High prevalence of apical periodontitis amongst type 2 diabetic patients

AIM: To study the prevalence of AP in patients with and without type 2 diabetes mellitus. METHODOLOGY: In a retrospective cohort study, the records of 38 subjects with diabetes and 32 control subjects were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the periapical index score. Statistical analyses were conducted using the Cohen's kappa test, analysis of variance and logistic regression. RESULTS: Apical periodontitis in at least one tooth was found in 81.3% of diabetic patients and in 58% of control subjects (P = 0.040; OR = 3.2; 95% CI = 1.1-9.4). Amongst diabetic patients 7% of the teeth had AP, whereas in the control subjects 4% of teeth were affected (P = 0.007; OR = 1.8; 95% CI = 1.2-2.8). CONCLUSIONS: Type 2 diabetes mellitus is significantly associated with an increased prevalence of AP.     

Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish population

AIM: To estimate the prevalence of teeth with apical periodontitis (AP) and root-filled teeth in an adult Spanish population. METHODOLOGY: A total of 180 subjects, aged 37.1 +/- 15.7 years, presenting as new patients to the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs). The frequency of root canal treatment and the periapical status of all teeth, using the periapical index (PAI) score, were assessed. An intraobserver agreement test on PAI scores produced a Cohen's kappa of 0.77 (substantial agreement). Results were analysed statistically using the Chi-square test. RESULTS: Apical periodontitis in one or several teeth was found in 110 subjects (61.1% prevalence), and 73 (40.6% prevalence) had at least one root-filled tooth. Among subjects with root-filled teeth, 48 (65.8%) had AP affecting at least one root-filled tooth. A total of 4453 teeth were examined, of these 186 (4.2%) had AP. The total number of root-filled teeth was 93 (2.1%), of which 60 (64.5%) had AP. Among non-root filled teeth, only 2.9% had AP. The prevalence of AP in connection with molar teeth was higher (5.5%) than for premolar (4.5%) and anterior teeth (3.2%; P < 0.01). More premolar and molar teeth were root-filled (2.8 and 2.7%, respectively) than anterior teeth (1.3%; P < 0.01). The prevalence of AP increased with age. CONCLUSIONS: The prevalence of AP in root-filled and untreated teeth, and the frequency of root-filled teeth were comparable to those reported in previous similar studies carried out in European countries. The prevalence of root-filled teeth with AP was found to be higher compared to that demonstrated in other epidemiological studies.     

Risk indicators for apical periodontitis

OBJECTIVES: The aim of the study was to identify risk indicators for apical periodontitis (AP) in the individual. A parameter was defined as a 'risk indicator' when its presence increased the individual's risk of exhibiting AP. Risk indicators may, but need not be directly associated with the disease. METHODS: The study included full-mouth surveys of 613 randomly selected individuals, who were 20-60 years old and living in Aarhus County. Logistic regression analyses were performed. The outcome variable was >or=1 AP/no AP. The independent variables were obtained from information on socioeconomic and dental status. RESULTS: It was found that smoking, no usage of services from the dentist, >or=2 secondary caries lesions, >or=3 inadequate coronal fillings and the presence of root filling(s) were statistically associated with AP. A separate analysis for individuals with no previous root fillings showed that individuals with regular dental visits as well as individuals who had all their teeth (third three molars excluded) were less likely to have AP, whereas individuals who had >or=3 inadequate coronal fillings were more likely to have AP. CONCLUSIONS: The results from the present study of a Danish population showed that the most important risk indicator of having AP in the individual was the radiographic evidence of root fillings. The presence of several caries lesions, the quality of the dental treatment, the regularity of dental visits and smoking were also statistically associated with AP. Further, the socioeconomic status of the individual did not provide much additional information on the periapical status.     

