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Systemic burden and cardiovascular risk to Porphyromonas species in apical periodontitis

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Abstract

Objective

Porphyromonas (P.) species (spp.) are a major etiological agent of apical periodontitis (AP), which in turn represents a risk factor for cardiovascular diseases. This study explored the associations between endodontic infection with Porphyromonas species, the systemic bacterial burden, and cardiovascular risk, based on high-sensitivity C-reactive protein (hsCRP), in young adults with AP.

Materials and methods

Cross-sectional study. Otherwise, healthy individuals with AP and controls (n = 80, ≤ 40 years) were recruited at the University Dental Clinic. Oral parameters and classic cardiovascular risk factors were registered. Endodontic Porphyromonas endodontalis and Porphyromonas gingivalis were identified using conventional PCR. Serum concentrations of anti-P. endodontalis and anti-P. gingivalis antibodies, and endotoxins were determined through ELISA and Limulus-amebocyte assays. Serum hsCRP was determined for cardiovascular risk stratification.

Results

Intracanal detection of P. endodontalis and P. gingivalis in AP were 33.3% and 22.9%, respectively. Serum anti-P. endodontalis and anti-P. gingivalis IgG was higher in AP than controls (p < 0.05 and p = 0.057, respectively). Intracanal P. endodontalis associated with higher endotoxemia (p < 0.05). Among endodontic factors, the presence (OR 4.2–5.5, p < 0.05) and the number of apical lesions (OR 2.3, p < 0.05) associated with moderate-severe cardiovascular risk, whereas anti-P. endodontalis IgG were protective (OR 0.3, p > 0.05).

Conclusions

AP and infection with P. endodontalis positively associated with cardiovascular risk based on hsCRP levels and endotoxemia, respectively, whereas anti-P. endodontalis IgG response seems to be protective against low-grade systemic inflammation.

Clinical relevance

Apical periodontitis and endodontic P. endodontalis can influence the systemic burden with impact on the surrogate cardiovascular risk marker hsCRP, providing mechanistic links.

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Acknowledgements

The authors thank Maria José Salas, Bernarda Parada, and Felipe Barragan for their valuable technical/clinical assistance.

Funding

The work was supported by the Chilean National Fund for Scientific and Technologic Development (FONDECYT; grants #1060741 and 1200098, M.H.), the Päivikki and Sakari Sohlberg Foundation (P.J.P.), the Sigrid Juselius Foundation (P.J.P.), the European Society of Endodontology (P.J.P.), and the Aarne Koskelo foundation.

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Authors and Affiliations

  1. Department of Oral Pathology, Faculty of Dentistry, Universidad Andrés Bello, Santiago, Chile

    Constanza Jiménez & Alejandra Fernández

  2. Laboratory of Periodontal Biology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile

    Constanza Jiménez, María José Bordagaray, Alejandra Fernández, Claudia Vega & Marcela Hernández

  3. Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile

    Mauricio Garrido & María José Bordagaray

  4. Department of Oral and Maxillofacial Diseases, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland

    Pirkko Pussinen

  5. Department of Periodontology, Centro de Investigación E Innovación Biomédica (CIIB), Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile

    Alejandra Chaparro

  6. Laboratory of Oral Microbiology, Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Olivos 943, Box 8380492, Independencia , Santiago, Chile

    Anilei Hoare

  7. Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Olivos 943, Box 8380492, Independencia , Santiago, Chile

    Marcela Hernández

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  1. Constanza Jiménez
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Correspondence to Anilei Hoare or Marcela Hernández.

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Jiménez, C., Garrido, M., Pussinen, P. et al. Systemic burden and cardiovascular risk to Porphyromonas species in apical periodontitis. Clin Oral Invest 26, 993–1001 (2022). https://doi.org/10.1007/s00784-021-04083-4

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