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Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 20 February 2026 | Viewed by 18290

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Prof. Dr. Juan J. Segura-Egea

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Department of Stomatology, School of Dentistry, University of Sevilla, Calle Avicena s/n, Sevilla, Spain
Interests: apical periodontitis; endodontic medicine; periodontal disease; periodontal medicine; pulpitis; systemic diseases; root canal treatment

Prof. Dr. Daniel Cabanillas-Balsera

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Guest Editor

Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
Interests: apical periodontitis; endodontic medicine; periodontal disease; periodontal medicine; pulpitis; systemic diseases; root canal treatment

Special Issue Information

Dear Colleagues,

The scientific evidence accumulated over the past few decades supports that although oral infections, including periodontal disease and endodontic infection, occur at a specific location in the body, they have an echo at a systemic level. The interrelations between periodontal disease and systemic diseases, such as diabetes and cardiovascular pathologies, have been widely considered. Numerous studies have also been conducted on the association of apical periodontitis or root canal treatment with systemic diseases and habits such as diabetes, arteriosclerosis, hypertension or smoking. A large number of cross-sectional epidemiological studies have found a significant association between the prevalence of oral infections and that of systemic pathology. In fact, it is striking that very few studies comparing control patients with patients with systemic pathology do not find an association. However, the existence of publication bias cannot be ruled out. On the other hand, longitudinal studies are needed to analyze endodontic and periodontal variables in control groups and those with systemic pathology over time.

In this Special Issue, we invite research articles on the prevalence of oral infections in patients with previously uninvestigated systemic pathologies, as well as longitudinal studies and systematic reviews on endodontic medicine and periodontal medicine.

Prof. Dr. Juan J. Segura-Egea
Prof. Dr. Daniel Cabanillas-Balsera
Guest Editors

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Keywords

dentistry
endodontics
apical periodontitis
endodontic medicine
periodontal disease
periodontal medicine
pulpitis
systemic diseases
root canal treatment

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Published Papers (10 papers)

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Research

Jump to: Review, Other

11 pages, 614 KB

Open AccessArticle

Factors Influencing the Healing of Maxillary Sinusitis of Endodontic Origin After Non-Surgical Endodontic Treatment

by Paweł Szczurowski, Krzysztof Gronkiewicz and Barbara Czopik

J. Clin. Med. 2025, 14(19), 6778; https://doi.org/10.3390/jcm14196778 - 25 Sep 2025

Viewed by 3064

Abstract

Background/Objectives: The purpose of this study was to indicate factors influencing the healing of maxillary sinusitis of endodontic origin (MSEO) after non-surgical endodontic treatment. Methods: The study was performed retrospectively on medical records and CBCT data of 114 teeth in 114 patients, who were referred to endodontic treatment between 2016 and 2024, performed by the same operator and according to the same treatment protocol. Fifteen factors were chosen for their possible influence on the healing of MSEO. Results: The rate of the complete healing of MSEO after RCT was 76.32%. The healing of MSEO was higher when CHX was applied in the final irrigation protocol (p = 0.022) and was less likely when there was a flare-up in-between visits or after obturation of the canals (p = 0.002). MSEO was more likely to heal when a tooth was treated in two appointments than with single-visit RCT (p = 0.012). The number of endodontic interventions significantly influenced the healing of MSEO, as it was less likely to heal when there was more than one endodontic retreatment for a tooth (p = 0.01). Conclusions: Within the limitations of this retrospective study, four factors significantly influenced the healing of MSEO, and these should be taken into consideration in obtaining treatment protocols for dental-induced sinusitis and the better assessment of the possible success of this non-invasive treatment approach. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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9 pages, 397 KB

Open AccessArticle

Does Toothache Before a Dental Visit Associate with the Risk of a First Myocardial Infarction?