Fungi in therapy-resistant apical periodontitis

The occurrence of yeasts in 967 microbiological endodontic samples taken from root canals in persistent endodontic infections was studied. The sampling was done by general practitioners in various parts of Finland from root canal infections which did not respond favourably to standard conservative therapy. The samples were cultivated aerobically on a non-selective enriched horse blood agar medium, on TSBV agar medium in 5% CO₂ and anaerobically on horse blood agar medium. Micro-organisms were found in 692 of the samples while 275 showed no growth. Forty-eight fungi were isolated from 47 samples which is 7% of the culture-positive samples. Twenty yeast strains were identified further by their colony morphology, growth and cellular characteristics and patterns of carbohydrate assimilation. All isolates except one belonged to the genus Candida. Candida albicans was the most common species. C. glabrata was found together with C. albicans in one sample. C. guilliermondii, C. inconspicua and Geotrichum candidum were each isolated once. Yeasts were found in pure culture in six samples and together with bacteria in 41 samples. In all the samples except two, the accompanying facultative bacteria were Gram positive. The most frequent of them were α- and non-haemolytic Streptococcus species which were found in 31 samples. Anaerobic bacteria were isolated together with yeasts from 12 root canals. They included both Gram positive species such as Peptostreptococcus micros and Gram negative species such as Fusobacterium nucleatum . The regular isolation of yeasts, also in pure culture, indicates that yeasts may have an important role in cases of apical periodontitis persisting after conventional treatment.     

Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population

AIM: The aim of this study was to investigate the prevalence of endodontically treated teeth and apical periodontitis (AP) in a Danish population. METHODOLOGY: From Aarhus County 614 individuals were radiographically examined, and the frequency of endodontic treatment and periapical status of all teeth were assessed. The year of birth of the subjects ranged from 1935 to 1975. The chi-squared test was used to determine the significance of differences between males and females and amongst age and tooth groups for the following parameters: AP, the number of endodontically treated teeth, and the number of endodontically treated teeth with AP. RESULTS: A total of 15 984 teeth were examined; of these 538 (3.4%) had AP and 773 (4.8%) had been endodontically treated. Of the endodontically treated teeth, 404 (52.2%) had AP. Females had more endodontically treated teeth than males; otherwise, no effect of gender was observed. Significantly more molars (P < 0.01) had been endodontically treated (8.1%) compared to premolars (5.4%) and anterior teeth (2.5%). The prevalence of AP in connection with molars was significantly (P < 0.01) higher (7.0%) than premolars (2.8%) and anterior teeth (1.5%). The prevalence of endodontically treated teeth and of teeth with AP gradually increased with age. CONCLUSIONS: The average number of teeth, the number of teeth with AP and the number of teeth with endodontic treatment in Danish adults were comparable to findings in other European countries. The frequency of endodontically treated teeth with AP was found to be high compared to that demonstrated in other epidemiological studies.     

Time-course and risk analyses of the development and healing of chronic apical periodontitis in man

Roots with and without preoperative chronic apical periodontitis were root canal treated and followed clinically and radiographically yearly for up to 4 years. Of 732 roots treated, 599 (82%) were available for evaluation at one or several recalls. Chronic apical periodontitis (CAP) was recorded with the periapical index scoring system. CAP developed in 29 of 473 (6%) of teeth without preoperative signs of disease, whereas 111 of 126 (88%) initially diseased roots showed signs of healing. The rate of healing CAP and the rate of emerging CAP were calculated, and analyses of event occurrence each year of observation were performed. Peak incidence of healing or emerging CAP was at 1 year in both instances. Risk assessments at 2, 3, and 4 years did not indicate an added risk of filled roots developing CAP during this period. Complete healing of preoperative CAP in some instances required 4 years for completion, while signs of initiated, but incomplete, healing were visible in at least 89% of all healing roots after 1 year. Risk analyses may provide relevant information in addition to or in substitution for success/failure analyses.     

The periapical index: A scoring system for radiographic assessment of apical periodontitis

Abstract A scoring system for registration of apical periodontitis in radiographs is presented. The system is termed the periapical index (PAI) and provides an ordinal scale of 5 scores ranging from 1 (healthy) to 5 (severe periodontitis with exacerbating features). Its validity is based on the use of reference radiographs of teeth with verified histological diagnoses. Results from studies involving 11 observers and 47 selected radiographs document that the PAI system is reasonably accurate, reproducible and able to discriminate between sub-populations. It may also allow for results from different researchers to be compared. The system may be suitable for the analysis of periapical radiographs in epidemiological studies, in clinical trials and in retrospective analyses of treatment results in endodontics.     

