Atherosclerosis and Chronic Apical Periodontitis: Systematic Review and Meta-Analysis

Background: Atherosclerosis is a chronic and progressive condition of the arteries, characterized by the thickening and hardening of their walls due to the formation of atherosclerotic plaques. Low-grade inflammation is implicated in the pathogeny of atherosclerosis. Chronic apical periodontitis (CAP), the chronic inflammation around the root apex of infected teeth, is associated with a low-grade inflammatory state, and thus a connection between atherosclerosis and CAP has been suggested. The aim of this study was to conduct a systematic review with meta-analysis to answer the following PICO question: In adult patients, does the presence or absence of atherosclerosis affect the prevalence of CAP? Methods: The PRISMA guidelines were followed to carry out this systematic review, which was registered in PROSPERO (651359). A bibliographic search was performed in PubMed-MEDLINE, Embase, and Scielo. The inclusion criteria selected studies presenting data on the prevalence of CAP in patients diagnosed with atherosclerosis and control patients. The statistical analysis was carried out using RevMan software v.5.4. The study characteristics and risk ratios with 95% confidence intervals (CIs) were extracted. Random-effects meta-analyses were performed. Risk of bias was assessed using the Newcastle-Ottawa scale, which was adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The quality of the evidence was evaluated using GRADE. Results: The search strategy recovered 102 articles, and only five met the inclusion criteria. Meta-analysis showed an overall OR = 2.94 (95% CI = 1.83–4.74; p < 0.01) for the prevalence of CAP among patients with atherosclerosis. The overall risk of bias was moderate. The quality of the evidence showed a low level of certainty. Conclusions: Patients with atherosclerosis are almost three times more likely to have CAP. This finding supports the hypothesis that chronic inflammatory processes in the oral cavity could significantly impact cardiovascular health, emphasizing the importance of an integrated approach to oral and systemic health care. This result should be translated to daily clinical practice, and the healthcare community should be aware of this association and suspect atherosclerotic pathology in patients who show a high prevalence of CAP. Likewise, patients with atherosclerosis should be monitored in the dental clinic for CAP.