School of Dentistry, University of Sevilla C/ Avicena s/n, 41009-Sevilla, Spain
Med Oral Patol Oral Cir Bucal. 2020 Sep 1;25(5):e652-e659. doi: 10.4317/medoral.23665.
Several studies published in the last two decades have found an association between the prevalence of apical periodontitis (AP) or root canal treatment (RCT) and cardiovascular diseases (CVDs). However, the demonstration of association does not prove by itself the existence of a cause-effect relationship. Two diseases can appear as statistically related without any of them directly affecting the values of the other, resulting in a non-causal relationship. The aim of this narrative review is to summarize the current state of knowledge regarding the association between AP and CVDs, analysing it according to the Hill's causality criteria.
Epidemiological studies carried out on the association between CVDs and AP or RCT published in English until 8 December 2019 were identified. Forty-four articles were selected and its results were analysed.
Numerous cross-sectional epidemiological studies have found significant relationship between CVDs and AP. The odds ratio values range 1.6 - 5.4. However, other studies have not found significant association. Respect to RCT, some studies found correlation, but others found no association or even found that RCT is a protective factor against CVDs.
The results are inconsistent and a causal relationship between CVDS and endodontic disease cannot be stablished. The risk factors common to both diseases can act as confounding factors, biasing the results. To reach definitive conclusions about the type of association (causal or non-causal) between both diseases, longitudinal epidemiological studies must be carried out to establish the temporal relationship and the dose-response gradient.
过去二十年发表的几项研究发现，根尖周炎（AP）或根管治疗（RCT）的流行与心血管疾病（CVD）之间存在关联。然而，关联的证明本身并不能证明存在因果关系。两种疾病可能在统计学上相关，而它们中的任何一种都不会直接影响另一种疾病的值，从而导致非因果关系。本叙述性综述的目的是根据希尔的因果关系标准，总结 AP 与 CVD 之间关联的现有知识状态，对其进行分析。
确定了截至 2019 年 12 月 8 日以英文发表的关于 CVD 与 AP 或 RCT 之间关联的流行病学研究。共选择了 44 篇文章，对其结果进行了分析。
许多横断面流行病学研究发现 CVD 与 AP 之间存在显著相关性。比值比（OR）值范围为 1.6-5.4。然而，其他研究并未发现显著关联。至于 RCT，一些研究发现了相关性，但其他研究则没有发现关联，甚至发现 RCT 是 CVD 的保护因素。
结果不一致，无法确立 CVD 和牙髓疾病之间的因果关系。两种疾病共有的危险因素可能作为混杂因素，使结果产生偏倚。为了对两种疾病之间的关联类型（因果或非因果）得出明确的结论，必须进行纵向流行病学研究以确定时间关系和剂量-反应梯度。
