Systemic health and endodontics
Featured Products Promotional FeaturesPosted by: Dental Design 8th October 2023
Dental clinicians today are no strangers to the associations between systemic and dental health. Indeed, many of us often take the most holistic approach possible to patient care in order to boost both their general and oral wellbeing. Improving one will always improve the other. There is a significant – and growing – body of research to support the links between dental and general health concerns. As an endodontist, I am particularly interested in the potential consequences of systemic health conditions on endodontic outcomes and was intrigued to come across some new research on the matter earlier this year.
Systemic and dental health overview
Periodontal disease is a major offender when it comes to systemic health concerns. A positive correlation has been found between periodontal disease and cardiovascular disease (CVD),[i] for example. Periodontitis is also associated with diabetes (which actually has a bi-directional relationship),[ii] musculoskeletal conditions[iii] and adverse pregnancy outcomes like low birth weight.[iv] Given the prevalence of periodontal disease – estimated at 19% of the global population by the World Health Organization[v] – we will all likely see many patients every week who may be affected. As such, it’s important that all dentists are prepared to offer the most appropriate care and guidance.
Systemic considerations in endodontics
A paper,[vi] published in the International Endodontic Journal, reviewed the existing scientific literature in an attempt to better determine the impact of systemic conditions on the healing of periapical lesions following root canal treatment. It found some evidence that systemic conditions which impair the immune system could alter pulp and periapical healing after endodontic treatment. These included diabetes mellitus, cardiovascular disease, osteoporosis, HIV and AIDS. Upon looking into the findings in more detail, it seems further research is needed to confirm the exact mechanisms and amount of influence such conditions have on endodontic outcomes. However, progress made so far does suggest that underlying systemic health concerns could have negative effects on endodontic outcomes and should therefore be considered as part of the treatment planning process.
As is often the way with these things, there are also research papers that postulate about the impact of endodontic infection on systemic health. The presence of endodontic disease can cause pathogens to enter the rest of the body from the root canals, and apical periodontitis has been associated with diabetes, hypertension, adverse pregnancy outcomes, skeletal infections and coronary heart disease.[vii] