Association between cardiovascular diseases and apical periodontitis: an umbrella review

Jakovljevic A 1 , Duncan HF 2 , Nagendrababu V 3 , Jacimovic J 4 , Milasin J 5 , Dummer PMH 6

Affiliations 

  • 1 Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
  • 2 Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
  • 3 Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
  • 4 Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
  • 5 Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
  • 6 School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
Int Endod J, 2020 Oct;53(10):1374-1386.
PMID: 32648971 DOI: 10.1111/iej.13364

Abstract

BACKGROUND: The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive.

OBJECTIVE: To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults.

METHODS: The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics' Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta-analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of 'high', 'moderate', 'low' or 'critically low' quality.

RESULTS: Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as 'moderate' quality, whereas one review was graded as 'critically low' quality.

DISCUSSION: Only one systematic review included a meta-analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis.

CONCLUSIONS: From the limited 'moderate' to 'critically low' quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well-designed, longitudinal clinical studies with long-term follow-up are required.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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