non-root-filled teeth decreased the risk of future events, whereas a higher Decayed, Missing and Filled Teeth score increased the risk and ≥1 primary apical periodontitis decreased the risk of suffering cardiovascular events. A higher Decayed, Missing and Filled Teeth score and decayed teeth increased the risk of all-cause mortality. Tooth loss is a strong indicator of an increased risk for future cardiovascular events. Root-filled teeth seem of limited value as a risk indicator when accounting for other risk factors. The potential effect of dental interventions on future events should be assessed in future research.

Sebring D ，Buhlin K ，Lund H ，Norhammar A ，Rydén L ，EndoReCo ，Kvist T ... -  《-》

Primary apical periodontitis correlates to elevated levels of interleukin-8 in a Swedish population: A report from the PAROKRANK study.

To explore associations between root filled teeth, primary and secondary apical periodontitis, and levels of inflammatory markers in blood from patients with a first myocardial infarction and matched controls. Between May 2010 and February 2014, 805 patients with a first myocardial infarction and 805 controls, matched for sex, age, and postal code area, were recruited to the multicentre case-control study PAROKRANK (periodontitis and its relation to coronary artery disease). All participants underwent a physical and oral examination, as well as blood sampling. Using panoramic radiography, root filled teeth, primary apical periodontitis, and secondary apical periodontitis were assessed by three independent observers. Blood samples were analysed with enzyme-linked immunosorbent assay method for the following inflammatory markers: interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12p70, tumour necrosis factor-α, and high-sensitivity C-reactive protein (hsCRP). Additionally, white blood cell count and plasma-fibrinogen were analysed. Associations between endodontic variables and the levels of inflammatory markers were statistically analysed with Mann-Whitney U-test and Spearman correlation, adjusted for confounding effects of baseline factors (sex, age, myocardial infarction, current smoking, diabetes, family history of cardiovascular disease, education, marital status, and periodontal disease). Mean age of the cohort was 62 years, and 81% were males. Root fillings were present in 8.4% of the 39 978 examined teeth and were associated with higher levels of hsCRP, fibrinogen, and leukocyte count, but lower levels of IL-2 and IL-12p70. After adjusting for confounders, root filled teeth remained associated with higher levels of fibrinogen, but lower levels of IL-1β, IL-2, IL-6, and IL-12p70. Primary apical periodontitis was found in 1.2% of non-root filled teeth and associated with higher levels of IL-8 (correlation 0.06, p = .025). Secondary apical periodontitis was found in 29.6% of root filled teeth but did not relate to the levels of any of the inflammatory markers. This study supports the notion that inflammation at the periapex is more than a local process and that systemic influences cannot be disregarded. Whether the observed alterations in plasma levels of inflammatory markers have any dismal effects on systemic health is presently unknown but, considering the present results, in demand of further investigation.

Sebring D ，Kvist T ，Lund H ，Jonasson P ，Lira-Junior R ，Norhammar A ，Rydén L ，Buhlin K ，EndoReCo ... -  《-》

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

To study the association between endodontic inflammatory disease and a first myocardial infarction (MI). 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). 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). 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.

Sebring D ，Buhlin K ，Norhammar A ，Rydén L ，Jonasson P ，EndoReCo ，Lund H ，Kvist T ... -  《-》

Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population.

To investigate the relationship of radiographic evidence of root filled teeth to cardiovascular outcomes. Baseline data for 506 subjects including 256 angiographically verified heart disease patients and 250 matched cardiologically healthy controls participating in the Kuopio Oral Health and Heart study were collected in 1995-1996. Cardiovascular disease (CVD) mortalities were accrued until 31 May 2015 and appended to the baseline data. Mortality status data were obtained from the Finnish National Death Register where all mortality cases and the causes of death are compiled for all Finnish citizens. Of the 506 participants, 473 subjects who had no missing values in the predictor, outcome or confounding factors were included in the analyses to assess the relationship of radiographic evidence of root filled teeth with prevalent coronary artery disease (CAD) cross sectionally and also with CVD mortality longitudinally. Multivariable logistic regression was used for the cross-sectional part and proportional hazard regression analyses for the longitudinal part of the study were used adjusting for age, sex, smoking, edentulism, diabetes, hypertension, total/HDL cholesterol ratio and income. Additionally, whether this association was independent of periodontitis, and a systemic marker of inflammation, serum C-reactive protein (CRP) was examined. Having ≥1 root filled teeth was associated with 84% lower odds of prevalent CAD with Odds Ratio (OR) = 0.16, 95% confidence interval (CI) 0.09-0.28, P < 0.0001. The OR for edentulism was 1.32 (CI: 0.73-2.38), P = 0.36, suggesting a nonsignificant increase in risk. Prospectively, having at least one root filled teeth was associated with a 49% lower risk of CVD mortality (hazard ratio [HR] = 0.51, CI = 0.27-0.97, P = 0.04) whilst edentulism was associated with nonsignificantly increased risk for CVD mortality: HR = 1.25 (CI: 0.65-2.42), P = 0.36. Adjustment for periodontitis or serum CRP levels changed the OR or HR slightly but the associations remained significant. Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.

Meurman JH ，Janket SJ ，Surakka M ，Jackson EA ，Ackerson LK ，Fakhri HR ，Chogle S ，Walls A ... -  《-》

Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction.

Gustafsson N ，Ahlqvist J ，Näslund U ，Buhlin K ，Gustafsson A ，Kjellström B ，Klinge B ，Rydén L ，Levring Jäghagen E ... -  《-》