Association among Oral Health,Apical Periodontitis,CD14 Polymorphisms,and Coronary Heart Disease in Middle-aged Adults

Introduction

There is evidence to suggest that an association exists between oral infections and coronary heart disease (CHD). Subjects presenting lesions of endodontic origin (LEOs) or pulpal inflammation had an increased risk of developing CHD. However, findings concerning systemic manifestations of apical periodontitis (AP) remain controversial. An association between CD14 gene polymorphisms and atherosclerosis-associated diseases has been shown, but there are no data regarding an association between CD14 polymorphism and AP. This study evaluated associations between clinical oral health status, CD14 polymorphisms, and CHD.

Methods

A case-controlled clinical trial was designed to compare middle-aged adults with acute myocardial infarction or unstable angina (n = 51) within 12 months of the acute event defined as first manifestation with healthy controls (n = 49). Participants were matched for age, sex, and socioeconomic status. Indicators of oral disease and compliance were evaluated. CD14 polymorphisms were analyzed by restriction fragment length polymorphism–polymerase chain reaction.

Results

CHD subjects had a higher prevalence of oral diseases and lower compliance to oral preventive strategies than healthy controls. Multivariate analysis showed a positive association between missing teeth (odds ratio [OR] = 1.37; 95% confidence interval [CI], 1.02–1.85), the number of LEOs (OR = 4.37; 95% CI, 1.69–11.28), chronic periodontitis (OR = 5.87; 95% CI, 1.17–29.4), and CHD. No statistically significant association emerged between the CD14 C(−260)T and the CD14 C(−159)T polymorphism, endodontic or periodontal disease, and CHD.

Conclusions

Chronic oral diseases may increase the risk of CHD and may be an unconventional risk factor for CHD.     

Association between Apical Periodontitis and Interleukin Gene Polymorphisms: A Systematic Review and Meta-analysis

Introduction

Genetic polymorphisms may result in altered gene expression or functional changes of the encoded molecules and could possibly generate a deficient immunity. Consequently, individuals with specific genotypes could be more susceptible to disease or could present an increase in disease severity. Our study is aimed to verify, through a systematic review and meta-analysis registered in the PROSPERO database (CRD42016043905), whether currently available evidence supports a relationship between interleukin gene polymorphisms and apical periodontitis (AP).

Periodontitis in Patients With Coronary Artery Disease: An 8‐Year Follow‐Up

Background: This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD‐related death) during 8‐year follow‐up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls. Methods: In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 ± 8.9 years) and 121 controls (101 males and 20 females, mean age: 69 ± 9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow‐up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register. Results: No significant differences were found among patients with CAD, with or without CAD‐related endpoints at 8‐year follow‐up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls. Conclusions: The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8‐year follow‐up. Further long‐term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD‐related death.     

慢性根尖周炎患牙根尖生物膜的细菌学研究

目的：对根尖生物膜细菌进行分离、培养和鉴定,了解根尖生物膜细菌的种类、组成和来源。方法：通过根尖外科手术收集25颗慢性根尖周炎患牙的根尖生物膜样本,同时收集其中20颗患牙的根管细菌样本。所有样本均按常规接种、分离、纯化后,根据耐氧实验、细菌和菌落的形态、菌落的颜色、革兰染色和生化实验对细菌进行鉴定。统计分析比较根尖生物膜和根管细菌的检出率、构成比,并对不同临床状态下的根尖生物膜细菌检出进行分析。结果：细菌检出发现92．0％根尖生物膜样本细菌培养阳性,G^＋菌和G^-菌的检出率分别为80．0％和84．0％,专性厌氧菌和兼性厌氧菌的检出率分别为80．0％和44．0％;根管样本细菌检出情况与根尖样本基本一致。结论：根尖生物膜细菌检出率高,大多数样本为多种细菌混合感染;根尖生物膜细菌的种类、检出率、构成比与感染根管细菌基本一致。     

慢性根尖周炎根尖生物膜的扫描电镜观察

目的：观察慢性根尖周炎根尖表面细菌生物膜分布及其超微结构。方法：扫描电镜观察新鲜拔除的24颗离体牙根尖表面,其中5颗为正畸或阻生拔除的活髓牙,5颗为X-ray显示根尖区正常的死髓牙,14颗为X-ay显示根尖区已有慢性病变的患牙。结果：在根尖区正常的活髓牙和死髓牙根尖表面均没有发现细菌生物膜;而在有慢性根尖病变的14颗患牙根尖表面,全部观察到了细菌生物膜的存在。这些生物膜分布于根尖表面的部分区域,可由单一细菌形成也可由多种微生物组成。结论：慢性根尖周炎根尖表面部分区域存在有细菌生物膜,其超微结构特征因细菌组成不同而异。     

