Skip to main content

Advertisement

SpringerLink
Log in

Association of severely damaged endodontically infected tooth with carotid plaque and abnormal carotid intima-media thickness: a retrospective analysis

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

We investigated the association of severely damaged endodontically infected tooth with carotid artery plaque and abnormal mean carotid intima-media thickness (CIMT) ≥ 1.0 mm.

Methods

A retrospective analysis of 1502 control participants and 1552 participants with severely damaged endodontically infected tooth who received routine medical and dental checkup in Health Management Center, Xiangya Hospital was performed. Carotid plaque and CIMT were measured with B-mode tomographic ultrasound. Data were analyzed using logistic and linear regression.

Results

Severely damaged endodontically infected tooth group had a significantly higher prevalence of carotid plaque (41.62%) compared to 32.22% of carotid plaque in control group. Participants with severely damaged endodontically infected tooth had a significantly higher prevalence of abnormal CIMT (16.17%) and a significantly increased level of CIMT (0.79 ± 0.16 mm) in comparison to 10.79% of abnormal CIMT and 0.77 ± 0.14 mm CIMT in control participants. Severely damaged endodontically infected tooth was significantly related with formation of carotid plaque [1.37(1.18–1.60), P < 0.001], top quartile length [1.21(1.02–1.44), P = 0.029] and top quartile thickness [1.27(1.08–1.51), P = 0.005] of carotid plaque and abnormal CIMT [1.47(1.18–1.83), P < 0.001]. Severely damaged endodontically infected tooth was significantly associated with both single [1.277(1.056–1.546), P = 0.012] and multiple carotid plaques [1.488(1.214–1.825), P < 0.001] and instable carotid plaques [1.380(1.167–1.632), P < 0.001]. Presence of severely damaged endodontically infected tooth increased 0.588 mm of carotid plaque length (P = 0.001), 0.157 mm of carotid plaque thickness (P < 0.001) and 0.015 mm of CIMT (P = 0.005).

Conclusion

Severely damaged endodontically infected tooth was associated with carotid plaque and abnormal CIMT.

Clinical relevance

Early treatment of endodontically infected tooth is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

All data used during the study are proprietary or confidential in nature and cannot be provided.

References

  1. Chestnutt IG, Binnie VI, Taylor MM (2000) Reasons for tooth extraction in Scotland. J Dent 28:295–297. https://doi.org/10.1016/s0300-5712(99)00069-x

    Article  PubMed  Google Scholar 

  2. Georgiou AC, Crielaard W, Armenis I, de Vries R, van der Waal SV (2019) Apical periodontitis is associated with elevated concentrations of inflammatory mediators in peripheral blood: a systematic review and meta-analysis. J Endod 45:1279-1295 e3. https://doi.org/10.1016/j.joen.2019.07.017

    Article  PubMed  Google Scholar 

  3. Paloma de Oliveira B, Camara AC, Aguiar CM (2017) Prevalence of asymptomatic apical periodontitis and its association with coronary artery disease in a Brazilian subpopulation. Acta Stomatol Croat 51:106–112. https://doi.org/10.15644/asc51/2/3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Messing M, Souza LC, Cavalla F, Kookal KK, Rizzo G, Walji M, Silva R, Letra A (2019) Investigating potential correlations between endodontic pathology and cardiovascular diseases using epidemiological and genetic approaches. J Endod 45:104–110. https://doi.org/10.1016/j.joen.2018.10.014

    Article  PubMed  Google Scholar 

  5. Liljestrand JM, Havulinna AS, Paju S, Mannisto S, Salomaa V, Pussinen PJ (2015) Missing teeth predict incident cardiovascular events, diabetes, and death. J Dent Res 94:1055–1062. https://doi.org/10.1177/0022034515586352

    Article  PubMed  Google Scholar 

  6. Lee HJ, Choi EK, Park JB, Han KD, Oh S (2019) Tooth loss predicts myocardial infarction, heart failure, stroke, and death. J Dent Res 98:164–170. https://doi.org/10.1177/0022034518814829

