Epidemiologic issues in studies of association between apical periodontitis and systemic health

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Perhaps the most exciting issue currently facing the dental research community centers around a hypothesized connection between chronic inflammatory oral infections, most notably periodontal disease, and the development of adverse systemic health conditions. To date, inflammation of endodontic origin (i.e., apical periodontitis (AP)) has not been extensively studied in this regard despite being a commonly found sequel to bacterial infection of the dental pulp space. Although numerous differences exist between chronic inflammatory disease of periodontal and endodontic origins, there are some notable similarities, primarily that: (1) both often are associated with Gram-negative anaerobic bacteria, and (2) elevated cytokine levels may be released systemically from acute and chronic manifestations of both disease processes. This article provides a brief review of several important concepts concerning adverse general health outcomes as they relate to periodontal disease, summarizes recent epidemiologic studies of AP and root canal therapy, and reviews some general issues involved in the conduct of epidemiologic studies as well as how these issues apply to investigations that address potential links between endodontic inflammatory disease and adverse systemic health outcomes.

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