It has been suspected for over 100 years that oral sepsis is associated and probably causes many systemic diseases (Hunter 1900). In recent years there have been many papers describing strong associations between chronic periodontal disease and cardiovascular disease (REVIEW: Hayashi et al 2010).
The dental profession is becoming aware of the importance of preventing and treating chronic periodontal diseases. However, less well known is the association between chronic apical periodontitis and cardiovascular disease (CVD). In 2012 Pasqualini D et. al. published an important paper showing an association between apical periodontitis and CVD which makes perfect sense since many of the same organisms found in periodontal diseases are found in apical disease.
For many years, as a radiologist, I have seen and reported on the presence of apical radiolucent areas as “probably apical granuloma and possibly a radicular cyst” as shown in the images below of two lesions seen in the same patient.
Fig 1 #30 mesial apex with 5 mm lucency.
Fig 2 #30 mesial apex with thin panoramic slice to reveal the true extent of the lucency.
Fig 3 Same patient as figs 1 and 2 #3 mesiobuccal apical lucency 6 mm in diameter with associated mucosal thickening of the floor of the right maxillary sinus
Recently I have decided that the research literature is showing such high association between oral infections and other systemic diseases that I would be failing in my reports just to state that oral sepsis is present. When I see a large cyst or possible malignant tumor I always add a recommendation such as “a biopsy and/or consultation with an oral surgeon is advised.” Carotid artery calcifications I recommend “the patient and their MD should be informed” so that they can decide if an ultrasound examination is needed. Apart from providing the best care for the patient it also ensures that you avoid the possible legal situation of failing to diagnose and appropriately deal with a serious medical condition. With regard to apical lucencies I now write “There is an association between chronic apical periodontitis and coronary heart disease (Pasqualini D et. al. Association among Oral Health, Apical Periodontitis, CD14 Polymorphisms, and Coronary Heart Disease in Middle-aged Adults. Journal of Endodontics 2012 38 (12) 1570-1577).”
“The times they are achangin” (Bob Dylan 1964)…….
Hunter W (1900). Oral sepsis as a cause of disease. Br Med J 2: 215.
Hayashi C et. al. (2010). Pathogen-induced inflammation at sites distant from oral infection. Molecular Oral Biology 25 305-316.
Pasqualini D et. al. (2012) Association among Oral Health, Apical Periodontitis, CD14 Polymorphisms, and Coronary Heart Disease in Middle-aged Adults. Journal of Endodontics 38 (12) 1570-1577.
—
Dr. Douglas K Benn