    Article  PubMed  Google Scholar 

  7. Koletsi D, Iliadi A, Tzanetakis GN, Vavuranakis M, Eliades T (2021) Cardiovascular disease and chronic endodontic infection. Is there an association? A systematic review and meta-analysis. Int J Environ Res Public Health 18:9111. https://doi.org/10.3390/ijerph18179111

  8. Costa TH, de Figueiredo Neto JA, de Oliveira AE, Lopes e Maia Mde F, de Almeida AL (2014) Association between chronic apical periodontitis and coronary artery disease. J Endod 40:164–167. https://doi.org/10.1016/j.joen.2013.10.026

    Article  PubMed  Google Scholar 

  9. Cheng F, Zhang M, Wang Q, Xu H, Dong X, Gao Z, Chen J, Wei Y, Qin F (2018) Tooth loss and risk of cardiovascular disease and stroke: A dose-response meta analysis of prospective cohort studies. PLoS One 13:e0194563. https://doi.org/10.1371/journal.pone.0194563

    Article  PubMed  PubMed Central  Google Scholar 

  10. An GK, Morse DE, Kunin M, Goldberger RS, Psoter WJ (2016) Association of radiographically diagnosed apical periodontitis and cardiovascular disease: a hospital records-based study. J Endod 42:916–920. https://doi.org/10.1016/j.joen.2016.03.011

    Article  PubMed  Google Scholar 

  11. Meurman JH, Janket SJ, Surakka M, Jackson EA, Ackerson LK, Fakhri HR, Chogle S, Walls A (2017) Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population. Int Endod J 50:1158–1168. https://doi.org/10.1111/iej.12772

    Article  PubMed  Google Scholar 

  12. Brun A, Nuzzo A, Prouvost B, Diallo D, Hamdan S, Meseguer E, Guidoux C, Lavallee P, Amarenco P, Leseche G, Bouchard P, Michel JB, Range H (2021) Oral microbiota and atherothrombotic carotid plaque vulnerability in periodontitis patients. A cross-sectional study. J Periodontal Res 56:339–350. https://doi.org/10.1111/jre.12826

    Article  PubMed  Google Scholar 

  13. Fernandes CP, Oliveira FA, Silva PG, Alves AP, Mota MR, Montenegro RC, Burbano RM, Seabra AD, Lobo Filho JG, Lima DL, Soares Filho AW, Sousa FB (2014) Molecular analysis of oral bacteria in dental biofilm and atherosclerotic plaques of patients with vascular disease. Int J Cardiol 174:710–712. https://doi.org/10.1016/j.ijcard.2014.04.201

    Article  PubMed  Google Scholar 

  14. Eberhard J, Stumpp N, Winkel A, Schrimpf C, Bisdas T, Orzak P, Teebken OE, Haverich A, Stiesch M (2017) Streptococcus mitis and Gemella haemolysans were simultaneously found in atherosclerotic and oral plaques of elderly without periodontitis-a pilot study. Clin Oral Investig 21:447–452. https://doi.org/10.1007/s00784-016-1811-6

    Article  PubMed  Google Scholar 

  15. Furusho H, Miyauchi M, Hyogo H, Inubushi T, Ao M, Ouhara K, Hisatune J, Kurihara H, Sugai M, Hayes CN, Nakahara T, Aikata H, Takahashi S, Chayama K, Takata T (2013) Dental infection of Porphyromonas gingivalis exacerbates high fat diet-induced steatohepatitis in mice. J Gastroenterol 48:1259–1270. https://doi.org/10.1007/s00535-012-0738-1

    Article  PubMed  Google Scholar 

  16. Chauhan N, Mittal S, Tewari S, Sen J, Laller K (2019) Association of apical periodontitis with cardiovascular disease via noninvasive assessment of endothelial function and subclinical atherosclerosis. J Endod 45:681–690. https://doi.org/10.1016/j.joen.2019.03.003

    Article  PubMed  Google Scholar 

  17. Bergandi L, Giuggia B, Alovisi M, Comba A, Silvagno F, Maule M, Aldieri E, Scotti N, Scacciatella P, Conrotto F, Berutti E, Pasqualini D (2019) Endothelial dysfunction marker variation in young adults with chronic apical periodontitis before and after endodontic treatment. J Endod 45:500–506. https://doi.org/10.1016/j.joen.2019.01.018