On the causes of persistent apical periodontitis: a review

Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.     

Frequency of root-filled teeth and prevalence of apical periodontitis in an adult Turkish population

AIM: To report the frequency and distribution of root-filled teeth as well as the prevalence of apical periodontitis in an adult population in Turkey. SUMMARY: Digital panoramic radiographs of 1000 patients who were examined at the Baskent University Faculty of Dentistry between December 2004 and May 2005 were evaluated. Patients ageing <15 years and those with less than nine remaining teeth were excluded. The coronal and periapical status of all the teeth with the exception of third molars was examined according to the criteria proposed by De Moor et al. (2000). Statistical analysis was performed with the Rao and Scott adjusted chi-square test for the comparison of clustered binary data. In all, 24 433 teeth were examined. A total of 346 teeth (1.4%) had radiographic signs of apical periodontitis, and 812 were root filled (3.3%). Of the 812 root-filled teeth, 148 (18.2%) had apical periodontitis. Of the 23,621 nonroot-filled teeth, 198 (0.8%) had apical periodontitis. The number of root-filled teeth in male subjects was significantly less than that in female subjects (P < 0.001), but the presence of apical periodontitis in male subjects was significantly higher than that in female subjects (P < 0.05). KEY LEARNING POINTS: * The prevalence of apical periodontitis and the frequency of root-filled teeth with apical periodontitis were lower than in comparable populations in other countries. * The number of root-filled teeth was comparable to that found in other epidemiologic studies.     

Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania

Abstract— Apical periodontitis is prevalent in many Western populations and is frequently detected in connection with inferior quality of endodontic treatment. However, information about endodontic conditions from eastern European countries is limited. The aim of the present investigation was to study the prevalence of apical periodontitis and the quality of endodontic treatment in 35–44-year-old Lithuanians. The prevalence of apical periodontitis was 70%. An overall success rate of 65% was found for root-filled teeth while 56% of pulp amputations (pulpotomies) were considered successful based on a radiographic evaluation. The quality of the root fillings showed little impact on the treatment results, except for over-extended fillings, which were associated with a high number of failures.     

Endodontic status amongst 35-year-old Oslo citizens and changes over a 30-year period

AIM: To determine the prevalence of apical periodontitis and quality of root fillings in 35-year-old citizens of Oslo, Norway in 2003, and to compare the results with data from the same age cohort collected by repetitive cross-sectional studies in 1973, 1984 and 1993. METHODOLOGY: A random sample of 250 35-year-old Oslo inhabitants was drawn from The National Bureau of Statistics Recordings. Attendance rate was 64%. Root filled teeth and teeth with periapical pathology were detected from panoramic radiographs and additional periapical radiographs of affected teeth were processed. The preriapical status was evaluated by applying the periapical index system (PAI). Chi-square and Student's t-tests were used for the evaluation of differences between the groups. RESULTS: Twenty-three per cent of the individuals examined had root filled teeth and 16% had at least one tooth with apical periodontitis. Root filled teeth were associated with PAI values of 1 and 2 (health) in 57% of cases. Prevalence of root filled teeth and apical periodontitis remained unchanged during the past 10 years. An increase in the proportion of root filled teeth with apical periodontitis from 18% in 1973 to 43% in 2003 was observed. CONCLUSIONS: Despite continuous improvement in dental health (reduced DMF-values) compared with the previous Oslo studies; there was no improvement in endodontic status from 1993 to 2003.     

Comparative analysis of prevalence of apical periodontitis in smokers and non-smokers using cone-beam computed tomography

Objective

The aim of this study was to compare the prevalence and size of periapical lesions among smokers and non-smokers using cone-beam computed tomography (CBCT).

A 20-year follow-up study of endodontic variables and apical status in a Swedish population

AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.     

The potential association between smoking and endodontic disease

The aim of this review was to analyse the literature to assess the possibility of an association between smoking and endodontic disease and the prognosis of endodontically treated teeth. The review of the prognosis of endodontically treated teeth involved taking account of any potential associations with smoking and endodontic disease and marginal periodontitis, and smoking and prosthodontic outcomes. In addition, the role of smoking in implant failure and surgical wound healing was analysed with a view to drawing parallels regarding the possible implications of smoking on the outcome of surgical endodontics. A MEDLINE and Cochrane library search including smoking and various endodontic keyword searches identified three papers which discussed the variables, and did not just mention them separately in the text. The literature demonstrates a paucity of evidence relating smoking with endodontic disease and prognosis, but nevertheless presents evidence of a possible influence on the prognosis of endodontically treated teeth in smokers and a likely increase in surgical complications. The possible merits of a smoking cessation protocol prior to surgical endodontics are also discussed.     

Risk factors for developing apical periodontitis in a general population

AIM: To identify and describe individual and tooth-specific factors associated with the incidence or the persistence of apical periodontitis (AP) in a general population. METHODOLOGY: In 1997, 616 randomly selected individuals had a full-mouth radiographic survey. In 2003, 77% of the participants returned for a new full-mouth radiographic examination. All teeth were assessed individually and data recorded for caries, marginal bone level, and tooth restorations. Multiple logistic regression analyses were performed to identify predictors of AP in the individual. Conditional logistic regression analyses were used to identify risk factors for development of AP in a tooth. Independent variables included a number of individual and tooth-specific variables. RESULTS: Root fillings, coronal restorations, primary carious lesions, and reduced marginal bone level were associated with the incidence of AP in the individual. In teeth, the quality and presence of a coronal restoration was associated with the incidence of AP, and presence of a root filling also increased the risk of developing AP. Furthermore, an increased risk of developing AP was seen in relation to primary carious lesions, reduced marginal bone level, and molar teeth. The quality of the root filling was not associated with the incidence of AP, but the results suggest an association between the quality of the root filling and the healing of AP. CONCLUSIONS: Results from the present study demonstrate that it is important to provide high quality dental restorations to minimize the risk of pulpal infection. The clinical focus, in relation to the incidence of AP, should be on improving the quality of the coronal restoration. The quality of a root filling was not associated with the incidence of AP, but may be of importance in relation to healing of AP.     

Healing of apical periodontitis after endodontic treatment using three different root canal sealers

Abstract In this study 3 commonly used sealers were evaluated. The materials tested were Proco-Sol, a zinc oxide-eugenol-based sealer, AH26, an epoxy resin, and Klorperka NØ, a resin-gutta-percha-chloroform sealer. The healing of periapical lesions was followed for a period of 3 years. While the response to Kloroperka NØ seemed slightly inferior to the 2 others, no statistically significant differences among the groups could be demonstrated.     

Characterization of bacterial flora in persistent apical periodontitis lesions

Introduction:  Microorganisms are able to survive and induce persistent infection in periapical tissues. The aim of this study was to investigate the composition of the microflora of persistent apical periodontitis lesions.
Methods:  Twenty apical lesion samples were obtained from 20 patients with chronic apical periodontitis by root end surgery and processed using aerobic or anaerobic culture techniques. All isolated strains were identified by 16S ribosomal DNA sequence analysis.
Results:  Seventy-four strains were isolated, belonging to 31 bacterial species obtained from the 20 apical lesions that were isolated. The majority of the strains were facultative anaerobes (51.6%). Propionibacterium acnes , Staphylococcus epidermidis , Pseudomonas aeruginosa and Fusobacterium nucleatum were isolated from 16.2, 9.5, 6.8 and 5.4% of the samples, respectively. Fifteen samples harboured more than one species. The predominant association was P. acnes , S. epidermidis and F. nucleatum.
Conclusion:  The microbiota of persistent apical periodontitis lesions is composed by diverse types of microorganisms with biofilm-forming capacity, including P. acnes , S. epidermidis and F. nucleatum .