Clinical Oral Investigations

, Volume 22, Issue 3, pp 1395–1401 | Cite as

Endodontic infections increase leukocyte and lymphocyte levels in the blood

  • Renata Oliveira Samuel
  • João Eduardo Gomes-Filho
  • Mariane Maffei Azuma
  • Dóris Hissako Sumida
  • Sandra Helena Penha de Oliveira
  • Fernando Yamamoto Chiba
  • Suely Regina Mogami Bomfim
  • Paulo César Ciarlini
  • Luis Gustavo Narciso
  • Luciano Tavares Angelo Cintra
Original Article



The aim of this study was to determine whether the presence of single or multiple apical periodontitis (AP) alters blood cell counts and cytokine production.

Material and methods

Thirty rats were divided into three groups: a control group comprising rats without AP, a group called 1AP comprising rats with AP in one tooth, and a group called 4AP comprising rats with AP in four teeth. Endodontic infection was induced by pulp exposure of the first right maxillary molar in the 1AP group or by exposing the first and second right maxillary and mandibular molars in the 4AP group. A blood count and cytokine levels were obtained 30 days after infection by collecting blood by cardiac puncture. The maxillae were dissected and stained with hematoxylin and eosin to evaluate the inflammatory infiltrate. The data were tabulated and subjected to statistical analysis (P < 0.05).


Histological analysis showed a predominance of mononuclear inflammatory cells. In blood, significant increase of leukocytes, lymphocytes, and tumor necrosis factor alpha (TNF-α) in 4AP compared with the control and 1AP groups (P < 0.05) was observed. In addition, significant decrease of interleukin-4 (IL-4) in 1AP and 4AP groups compared with the control was observed (P < 0.05).


In the rat model, the presence of multiple AP can affect health by increasing lymphocyte and TNF-α levels in the blood.

Clinical relevance

The presence of endodontic infections can interfere with the blood profile, altering systemic health.


Apical periodontitis Leukocytes Lymphocytes Blood count 



This study was supported by a grant (2013/23358-8) from the São Paulo Research Foundation (FAPESP), São Paulo, SP, Brazil.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants performed by any authors. The animal study was approved by the Institutional Ethics Committee (CEUA 2014-00108) of Universidade Estadual Paulista, São Paulo, Brazil and conducted in accordance with ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Renata Oliveira Samuel
    • 1
    • 2
  • João Eduardo Gomes-Filho
    • 1
  • Mariane Maffei Azuma
    • 1
    • 3
  • Dóris Hissako Sumida
    • 4
  • Sandra Helena Penha de Oliveira
    • 4
  • Fernando Yamamoto Chiba
    • 4
  • Suely Regina Mogami Bomfim
    • 5
  • Paulo César Ciarlini
    • 5
  • Luis Gustavo Narciso
    • 5
  • Luciano Tavares Angelo Cintra
    • 1
  1. 1.Department of Endodontics, School of DentistrySão Paulo State University (Unesp)AraçatubaBrazil
  2. 2.Department of Clinical Dentistry, Dental SchoolUNIUBE—Universidade de UberabaUberabaBrazil
  3. 3.Department of EndodonticsIngá University Center, UNINGÁMaringáBrazil
  4. 4.Department of Basic Sciences, School of DentistrySão Paulo State University (Unesp)AraçatubaBrazil
  5. 5.Department of Veterinary Clinical Laboratory, School of Veterinary MedicineSão Paulo State University (Unesp)AraçatubaBrazil

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