    Article  PubMed  Google Scholar 

  18. Friedlander AH, Sung EC, Chung EM, Garrett NR (2010) Radiographic quantification of chronic dental infection and its relationship to the atherosclerotic process in the carotid arteries. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:615–621. https://doi.org/10.1016/j.tripleo.2009.10.036

    Article  PubMed  Google Scholar 

  19. Ding L, You Q, Jiang Q, Cao S, Jiang S (2022) Meta-analysis of the association between periodontal disease, periodontal treatment and carotid intima-media thickness. J Periodontal Res 57:690–697. https://doi.org/10.1111/jre.13006

    Article  PubMed  Google Scholar 

  20. Inaba Y, Chen JA, Bergmann SR (2012) Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis 220:128–133. https://doi.org/10.1016/j.atherosclerosis.2011.06.044

    Article  PubMed  Google Scholar 

  21. Garcia Garcia J, Roquer J, Serena J, Castillo J, Blanco M, Diaz-Maroto I, Segura T, Study A (2016) Carotid intima-media thickness is not associated with markers of atherosclerosis in stroke patients. J Stroke Cerebrovasc Dis 25:1070–1075. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.002

    Article  PubMed  Google Scholar 

  22. Rothwell PM, Gibson R, Warlow CP (2000) Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists’ Collaborative Group. Stroke 31:615–621. https://doi.org/10.1161/01.str.31.3.615

    Article  PubMed  Google Scholar 

  23. Touboul PJ, Hernandez-Hernandez R, Kucukoglu S, Woo KS, Vicaut E, Labreuche J, Migom C, Silva H, Vinueza R, Investigators P-A (2007) Carotid artery intima media thickness, plaque and Framingham cardiovascular score in Asia, Africa/Middle East and Latin America: the PARC-AALA study. Int J Cardiovasc Imaging 23:557–567. https://doi.org/10.1007/s10554-006-9197-1

    Article  PubMed  Google Scholar 

  24. Naqvi TZ, Lee MS (2014) Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging 7:1025–1038. https://doi.org/10.1016/j.jcmg.2013.11.014

    Article  PubMed  Google Scholar 

  25. Baber U, Mehran R, Sartori S, Schoos MM, Sillesen H, Muntendam P, Garcia MJ, Gregson J, Pocock S, Falk E, Fuster V (2015) Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol 65:1065–1074. https://doi.org/10.1016/j.jacc.2015.01.017

    Article  PubMed  Google Scholar 

  26. Graetz C, Mann L, Krois J, Salzer S, Kahl M, Springer C, Schwendicke F (2019) Comparison of periodontitis patients’ classification in the 2018 versus 1999 classification. J Clin Periodontol 46:908–917. https://doi.org/10.1111/jcpe.13157

    Article  PubMed  Google Scholar 

  27. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX (1997) Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 146:483–494. https://doi.org/10.1093/oxfordjournals.aje.a009302

    Article  PubMed  Google Scholar 

  28. Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ (1988) Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino) 29:676–681

    PubMed  Google Scholar 

  29. Taguchi A, Sanada M, Suei Y, Ohtsuka M, Lee K, Tanimoto K, Tsuda M, Ohama K, Yoshizumi M, Higashi Y (2004) Tooth loss is associated with an increased risk of hypertension in postmenopausal women. Hypertension 43:1297–1300. https://doi.org/10.1161/01.HYP.0000128335.45571.ce

    Article  PubMed  Google Scholar 

  30. Segura-Egea JJ, Jimenez-Moreno E, Calvo-Monroy C, Rios-Santos JV, Velasco-Ortega E, Sanchez-Dominguez B, Castellanos-Cosano L, Llamas-Carreras JM (2010) Hypertension and dental periapical condition. J Endod 36:1800–1804. https://doi.org/10.1016/j.joen.2010.08.004

