Association between cardiovascular diseases and apical periodontitis: an umbrella review

A Jakovljevic; H F Duncan; V Nagendrababu; J Jacimovic; J Milasin; P M H Dummer

doi:10.1111/iej.13364

Association between cardiovascular diseases and apical periodontitis: an umbrella review

Int Endod J. 2020 Oct;53(10):1374-1386. doi: 10.1111/iej.13364. Epub 2020 Aug 8.

Authors

A Jakovljevic¹, H F Duncan², V Nagendrababu³, J Jacimovic⁴, J Milasin⁵, P M H Dummer⁶

Affiliations

¹ Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
² Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
³ Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
⁴ Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
⁶ School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.

PMID: 32648971
DOI: 10.1111/iej.13364

Abstract

Background: The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive.

Objective: To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults.

Methods: The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics' Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta-analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of 'high', 'moderate', 'low' or 'critically low' quality.

Results: Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as 'moderate' quality, whereas one review was graded as 'critically low' quality.

Discussion: Only one systematic review included a meta-analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis.

Conclusions: From the limited 'moderate' to 'critically low' quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well-designed, longitudinal clinical studies with long-term follow-up are required.

Keywords: apical periodontitis; cardiovascular disease; meta-analysis; systematic review; umbrella review.

Publication types

Review

MeSH terms

Adult
Cardiovascular Diseases* / epidemiology
Databases, Factual
Humans
Meta-Analysis as Topic
Periapical Periodontitis* / complications
Periapical Periodontitis* / epidemiology
Systematic Reviews as Topic

Grants and funding

175075/Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja