Search

Aim To investigate referrals to a specialist clinic in endodontics in relation to previously root filled teeth and to determine how many of these teeth had a history of symptoms and the extent to which antibiotics were prescribed. Methodology The total number of referrals to the specialist clinic in endodontics in Gothenburg, Sweden, in 2011 was investigated retrospectively by means of patient records. The endodontic status together with the presence or absence of symptoms was registered. The following variables were also examined: gender, age, tooth number and lower or upper jaw. Additionally for root filled teeth, the type of restoration, the technical quality of the root filling and the presence of apical periodontitis were registered. The use of antibiotics was examined for all of the included teeth. Statistical analysis was performed using generalized estimating equation methods applied to univariable and multivariable logistic regression. Results A total of 1117 patient records were investigated, including 1341 referred teeth. Pain and/or swelling were recorded for 658 (54.3%) teeth. Symptoms were significantly more associated with females (P < 0.0001) and molar teeth (P < 0.0001). Seven hundred twenty-nine (54.4%) of the referred teeth were root filled, and of these, 377 (56.0%) were associated with pain and/or swelling. Root filled teeth restored with a post and core were less frequently related to symptoms (P = 0.009). One hundred sixty-two (22.3%) root filled teeth were treated with antibiotics, which was significantly more frequent than for non-root filled teeth (P < 0.0001). Also, root filled teeth with an adequate root filling were significantly associated with more frequent antibiotics prescriptions (23.8%) than root filled teeth with an inadequate root filling (17.0%) (P = 0.0010). Conclusion Root filled teeth constituted the majority of cases referred to this specialist clinic in endodontics. The majority of these teeth were associated with symptomatic conditions, and antibiotics were prescribed to approximately 20% of the patients referred for a root filled tooth. The findings suggest that symptomatic root filled teeth may be a substantial clinical problem in general dentistry and contribute to avoidable prescription of antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: 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., Methodology: 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)., Results: 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., Conclusions: 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., (© 2023 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Purpose: To explore a weighted composite of endodontic inflammatory disease (EID) as a risk factor for suffering a first myocardial infarction (MI)., Materials and Methods: Seven tooth-specific conditions related to EID were assessed radiographically in 797 patients suffering a first MI and 796 controls. A weighted composite of EID was calculated as the sum of all teeth, excluding third molars. Using maximum likelihood estimation, each condition was assigned a specific weight. With multivariable conditional regression, EID variables, periodontal disease, and missing teeth were assessed as predictors of a first MI., Results: Periodontal disease (OR 1.38; 95% CI 1.13-1.69, p = 0.0016) and missing teeth (OR 1.03; 95% CI 1.002-1.05, p = 0.034) were related to the risk of a first MI, while none of the EID-related conditions individually were. However, when assessed as an aggregate, a weighted composite of EID (OR 1.97; 95% CI 1.23-3.17, p = 0.0050) and periodontal disease (OR 1.34; 95% CI 1.09-1.63, p = 0.0046) was associated with the risk of MI. Missing teeth did not remain a statistically significant predictor of MI in the final model., Conclusions: A weighted composite of EID was associated with the risk of MI and strengthens the evidence for a direct connection between oral inflammatory diseases and cardiovascular disorders.

Aim: To study the association between endodontic inflammatory disease and a first myocardial infarction (MI)., Methodology: 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)., Results: 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)., Conclusions: 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., (© 2021 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Objective: To determine whether calibration improves observer reliability when assessing DMFT-score, root-filled teeth and periapical lesions on panoramic radiographs., Material and Methods: A sample of 100 panoramic radiographs was selected from a cohort of myocardial infarction patients ( n  = 797) and matched controls ( n  = 796). The following variables were assessed: DMFT-score, remaining teeth, root-filled teeth and periapical lesions. Two specialists, an endodontist and a radiologist, served as reference examiners and undertook two separate assessments. Disagreement cases were jointly assessed and the final results were used as the reference standard. Three observers undertook three separate assessments, the first without prior training, the second after calibration against the reference standard and the third with the sample concealed in the complete material. Statistical analysis was made with Wilcoxon Signed rank test and Sign test. Agreement was calculated as Intraclass Correlation Coefficient (ICC) (95% CI) and Weighted Kappa ( κ ) (95% CI)., Results: Periapical lesions disclosed high inter-observer variability for the reference examiners and diverged significantly between the observers and the reference standard. For the reference examiners, inter-observer agreement was κ  = 0.53. The observers, in their first assessments had κ values ranging from 0.22 to 0.60 in relation to the reference standard. Following calibration, the κ values increased, ranging from 0.59 to 0.80. For the third assessment, the κ values ranged from 0.54 to 0.75. DMFT-score, remaining teeth and root-filled teeth disclosed high reliability throughout all assessments (ICC = 0.88-0.98 and κ  = 0.98-0.99)., Conclusions: DMFT-score, remaining teeth and root-filled teeth can be reliably assessed on panoramic radiographs. Calibration against a reference standard improves observer reliability in the detection of periapical lesions.

Introduction: The aim of the present study was to evaluate endodontic status and diagnosis of teeth before extraction and their impact on treatment planning and treatment outcomes of dental implant therapy., Methods: Data were retrieved from patient files and radiographs of 596 Swedish individuals provided with implant therapy. Patients were categorized according to diagnosis in conjunction with tooth extraction as follows: PERIO (reason for extraction: periodontitis), CARIES (reason for extraction: caries, apical periodontitis, and/or root fracture), OTHER (reason for extraction: trauma and other), and MIX (a combination of these). Details on treatment planning (timing of implant installation and use of prophylactic antibiotics) and outcomes (early/late implant loss and peri-implantitis) were assessed from patient records or by clinical examination. Tooth status (endodontically treated: yes/no; apical lesion: yes/no) and diagnosis category were explored as independent parameters by logistic regression analyses., Results: For the majority of patients (64%), tooth extraction was based on a caries or caries-related diagnosis. Fifty-one percent of all extracted teeth were endodontically treated. Every third tooth showed radiographic signs of an apical lesion. Immediate implant installation at such sites was less common. Endodontic status before extraction was not associated with the use of antibiotics or with treatment outcomes. The diagnosis category MIX was associated with early implant loss. PERIO was indicative of a higher risk for peri-implantitis., Conclusions: Endodontic status before extraction had a limited impact on treatment planning and was not associated with early/late implant loss or peri-implantitis. Immediate implant installation after tooth extraction was less commonly performed at sites with apical lesions., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Because amyotrophic lateral sclerosis (ALS) differs in many of its characteristics from other progressive and fatal diseases, much of the literature on terminal or paralyzing illness only partially describes the experience of ALS patients. This study details the psychosocial impact of the disease for patients and their families and concludes with specific recommendations on intervention for health care and for social service providers.