    Article  PubMed  Google Scholar 

  31. Gonzalez-Navarro B, Segura-Egea JJ, Estrugo-Devesa A, Pinto-Sala X, Jane-Salas E, Jimenez-Sanchez MC, Cabanillas-Balsera D, Lopez-Lopez J (2020) Relationship between apical periodontitis and metabolic syndrome and cardiovascular events: a cross-sectional study. J Clin Med 9:3205. https://doi.org/10.3390/jcm9103205

  32. Segura-Egea JJ, Jimenez-Pinzon A, Rios-Santos JV, Velasco-Ortega E, Cisneros-Cabello R, Poyato-Ferrera M (2005) High prevalence of apical periodontitis amongst type 2 diabetic patients. Int Endod J 38:564–569. https://doi.org/10.1111/j.1365-2591.2005.00996.x

    Article  PubMed  Google Scholar 

  33. Kimak A, Strycharz-Dudziak M, Bachanek T, Kimak E (2015) Lipids and lipoproteins and inflammatory markers in patients with chronic apical periodontitis. Lipids Health Dis 14:162. https://doi.org/10.1186/s12944-015-0156-5

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gaewkhiew P, Sabbah W, Bernabe E (2017) Does tooth loss affect dietary intake and nutritional status? A systematic review of longitudinal studies. J Dent 67:1–8. https://doi.org/10.1016/j.jdent.2017.10.012

    Article  PubMed  Google Scholar 

  35. Tavares CO, Rost FL, Silva RBM, Dagnino AP, Adami B, Schirmer H, de Figueiredo JAP, Souto AA, Maito FDM, Campos MM (2019) Cross talk between apical periodontitis and metabolic disorders: experimental evidence on the role of intestinal Adipokines and Akkermansia muciniphila. J Endod 45:174–180. https://doi.org/10.1016/j.joen.2018.10.013

    Article  PubMed  Google Scholar 

  36. Shin JM, Luo T, Lee KH, Guerreiro D, Botero TM, McDonald NJ, Rickard AH (2018) Deciphering endodontic microbial communities by next-generation sequencing. J Endod 44:1080–1087. https://doi.org/10.1016/j.joen.2018.04.003

    Article  PubMed  Google Scholar 

  37. Georgiou AC, van der Waal SV, Buijs MJ, Crielaard W, Zaura E, Brandt BW (2023) Host microbiome interactions in apical periodontitis: the endodontic microbiome in relation to circulatory immunologic markers. Int Endod J 56:748–764. https://doi.org/10.1111/iej.13912

    Article  PubMed  Google Scholar 

  38. Buonavoglia A, Zamparini F, Lanave G, Pellegrini F, Diakoudi G, Spinelli A, Lucente MS, Camero M, Vasinioti VI, Gandolfi MG, Martella V, Prati C (2023) Endodontic microbial communities in apical periodontitis. J Endod 49:178–189. https://doi.org/10.1016/j.joen.2022.11.015

    Article  PubMed  Google Scholar 

  39. Willershausen B, Kasaj A, Willershausen I, Zahorka D, Briseno B, Blettner M, Genth-Zotz S, Munzel T (2009) Association between chronic dental infection and acute myocardial infarction. J Endod 35:626–630. https://doi.org/10.1016/j.joen.2009.01.012

    Article  PubMed  Google Scholar 

  40. Cotti E, Dessi C, Piras A, Flore G, Deidda M, Madeddu C, Zedda A, Longu G, Mercuro G (2011) Association of endodontic infection with detection of an initial lesion to the cardiovascular system. J Endod 37:1624–1629. https://doi.org/10.1016/j.joen.2011.09.006

    Article  PubMed  Google Scholar 

  41. Amato M, Veglia F, de Faire U, Giral P, Rauramaa R, Smit AJ, Kurl S, Ravani A, Frigerio B, Sansaro D, Bonomi A, Tedesco CC, Castelnuovo S, Mannarino E, Humphries SE, Hamsten A, Tremoli E, Baldassarre D, group Is (2017) Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification. Atherosclerosis 263:412–419. https://doi.org/10.1016/j.atherosclerosis.2017.05.023

