1 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
2 Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
J Dent Res. 2016 Nov;95(12):1358-1365. doi: 10.1177/0022034516660509. Epub 2016 Jul 28.
An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finnish Parogene study consists of 508 patients (mean age, 62 y) who underwent coronary angiography and extensive clinical and radiographic oral examination. The cardiovascular outcomes included no significant CAD ( n = 123), stable CAD ( n = 184), and acute coronary syndrome (ACS; n = 169). EL was determined from a panoramic tomography. We combined data of widened periapical spaces (WPSs) and apical rarefactions to a score of EL: 1, no EL ( n = 210); 2, ≥1 WPS per 1 apical rarefaction ( n = 222); 3, ≥2 apical rarefactions ( n = 76). Subgingival P. endodontalis was defined by checkerboard DNA-DNA hybridization analysis, and corresponding serum antibodies were determined by ELISA. In our population, 50.4% had WPSs, and 22.8% apical rarefactions. A total of 51.2% of all teeth with apical rarefactions had received endodontic procedures. Subgingival P. endodontalis levels and serum immunoglobulin G were associated with a higher EL score. In the multiadjusted model (age, sex, smoking, diabetes, body mass index, alveolar bone loss, and number of teeth), having WPSs associated with stable CAD (odds ratio [OR] = 1.94, 95% confidence interval [95% CI] = 1.13 to 3.32, P = 0.016) and highest EL score were associated with ACS (OR = 2.46, 95% CI = 1.09 to 5.54, P = 0.030). This association was especially notable in subjects with untreated teeth with apical rarefactions ( n = 59, OR = 2.72, 95% CI = 1.16 to 6.40, P = 0.022). Our findings support the hypothesis that ELs are independently associated with CAD and in particular with ACS. This is of high interest from a public health perspective, considering the high prevalence of ELs and CAD.
牙髓病变（EL）是牙髓感染的常见表现，其中牙髓卟啉单胞菌经常被发现。EL 可能通过与边缘性牙周炎类似的途径与冠状动脉疾病（CAD）的风险增加相关。本横断面研究旨在描绘 EL 与 CAD 之间的关联。将龈下牙髓卟啉单胞菌、其免疫反应和血清脂多糖作为这两种疾病之间的潜在介质进行检查。芬兰 Parogene 研究包括 508 名（平均年龄 62 岁）接受冠状动脉造影和广泛临床及影像学口腔检查的患者。心血管结局包括无显著 CAD（n = 123）、稳定 CAD（n = 184）和急性冠状动脉综合征（ACS；n = 169）。EL 是从全景断层扫描中确定的。我们将宽根尖间隙（WPSs）和根尖稀疏结合起来，得到 EL 评分：1，无 EL（n = 210）；2，每 1 个根尖稀疏有≥1 个 WPS（n = 222）；3，有≥2 个根尖稀疏（n = 76）。龈下牙髓卟啉单胞菌通过棋盘 DNA-DNA 杂交分析确定，相应的血清抗体通过 ELISA 确定。在我们的人群中，50.4%有 WPSs，22.8%有根尖稀疏。所有根尖稀疏的牙齿中，有 51.2%接受了牙髓治疗。龈下牙髓卟啉单胞菌水平和血清 IgG 与更高的 EL 评分相关。在多因素调整模型（年龄、性别、吸烟、糖尿病、体重指数、牙槽骨丧失和牙齿数量）中，WPSs 与稳定 CAD 相关（比值比 [OR] = 1.94，95%置信区间 [95%CI] = 1.13 至 3.32，P = 0.016），最高的 EL 评分与 ACS 相关（OR = 2.46，95%CI = 1.09 至 5.54，P = 0.030）。这一关联在未经治疗的根尖稀疏牙齿的受试者中尤为显著（n = 59，OR = 2.72，95%CI = 1.16 至 6.40，P = 0.022）。我们的发现支持这样一种假设，即 EL 与 CAD 独立相关，特别是与 ACS 相关。从公共卫生的角度来看，考虑到 EL 和 CAD 的高患病率，这是非常重要的。