by Dan Sebring, Kåre Buhlin and Thomas Kvist

J. Clin. Med. 2025, 14(19), 6729; https://doi.org/10.3390/jcm14196729 - 24 Sep 2025

Viewed by 1106

Abstract

Background/Objectives: Ischemic heart disease is typically characterized by chest pain that sometimes radiate to other areas, including the orofacial region. Atypical clinical presentation of cardiac disease risks leading to a delay in the diagnosis and treatment. Symptoms in the orofacial region may also lead to unnecessary dental interventions. The objective of this study was to assess occurrence of toothache, or other oral problems, that prompted a visit to a dental office prior to a first myocardial infarction. Methods: In 2010 until 2014, a total of 805 patients hospitalized for a first myocardial infarction and 805 controls matched for age, sex, and postal code area, were recruited to the case–control study PAROKRANK (Periodontitis and its relation to cardiovascular disease). In addition to medical and oral examinations that included panoramic radiography and blood sampling, all participants responded to a survey that covered questions related to oral habits and dental service use. The present study focused on responses to questions concerning the most recent visit to a dental office, specifically if toothache, chewing problem, and/or other problems with the teeth were present, whilst also taking endodontic variables into consideration. Results: Time since the most recent visit to a dental office ranged between 0–14 years, with a mean value of 1.08 years and no difference between patients and controls. A majority of responders (80.9%) gave the reason to be a routine dental examination. Toothache as the reason was reported by 146 (11.5%) respondents: 71 (10.9%) patients and 75 (12.1%) controls (p = 0.59). No difference was observed between patients and controls. Conclusions: Within the limitations of the present study design, seeking dental care for toothache was not associated with the risk of a subsequent first myocardial infarction. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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9 pages, 540 KB

Open AccessArticle

Endo-Periodontal Lesions Without Root Damage: Recommendations for Clinical Management

by Susana Aranda Verdú, Antonio Pallarés Sabater, Antonio Pallarés Serrano, Jorge Rubio Climent and Alberto Casino Alegre

J. Clin. Med. 2025, 14(18), 6655; https://doi.org/10.3390/jcm14186655 - 22 Sep 2025

Cited by 1 | Viewed by 1780

Abstract

Background: Endo-periodontal lesions (EPLs) are defined by a pathological connection between the pulp and the periodontium in a specific tooth. Although the identification of EPL etiology is of paramount importance for a correct treatment plan, it may be impossible at times to pinpoint the primary cause prospectively. A critical aspect of treatment planning involves assessing the necessity of root canal treatment in periodontal patients presenting with EPLs, evaluating the indication for periodontal intervention in cases of endodontic origin and determining whether splinting of the affected tooth is required. The aim of this article is to provide a concise perspective on the management of EPLs without root damage. Methods: A clinical decision-making flowchart was created based on current classification systems to guide treatment strategies for EPLs. Results: A flowchart of the treatment of EPLs based on possible decision pathways with a starting point in the diagnosis of the periodontitis or non-periodontitis patient that can prove particularly useful in cases where the initial etiology remains uncertain. Conclusions: EPLs are infections that represent a significant clinical challenge. This article summarizes key diagnostic considerations and therapeutic steps, offering practical guidance for clinicians managing these lesions. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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13 pages, 1228 KB

Open AccessArticle

Radiographic and Clinical Outcomes of Laser-Enhanced Disinfection in Endodontic Therapy

by Janos Kantor, Sorana Maria Bucur, Eugen Silviu Bud, Victor Nimigean, Ioana Maria Crișan and Mariana Păcurar

J. Clin. Med. 2025, 14(12), 4055; https://doi.org/10.3390/jcm14124055 - 8 Jun 2025

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Abstract

Background and Objectives: Periapical healing and bone regeneration are key indicators of endodontic success. This study evaluated the effectiveness of laser-assisted disinfection compared to conventional chemical irrigation in promoting periapical healing across various bone densities (D1–D5), using cone-beam computed tomography (CBCT) over multiple follow-up intervals. Materials and Methods: A total of 120 patients with radiographically confirmed periapical lesions were enrolled and allocated into two groups: an experimental group (n = 60, chemical irrigation + Er,Cr:YSGG laser disinfection) and a control group (n = 60, chemical irrigation only). CBCT scans were obtained at 6 months, 1 year, 2 years, and 2.5 years post-treatment to assess lesion size and CBCT-PAI scores. Lesions were classified radiographically as either well-defined radiolucent lesions or undefined periapical radiolucencies. Paired t-tests and ANOVA were used for statistical comparisons. Results: The experimental group demonstrated significantly greater reductions in lesion size and improvements in CBCT-PAI scores at all time points. Healing was especially enhanced in low-density bone (D4–D5). Complete healing rates were higher in the laser group for well-defined radiolucent (89.5% vs. 68.4%) and undefined lesions (81.8% vs. 59.1%). Post hoc power analysis confirmed statistical reliability (Cohen’s d = 3.48; power > 0.99). Conclusions: Laser-assisted endodontic disinfection significantly accelerates periapical healing and promotes bone regeneration, particularly in low-density bone. CBCT imaging supports its clinical superiority over conventional irrigation methods. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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18 pages, 2901 KB

Open AccessArticle

Knowledge of Antibiotic Management in Surgery, Periodontics and Endodontics Among Patients, Students and Dentistry Professors: A Cross-Sectional Study at the University of Barcelona (Spain)

by Adrián Toribio-Méndez, Paloma Montero-Miralles, Sonia Egido-Moreno, Verónica Schiavo Di Flaviano, Beatriz González-Navarro and José López-López

J. Clin. Med. 2025, 14(7), 2179; https://doi.org/10.3390/jcm14072179 - 22 Mar 2025

Viewed by 1304

Abstract

Background/Objectives: The main objective of this study was to analyze the knowledge on the use and management of antibiotics in dentistry within three different groups of interest: patients, fifth-year dental students at the University of Barcelona and professors of the faculty of dentistry of the University of Barcelona. Methods: A cross-sectional pilot study was carried out using questionnaires addressed to the three groups of interest: patients (n = 250), students (n = 79) and professors (n = 50). Sociodemographic questions were asked of all the groups. The professor and student questions were related to antibiotic therapy in relation to dental procedures. The patients were asked questions related to antibiotic management. Results: Regarding the patient group, there were statistically significant differences between the participants of the group; people without higher education were more likely to self-medicate (p = 0.043) or to be unaware of the adverse effects (p = 0.045). Regarding the student and professor groups, there were no significant differences in the prescription of antibiotics. Amoxicillin 750 mg was the most commonly used in patients without an allergy to Penicillin, but there were significant differences in the antibiotic of choice for those patients allergic to Penicillin, the most commonly prescribed being either Clindamycin or Azithromycin (p = 0.002). Conclusions: The study revealed a lack of uniformity in the knowledge and management of antibiotics among both students and professors, which highlights the need to improve university training in pharmacology and for professors to continue education throughout their working lives. It also indicates the need for patient health education regarding antibiotics. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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13 pages, 240 KB

Open AccessArticle

Cone-Beam Computed Tomography Assessment of the Prevalence and Association of Pulp Calcification with Dental and Periodontal Pathology: A Descriptive Study

by José Luis Sanz, Lucía Callado, Stefana Mantale, Jenifer Nicolás, James Ghilotti and Carmen Llena

J. Clin. Med. 2025, 14(4), 1373; https://doi.org/10.3390/jcm14041373 - 19 Feb 2025

Cited by 2 | Viewed by 1364

Abstract

Background/Objectives: Pulp stones (PSs) are calcified masses, with rounded or oval shapes, ranging from small particles to masses larger than the chamber and/or canals. There are limited data regarding the prevalence of pulp stones in the Iberian population. Our aim was to determine the prevalence of PSs, using CBCT, in an Iberian population, and its association with gender, age, tooth location (arch and hemiarch), dental group, the presence of caries, restorations, alveolar bone loss, and a history of orthodontic treatment. Methods: In total, 300 CBCTs were analyzed, selected from the database of the Dental Clinic of the University of Valencia. A total of 5485 teeth were included. The images were obtained by NewTom equipment and visualized using NNT software 11 by a single calibrated examiner in the axial, sagittal, and coronal planes. The Chi-square test, ANOVA, and t-test were used to analyze the study variables for a significance level of p < 0.05. Results: The prevalence of PSs was 88.3% from the total number of patients assessed and 61.2% from the total number of teeth assessed. No differences were found by gender or age. A significant association was found within tooth groups between arches and hemiarches. The proportion of PSs was 3.7 times higher in teeth with caries, 4.7 times higher in teeth with fillings, and 2.3 times higher in teeth with alveolar bone loss. Conclusions: PSs were more prevalent in molars. The presence of caries, fillings, and bone loss increased the chance of presenting PSs. Maxillary teeth had a higher prevalence of PSs than mandibular teeth. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

Review

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16 pages, 1477 KB

Open AccessReview

Atherosclerosis and Chronic Apical Periodontitis: Systematic Review and Meta-Analysis

by María León-López, Daniel Cabanillas-Balsera, Jenifer Martín-González, Benito Sánchez-Domínguez, Juan J. Saúco-Márquez and Juan J. Segura-Egea

J. Clin. Med. 2025, 14(5), 1504; https://doi.org/10.3390/jcm14051504 - 24 Feb 2025

Cited by 4 | Viewed by 2790

Abstract

Background: Atherosclerosis is a chronic and progressive condition of the arteries, characterized by the thickening and hardening of their walls due to the formation of atherosclerotic plaques. Low-grade inflammation is implicated in the pathogeny of atherosclerosis. Chronic apical periodontitis (CAP), the chronic inflammation around the root apex of infected teeth, is associated with a low-grade inflammatory state, and thus a connection between atherosclerosis and CAP has been suggested. The aim of this study was to conduct a systematic review with meta-analysis to answer the following PICO question: In adult patients, does the presence or absence of atherosclerosis affect the prevalence of CAP? Methods: The PRISMA guidelines were followed to carry out this systematic review, which was registered in PROSPERO (651359). A bibliographic search was performed in PubMed-MEDLINE, Embase, and Scielo. The inclusion criteria selected studies presenting data on the prevalence of CAP in patients diagnosed with atherosclerosis and control patients. The statistical analysis was carried out using RevMan software v.5.4. The study characteristics and risk ratios with 95% confidence intervals (CIs) were extracted. Random-effects meta-analyses were performed. Risk of bias was assessed using the Newcastle-Ottawa scale, which was adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The quality of the evidence was evaluated using GRADE. Results: The search strategy recovered 102 articles, and only five met the inclusion criteria. Meta-analysis showed an overall OR = 2.94 (95% CI = 1.83–4.74; p < 0.01) for the prevalence of CAP among patients with atherosclerosis. The overall risk of bias was moderate. The quality of the evidence showed a low level of certainty. Conclusions: Patients with atherosclerosis are almost three times more likely to have CAP. This finding supports the hypothesis that chronic inflammatory processes in the oral cavity could significantly impact cardiovascular health, emphasizing the importance of an integrated approach to oral and systemic health care. This result should be translated to daily clinical practice, and the healthcare community should be aware of this association and suspect atherosclerotic pathology in patients who show a high prevalence of CAP. Likewise, patients with atherosclerosis should be monitored in the dental clinic for CAP. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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Other

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19 pages, 1363 KB

Open AccessSystematic Review

Chronic Kidney Disease and Chronic Oral Inflammatory Diseases: A Systematic Review and Meta-Analysis of Periodontitis and Apical Periodontitis

by Laura López-Sanz, María León-López, Sonia Egido-Moreno, Carlos Segura-Raya, José López-López, Juan J. Segura-Sampedro, Daniel Cabanillas-Balsera and Juan J. Segura-Egea

J. Clin. Med. 2025, 14(22), 7947; https://doi.org/10.3390/jcm14227947 - 10 Nov 2025

Viewed by 861

Abstract

Background: Chronic kidney disease (CKD) has been increasingly associated with oral chronic inflammatory conditions, including periodontitis (PD) and apical periodontitis (AP). Both share common pathophysiological pathways involving systemic inflammation, immune dysregulation, and oxidative stress. This systematic review and meta-analysis aimed to synthesize current evidence on the association between CKD and chronic oral inflammatory diseases. Methods: The PRISMA guidelines were followed and the proto-col was registered in PROSPERO: CRD420251167323. A comprehensive electronic search was conducted in PubMed, Scopus, Web of Science, and ProQuest up to September 2025. Observational studies reporting prevalence of chronic oral inflammatory diseases in CKD patients and controls subjects were included. The Newcastle–Ottawa scale was used for assessing risk of bias. Pooled odds ratios (ORs) were calculated using a random-effects model. Results: Seven studies published between 2011 and 2025, including 13,139 participants, met the inclusion criteria. CKD patients had significantly higher prevalence of oral inflammatory disease than controls (OR = 4.2; 95% CI = 2.5–7.2; p < 0.00001). Heterogeneity was high (I² = 83.0%). Subgroup analysis showed an OR of 4.3 (95% CI = 2.6–7.0; p < 0.0001) for AP and 4.3 (95% CI = 2.2–8.7) for PD. The overall risk of bias was moderate, and the certainty of evidence according to GRADE was rated as low. Conclusions This systematic review and meta-analysis highlight a potential link between chronic oral inflammatory disease, including both AP and PD, and chronic kidney disease (CKD). However, the certainty of the evidence is low, and substantial heterogeneity exists across studies. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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16 pages, 1317 KB

Open AccessSystematic Review

Association Between Oral Dysbiosis and Depression: A Systematic Review

by Paula García-Rios, Miguel R. Pecci-Lloret, María Pilar Pecci-Lloret, Laura Murcia-Flores and Nuria Pérez-Guzmán

