Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Aging

Abstract

Aim

To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) – as the sum of AP and RCT sites – were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Aging (BLSA).

Methodology

This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. Total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was, incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean=17.4±11.1 years) following dental examination. Relative Risks (RR) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE.

Results

Mean age at baseline was 55.0±16.8 years and 51.4% were men. Sixty two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age≥60 years (RR=3.07, 95%CI=1.68-5.62), hypertension (RR=2.0, 95%CI=1.16-3.46) and EB≥3 (RR=1.77, 95%CI=1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to non-significance after adjustments (RR=1.97, 95%CI=0.83-4.70).

Conclusions

EB in mid-life was an independent predictor of CVE among community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.