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J Endod. 2019 Jun;45(6):681-690. doi: 10.1016/j.joen.2019.03.003. Epub 2019 Apr 26.

Association of Apical Periodontitis with Cardiovascular Disease via Noninvasive Assessment of Endothelial Function and Subclinical Atherosclerosis.

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Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.
Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India. Electronic address:
Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.



Chronic infections of endodontic origin might predispose to the onset of cardiovascular disease (CVD). The studies depicting the link between apical periodontitis (AP) and CVD are few, and the association is very controversial; also, the markers used are expensive, which makes them difficult to use in general practice. The purpose of this study was to investigate whether an association exists between AP and CVD using noninvasive methods (ie, flow-mediated dilatation [FMD] and carotid intima-media thickness [c-IMT]).


This cross-sectional study included 120 men between 20 and 40 years old free from periodontal disease, CVD, and traditional cardiovascular risk factors; 60 subjects had AP, and 60 acted as controls. All subjects underwent complete physical and dental examination, echocardiography, ultrasound assessment of FMD of the right brachial artery, and c-IMT. Data were analyzed using the Mann-Whitney U test and the Spearman rank correlation (rs) test.


FMD was found to be significantly impaired in patients with AP (mean = 4.9% ± 2.05%) compared with healthy controls (mean = 9.74% ± 2.59%, P = .000). The study also depicts statistically significant differences between c-IMT of the AP (mean = 0.64 ± 0.12 mm) and control (mean = 0.54 ± 0.08 mm) groups (P = .000). A significant inverse correlation between c-IMT and FMD was observed (rs = -0.381, P = .000).


Impaired FMD and greater c-IMT in subjects with AP suggests a potential association between endodontic infection and CVD.


Apical periodontitis; cardiovascular disease; carotid intima-media thickness; endothelial dysfunction; flow mediated dilatation


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