J. Clin. Med. 2025, 14(14), 5162; https://doi.org/10.3390/jcm14145162 - 21 Jul 2025

Cited by 1 | Viewed by 1827

Abstract

Background: Depression is a mental disorder characterized by a combination of somatic and cognitive disturbances, in which a predominantly sad or irritable mood significantly interferes with the patient’s functioning. This condition can affect individuals of all ages and socioeconomic backgrounds. Currently, various studies are exploring a possible association between oral dysbiosis and depression—an increasingly relevant topic, as confirmation of such a relationship could position the oral microbiota as a potential etiological or diagnostic factor for depression, given its accessibility and ease of analysis. Aim: To present a qualitative synthesis of studies addressing how oral dysbiosis influences the onset of depression, as well as the importance of controlling this alteration of the oral microbiota to aid in the prevention of the disease. Materials and Methods: The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) outline the procedures to be followed for conducting this systematic review. The article search was carried out on 22 May 2025, across the PubMed, Scopus, Scielo, and The Cochrane Library databases, using terms related to “depression” and “oral dysbiosis”. Studies published within the last 10 years that addressed the potential association between oral dysbiosis, and depression were included. Furthermore, the quality of the studies was assessed using various tools depending on their design: the Newcastle–Ottawa Scale (NOS) was applied to case-control and cohort studies; the Joanna Briggs Institute (JBI) critical appraisal checklist was used for cross-sectional studies; and experimental studies were evaluated using SYRCLE’s Risk of Bias Tool. Results: A total of eleven studies were included in this systematic review. The findings suggest the presence of alterations in the oral microbiota of patients with depression, particularly in terms of composition, structure, and diversity. A reduction in alpha diversity—an indicator of local microbial balance—was observed, along with an increase in beta diversity, indicating greater inter-individual variability, which may be associated with inflammatory processes or immunological dysfunctions. Some studies reported differing results, which may be attributable to methodological variability regarding study design, or the populations sampled. Conclusions: This systematic review suggests that the oral microbiome could be considered a diagnostic biomarker and therapeutic target for depression, as the analyzed studies demonstrate a significant association between oral microbiome dysbiosis and this mental disorder. However, the methodological heterogeneity among the studies highlights the need for further research to confirm this potential relationship. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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16 pages, 1505 KB

Open AccessSystematic Review

Association Between Oral Dysbiosis and Alzheimer’s Disease: A Systematic Review

by Valeria Martínez-Martínez, Francisco Javier Rodríguez-Lozano, María Pilar Pecci-Lloret and Nuria Pérez-Guzmán

J. Clin. Med. 2025, 14(10), 3415; https://doi.org/10.3390/jcm14103415 - 13 May 2025

Cited by 2 | Viewed by 1774

Abstract

Objective: The main objective of this systematic review is to select and critically synthesize the available evidence from studies that aimed to verify whether there is a relationship between dysbiosis of the oral cavity and the development of Alzheimer’s disease. Methodology: A search was conducted on 30 November 2024 and updated on 9 January 2025, in the PubMed, SciELO Scopus, and Web of Science databases, limiting the search to the last 5 years. The review was carried out under the criteria of the PRISMA 2020 guide for systematic reviews and has been accepted into the PROSPERO registry (CRD42025636275). We analyzed the risk of bias of studies using the JBI guidelines. Results: Initially, 2009 articles were obtained. After eliminating duplicates, we obtained 1716; of these, following the inclusion and exclusion criteria, 185 articles were reviewed by title and abstract, discarding 171. Of the remaining 14 articles, 12 final articles were selected. In the results obtained, it has been observed that there is a relationship between inflammation derived from oral dysbiosis caused by periodontal disease and its extension to the neuronal tissue via the hematogenous blood–brain barrier (BBB) and nerve (V pair). Among the most frequently found oral microbiota are Veillonella, Fusobacteria, Prevotella, Porphyromonas, Lactobacillus, and Streptococcus. Conclusions: Oral dysbiosis gives rise to the establishment of inflammatory processes that lead to neurological degeneration, either through its passage across the blood–brain barrier or by a direct connection between the free nerve endings of the periodontium and the proprioceptors found in the central nervous system. Therefore, the chronic inflammation caused by oral dysbiosis and its role in systemic inflammation could be associated with the onset and progression of Alzheimer’s disease (AD); however, more studies are needed to show the association between oral dysbiosis and Alzheimer’s disease. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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