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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]

Aim: To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics. Method: The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow‐up questionnaire. Both descriptive and analytical statistics were used to compare respondents and nonrespondents and tooth groups. Results: One hundred and fifty‐nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for nonrespondents (p <.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, p =.02). Fifty per cent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty‐three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present or had not experienced much discomfort during or after RCT. Forty‐four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good. Conclusions: The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient‐centred outcomes. [ABSTRACT FROM AUTHOR]

Apical periodontitis caused by root canal infection is the most frequent pathological lesion in the jaws, mainly manifested as periapical granulomas and cysts. Understanding of the formation and progression of apical periodontitis as well as the identification of inflammatory biomarkers can help increase the knowledge of pathogenic mechanisms, improve the diagnosis and provide support for different therapeutic strategies. The objective of the present article is to review inflammatory biomarkers such as cytokines, chemokines, inflammatory cells, neuropeptides, RANK/RANKL/OPG system and other inflammatory markers and to relate these systems to the development and progression of pathological conditions related to apical periodontitis. [ABSTRACT FROM AUTHOR]

Summary: Background: After root canal treatment, a choice is made between different coronal restorations which in the long run could affect the survival of the tooth. Objective: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals choosing other restorations after completion of a root filling. Methods: The cohort consisted of all root‐filled upper first molars that were reported to the tax‐funded Swedish Social Insurance Agency (SSIA) during 2009. After registration of the root filling, any subsequent coronal restorations within 2 years were identified. The crown group consisted of individuals registered with an indirect coronal restoration and the restoration group was the remaining individuals with a direct coronal restoration or lacking registration. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi‐square test, t test and logistic regression analysis. P < 0.05 was considered statistically significant. Results: An indirect coronal restoration was received by 7806 individuals (21.9%), and 27 886 individuals (78.1%) received a direct restoration. All demographic variables except gender differed significantly between groups. Logistic regression analysis found significant associations for all demographic variables and the registration of an indirect restoration except for country of birth and gender. Conclusions: The identified demographic differences between individuals choosing to restore their newly root‐filled teeth with an indirect restoration compared to those receiving other restorations may indicate that the tax‐funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens. [ABSTRACT FROM AUTHOR]