慢性根尖周炎一次性根管治疗的临床疗效观察

目的：评价慢性根尖周炎一次性根管治疗的临床效果和可靠性。方法：选择患有慢性根尖周炎的直根管患牙200例,采用改良双敞技术和平衡力法预备根管,0．5％次氯酸钠及17％EDTA冲洗,随机均分为两组：一次性根管治疗组在上述操作完成后立即行牙胶尖加树脂类封闭剂AHplus侧方加压术充填根管;多次性根管治疗组根管内封入氢氧化钙糊剂复诊,待无症状后再行根充。治疗结束后1d、7d、30d随访记录患者的疼痛反应。1年后进行临床及X线复查,计算每组根管治疗的成功及失败率,并进行统计学检验。结果：有94例患者回访,一次性根管治疗组43例,多次根管治疗51例。根管治疗术后1d疼痛发生率一次性治疗组高于多次性组,且有统计学差异,7d、30d的疼痛发生率两组间无明显差异。1年后复查两组的成功率无统计学差异。一次性根管治疗组的前牙与后牙治疗成功率间无统计学差异。结论：慢性根尖周炎一次性根管治疗术后疼痛发生率较多次法高,但远期疗效等同于多次法者。     

Association between chronic periodontitis and vasculogenic erectile dysfunction

Background: Erectile dysfunction (ED) and chronic periodontitis (CP) share common risk factors. There is only one report on the association between ED and CP. Thus, the aim of this study is to find the association between vasculogenic ED and CP. Methods: A total of 70 patients (mean age: 35.3 ± 3.64 years) clinically diagnosed with ED were included in the study. They were given the Sexual Health Inventory for Men Questionnaire and subjected to colored penile Doppler ultrasound. Periodontal parameters of probing depth and periodontal attachment level were recorded. Five patients with ED and CP were selected randomly for cardiac color Doppler to assess the integrity. Results: Among the selected vasculogenic patients with ED, mild‐to‐moderate vasculogenic ED showed the highest prevalence, whereas prevalence for CP among all vasculogenic patients with ED was highest among severe ED (81.8%). Association of CP and vasculogenic ED was found to be correlated positively, but it showed no statistical significance. Two of five patients were found to have vascular insufficiency. Conclusions: It can be hypothesized that an association exists between vasculogenic ED and CP in young males. However, a large‐scale study with confounder analysis and a longitudinal follow‐up is warranted.     

急、慢性根尖周炎患牙根管内内毒素水平的分析测定

目的　比较急、慢性根尖周炎患牙根管内的内毒素水平并探讨内毒素与患牙尖周瘘管的关系。方法　选择急性根尖周炎、慢性根尖周炎根尖暗影直径<2 mm、根尖暗影直径>2 mm有瘘道和无瘘道的患牙各10例,采用产色基质鲎试剂法检测根管内内毒素含量。结果　慢性根尖周炎根尖暗影<2 mm的患牙,根管内内毒素水平明显低于急性根尖周炎及慢性根尖周炎根尖暗影>2 mm(有或无瘘道)的患牙,其差异有统计学意义(P<0·01)。结论　内毒素可能与尖周炎临床症状及根尖骨吸收程度密切相关。     

根尖倒充填术用于慢性根尖周炎伴牙根外吸收治疗的临床报道

目的观察根尖手术治疗慢性根尖周炎伴牙根外吸收的临床效果。方法选择慢性根尖周炎伴牙根外吸收患者6例,术前常规根管治疗,局麻下翻瓣、去骨、清理病变肉芽组织,行根尖倒预备和倒充填。术后3个月、半年和1年复诊,行临床检查及拍摄X线片观察根尖周骨质恢复情况。结果6例患牙临床症状全部消失,X线片复查牙根外吸收停止,其中4例根尖周骨质破坏完全恢复,2例根尖周骨质破坏范围明显减小。结论根尖手术对慢性根尖周炎伴牙根外吸收有良好的治疗效果。     

Association of Apical Periodontitis with Cardiovascular Disease via Noninvasive Assessment of Endothelial Function and Subclinical Atherosclerosis