    Article  PubMed  PubMed Central  Google Scholar 

  42. Yu H, Qi LT, Liu LS, Wang XY, Zhang Y, Huo Y, Luan QX (2014) Association of carotid intima-media thickness and atherosclerotic plaque with periodontal status. J Dent Res 93:744–751. https://doi.org/10.1177/0022034514538973

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hayashida H, Saito T, Kawasaki K, Kitamura M, Furugen R, Iwasaki T, Hayashida Y, Nakazato M, Sekita T, Takamura N, Maeda T (2013) Association of periodontitis with carotid artery intima-media thickness and arterial stiffness in community-dwelling people in Japan: the Nagasaki Islands study. Atherosclerosis 229:186–191. https://doi.org/10.1016/j.atherosclerosis.2013.04.002

    Article  PubMed  Google Scholar 

  44. Ahn YB, Shin MS, Han DH, Sukhbaatar M, Kim MS, Shin HS, Kim HD (2016) Periodontitis is associated with the risk of subclinical atherosclerosis and peripheral arterial disease in Korean adults. Atherosclerosis 251:311–318. https://doi.org/10.1016/j.atherosclerosis.2016.07.898

    Article  PubMed  Google Scholar 

  45. Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Sacco RL, Papapanou PN (2005) Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation 111:576–582. https://doi.org/10.1161/01.CIR.0000154582.37101.15

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kapellas K, Maple-Brown LJ, Jamieson LM, Do LG, O’Dea K, Brown A, Cai TY, Anstey NM, Sullivan DR, Wang H, Celermajer DS, Slade GD, Skilton MR (2014) Effect of periodontal therapy on arterial structure and function among aboriginal australians: a randomized, controlled trial. Hypertension 64:702–708. https://doi.org/10.1161/HYPERTENSIONAHA.114.03359

    Article  PubMed  Google Scholar 

  47. Orlandi M, Suvan J, Petrie A, Donos N, Masi S, Hingorani A, Deanfield J, D’Aiuto F (2014) Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis 236:39–46. https://doi.org/10.1016/j.atherosclerosis.2014.06.002

    Article  PubMed  Google Scholar 

  48. Lopez-Jornet P, Berna-Mestre JD, Berna-Serna JD, Camacho-Alonso F, Fernandez-Millan S, Reus-Pintado M (2012) Measurement of atherosclerosis markers in patients with periodontitis: a case-control study. J Periodontol 83:690–698. https://doi.org/10.1902/jop.2011.110412

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (No. 8170041519) and Fundamental Research Funds for the Central Universities of Central South University (No. 2021zzts1035). The authors deny any conflicts of interest related to this study.

Author information

Authors and Affiliations

  1. Health Management Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Yundong Liu

  2. Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China

    Mi He, Ziran Zheng & Changyun Fang

  3. Changsha Health Vocational College, Changsha, Hunan, 410605, People’s Republic of China

    Tao Yin

  4. Department of Infectious Diseases, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Shifang Peng

Authors
  1. Yundong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mi He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ziran Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Changyun Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shifang Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yundong Liu: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Writing- Original draft preparation, Writing- Reviewing and Editing, Funding acquisition. Mi He: Investigation, Data curation, Formal analysis, Validation, Writing- Reviewing and Editing, Funding acquisition. Tao Yin: Investigation, Data curation, Formal analysis, Validation. Ziran Zheng: Investigation, Data curation. Changyun Fang: Formal analysis. Shifang Peng: Conceptualization, Methodology, Formal analysis, Validation, Writing- Reviewing and Editing.

Corresponding authors

Correspondence to Yundong Liu or Shifang Peng.

Ethics declarations

Ethics and consent to participate

Written informed consents were obtained for all the participants. The study followed the STROBE protocols and all the data collection and procedures associated with this study were approved by Xiangya hospital Ethics Committee. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, Y., He, M., Yin, T. et al. Association of severely damaged endodontically infected tooth with carotid plaque and abnormal carotid intima-media thickness: a retrospective analysis. Clin Oral Invest 27, 4677–4686 (2023). https://doi.org/10.1007/s00784-023-05094-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-023-05094-z

Keywords

Search

Navigation