Search

Aim: To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular‐ and all‐cause mortality in a follow‐up of approximately 8 years. Methodology: The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co‐occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow‐up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses. Results: A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD‐10 I00–I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum‐likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (all‐cause 0.91; 0.86–0.96, CVD mortality 0.89; 0.83–0.96), use of removable dentures (all‐cause 0.24; 0.09–0.62, CVD mortality 0.20; 0.06–0.72), root canal fillings (all‐cause 0.82; 0.70–0.94, CVD mortality 0.79; 0.63–0.96) and having root canal fillings in all teeth with apical rarefactions (all‐cause 0.27; 0.06–0.79, CVD mortality 0.09; 0.01–0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for. Conclusions: The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services. [ABSTRACT FROM AUTHOR]

Aim: To assess the diagnostic accuracy of Cone Beam Computed Tomography (CBCT) to diagnose apical periodontitis (AP) using histopathology of ex vivo human jaws as the reference standard., Methodology: Based on periapical radiographs of jaw specimens from human bodies donated for science, a sample of 223 teeth with 340 roots including all tooth groups, and different disease and treatment statuses was selected. Cone Beam Computed Tomography was performed using Cranex ® 3Dx (Soredex Oy, Tuusula, Finland), small field-of-view (5 × 5 cm), and isotropic resolution 0.085 mm. Three observers assessed the presence of AP using a probability index. Histopathological examination of the periapical area was used as a reference standard to calculate estimates of diagnostic accuracy., Results: For non-root filled teeth all estimates of diagnostic accuracy; sensitivity (SENS), specificity (SPEC), positive predictive value (PPV) and negative predictive value (NPV) were high. All estimates were lower for root filled teeth. When mild AP was classified as 'AP', SENS, SPEC and NPV were significantly lower in root filled roots (P < 0.001 in all cases). The same tendency was seen when mild AP was classified as 'No AP' but here only the difference in SPEC was significant (P < 0.001)., Conclusion: The diagnostic accuracy of CBCT used for diagnosis of AP is dependent on the treatment status of the tooth. For non-root filled teeth the diagnostic accuracy of CBCT is high and almost all cases of AP can be diagnosed correctly with only a very small risk of over-diagnosis. All diagnostic accuracy parameters were lower for root filled roots, hence the diagnosis of AP on root filled roots using CBCT was less accurate., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)