IntroductionChronic infections of endodontic origin might predispose to the onset of cardiovascular disease (CVD). The studies depicting the link between apical periodontitis (AP) and CVD are few, and the association is very controversial; also, the markers used are expensive, which makes them difficult to use in general practice. The purpose of this study was to investigate whether an association exists between AP and CVD using noninvasive methods (ie, flow-mediated dilatation [FMD] and carotid intima-media thickness [c-IMT]).MethodsThis cross-sectional study included 120 men between 20 and 40 years old free from periodontal disease, CVD, and traditional cardiovascular risk factors; 60 subjects had AP, and 60 acted as controls. All subjects underwent complete physical and dental examination, echocardiography, ultrasound assessment of FMD of the right brachial artery, and c-IMT. Data were analyzed using the Mann-Whitney U test and the Spearman rank correlation (r_s) test.ResultsFMD was found to be significantly impaired in patients with AP (mean = 4.9% ± 2.05%) compared with healthy controls (mean = 9.74% ± 2.59%, P = .000). The study also depicts statistically significant differences between c-IMT of the AP (mean = 0.64 ± 0.12 mm) and control (mean = 0.54 ± 0.08 mm) groups (P = .000). A significant inverse correlation between c-IMT and FMD was observed (r_s = −0.381, P = .000).ConclusionsImpaired FMD and greater c-IMT in subjects with AP suggests a potential association between endodontic infection and CVD.     

Accuracy of Cone-beam Computed Tomography and Periapical Radiography in Apical Periodontitis Diagnosis

Introduction

This study aimed to investigate the correlation and the agreement between periapical radiography (PR) and cone-beam computed tomography (CBCT) correlating to histologic findings in the diagnosis of apical periodontitis (AP).

Methods

One hundred thirty-four premolar root canals from 10 dogs were treated after AP induction. Four months later, the animals were killed, and standard digital PRs were obtained. The area of AP was measured by using ImageJ software. CBCT (i-CAT) images from each arch were obtained, and AP area and volume were measured by using Osiri-X software. The apical inflammatory infiltrate was evaluated under light microscopy. The correlation between imaging methods was evaluated by using the Pearson coefficient. The Bland-Altman method was used to assess the agreement between PR and CBCT data. The Spearman coefficient was used to correlate the imaging data and histologic findings.

Results

Despite a strong correlation between PR and CBCT areas, the agreement limits were very broad (95% limits of agreement, 0.19–1.08). PR only measured, on average, 63% of CBCT values. Although there was a strong correlation between PR area and CBCT volume, the Bland-Altman method suggests that the larger the CBCT volume, the more underestimated the PR value. When APs had a volume smaller than 6 mm³, the PR estimation of CBCT data was unpredictable. A positive correlation was found for PR area, CBCT area, CBCT volume, and histology data.

Conclusions

The diagnosis of AP based on PR data is clinically limited, and it should not be used for scientific investigations.     

三种根管消毒药物对慢性根尖周炎根管中内毒素水平的影响

目的:探讨以甲硝唑为代表的抗厌氧菌药物在根管治疗中的应用前景。方法:选择慢性根尖周炎患牙共30 例,随机分别封甲酚醛、樟脑酚、甲硝唑各10例,封药前后分别取样,采用产色基质鲎试剂法检测内毒素含量,比较内毒素下降水平。结果:3组间内毒素下降水平无统计学差异。结论:根管封药可应用抗厌氧菌药物以治疗慢性根尖周炎。     

IL-17在乳牙根尖周病损组织中的表达

目的:检测IL-17在乳牙根尖周病损组织中的表达和分布,分析其在不同病理类型及炎症程度之间的关系,探讨其在乳牙慢性根尖周炎发病机制中的可能作用。方法:收集120例乳牙慢性根尖周病损组织行常规组织病理学检查,确定病理类型并按炎症细胞浸润程度分级;免疫组织化学法检测组织中IL-17的分布特点;ELISA法检测IL-17的蛋白表达量。结果:120例乳牙慢性根尖周病损组织中根尖周肉芽肿占65.8%,根尖周囊肿占18.4%,根尖周脓肿占15.8%。IL-17在3种病理类型中均有表达,主要表达于淋巴细胞、浆细胞。ELISA结果显示IL-17在不同病理类型组中的表达均低于正常对照组,在根尖肉芽肿组中的表达与炎症程度呈负相关。结论:IL-17在乳牙根尖周病损组织内广泛存在,随炎症程度加重表达逐渐降低,推测IL-17在乳牙慢性根尖周炎的病程进展中可能发挥一定的抑制作用。     

8-Year Follow-up of Central Giant Cell Lesion Mimicking Apical Periodontitis

Introduction

Lesions of nonendodontic origin may mimic apical periodontitis. Central giant cell lesions (CGCLs) are aggressive or nonaggressive benign idiopathic intraosseous lesions of the jaw. This report describes a case of a CGCL in the periapical region of teeth #21–#26 of a 17-year-old female who sought orthodontic care because of a change in the position of tooth #23.

