Review ArticleCan Apical Periodontitis Modify Systemic Levels of Inflammatory Markers? A Systematic Review and Meta-analysis
Section snippets
Literature Search Strategy
A search was undertaken to identify all the studies that reported on the relationship between AP and circulating or systemic levels of IMs. The MEDLINE (Ovid), Embase, PubMed, and Cochrane Library databases were searched for human studies published between 1948 and 2012 (last accessed September 13th, 2012) using the following key words: ("periapical diseases"/exp OR "lesions of endodontic origin" OR "periapical tissue"/exp OR "periapical lesions" OR "apical lesions" OR "periradicular lesions")
Results
Results from the electronic search yielded a total of 531 hits. After duplicate references were discarded, a subsequent search at the title and abstract level revealed 30 articles for full-text reading, 9 of which were identified through a hand search 62, 63, 64, 65, 66, 67, 68, 69, 70, 71. At this level, 10 studies were excluded, and reasons for exclusions are listed in Table 1.
Discussion
Systemic inflammation appears to play an important role in the development of many debilitating diseases including cardiovascular disease among others 2, 3. To our knowledge, the present study is novel in summarizing the available evidence to respond whether patients with AP present modifications in serum levels of IMs. Although the limitations related to available studies, findings from this systematic review reveal a generalized increase in systemic IMs in humans with AP compared with
Implications for Further Research
Available evidence is limited but consistent, suggesting that AP is associated with increased levels of systemic inflammation in humans. Thus, AP may add to the systemic inflammatory burden of affected individuals, and it seems reasonable to consider that untreated AP may have a proatherogenic effect with a potential role in patient's global vascular risk. Future large-scale prospective controlled studies designed to directly test this hypothesis are fundamental.
Conclusions
Available evidence suggest that AP is associated with increased levels of systemic inflammation in humans. Meta-analysis results suggest that serum levels of IgA, IgG, and IgM are increased in humans with apical periodontitis compared with healthy controls and serum levels of CRP, IgA, IgE, IgG, and IgM were not significantly different between patients with AP before and after the treatment intervention. There is a clear need for large-scale prospective controlled studies designed to directly
Acknowledgments
The authors thank Ms Mary Ann Williams, the librarian from the Health Sciences and Human Services Library, University of Maryland, for her valuable contribution during the literature search.
The authors deny any conflicts of interest related to this study.
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Supported in part by the CAPES Foundation, Ministry of Education of Brazil (doctorate scholarship number 1433/11-3) and in part by the Military Police, State Government of Rio Grande do Sul, Brazil.