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Aim: To investigate what happens to cross‐sectionally identified root‐filled teeth over a 6‐year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root‐filled teeth over the same time were associated with variables obtained from a baseline examination. Methodology: Adult patients with ≥1 previously root‐filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root‐filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision‐making and treatments. After six years, information on events of the root‐filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5‐point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient‐ and tooth‐related factors and events. Results: A total of 445 patients with 1007 root‐filled teeth were followed the entire observation time. Twenty (2.0%) of the root‐filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p <.0001), tenderness to percussion (p <.0001), and poor coronal restoration (p <.0001). Conclusions: This study corroborates the notion that in general dentistry, root‐filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root‐filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six‐year period. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]