Methods

Clinical examination revealed mild facial asymmetry caused by increased volume in the mental region and cortical bone expansion but no cortical disruption. A panoramic radiograph showed a well-defined radiolucent osteolytic lesion involving teeth #21–#26. The cortical bone was not affected, and there was no root resorption. Incisional biopsy was performed, and the diagnosis was a CGCL. The lesion was enucleated surgically. CGCLs should be included in the differential diagnosis of jaw lesions that mimic apical periodontitis.

Results

The patient subsequently underwent orthodontic treatment successfully.

Conclusions

The 8-year clinical and radiographic follow-up confirmed lesion remission, no recurrence, and pulp vitality of all teeth.     

Nonendodontic Lesions Misdiagnosed as Apical Periodontitis Lesions: Series of Case Reports and Review of Literature

Introduction

This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.

Methods

A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.

Results

The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.

Conclusions

Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.     

白细胞介素-4基因-590C／T多态性与慢性牙周炎的相关性研究

目的研究白细胞介素-4（interleukin-4,IL-4）基因-590C／T多态性与慢性牙周炎易感性的关系。方法采用病例对照试验设计,聚合酶链反应一限制性内切酶片段长度多态性基因分析方法,比较104例慢性牙周炎患者（慢性牙周炎组）和106例牙周健康者（健康对照组）IL-4基因-590位点基因型和等位基因分布特点。结果IL-4基因-590位点C、T等位基因频率（X2=0．771,P=0．380）及基因型频率（X2=1．904,P=0．386）在两组间分布差异无统计学意义。结论IL-4基因-590位点的多态性与汉族人群慢性牙周炎的易感性无明显相关性。     

慢性牙周炎与种植体周围炎相关性的临床研究

目的：通过临床观察慢性牙周炎患者进行牙种植修复的早期临床效果,初步探讨慢性牙周炎与种植体周围炎发生发展的相关性。方法：选择15例慢性牙周炎患者24颗种植牙作为实验组,选择10例牙周健康者20颗种植牙作为对照组,二期修复负载时（种植体植入后4～6个月）检测两组患者种植体周围龈沟液量（PISF）、改良菌斑指数（mPLI）、改良龈沟出血指数（mBI）、探诊深度（PD）及附着丧失（AL）等各项临床指标,并进行比较。结果：慢性牙周炎患者种植体周的龈沟液量明显多于牙周健康患者（P〈0.05）;两组种植体周的各项临床指标均值除mPLI外均有显著性差异（P〈0.05）。结论：慢性牙周炎与种植体周围炎的发生可能具有一定的相关性。     

Accuracy of Orthopantomography for Apical Periodontitis without Endodontic Treatment

Introduction

This study aimed to evaluate the diagnostic accuracy of orthopantomography (OPT) for the detection of clinically/surgically confirmed apical periodontitis (AP) without endodontic treatment using cone-beam computed tomographic (CBCT) imaging as the reference standard.

伴冠心病中老年牙周炎患者牙周治疗疗效影响因素的logistic回归分析

目的：通过对中老年牙周炎患者牙周治疗前后的调查随访,明确伴冠心病的中老年牙周炎患者牙周治疗疗效的影响因素,从而为该类患者制定个性化治疗方案提供指导。方法：通过制定专用结构式调查诊治表,进行问卷调查及临床检查。结构式调查表进行问卷调查,获得患者年龄、性别、学历、职业、口腔卫生习惯（刷牙时间、是否使用牙间隙清洁工具）、生活作息规律、性格偏向、饮食中动物脂肪的摄入、吸烟、饮酒、嚼槟榔习惯、高血压、高血压家族史、全身疾病以及患者依从性等相关资料。口腔临床检查详细记录初诊及第一次牙周基础治疗完成后1、3、6个月,1年后复诊时每个牙齿各检测位点的探诊深度、附着丧失、探诊出血、牙齿松动度、血液检查获取血脂等生化指标。logistic回归分析了解牙周治疗后复发的相关因素。结果：影响伴冠心病的中老年牙周炎患者牙周治疗疗效的影响因素很多,其中,吸烟、患者依从性、口腔卫生习惯、血脂水平、饮食中动物脂肪摄入等OR值最高。结论：影响牙周治疗疗效的因素中,有许多因素与冠心病发生的危险因素有许多是共同的,这为该类患者制定个性化治疗方案有重要指导意义。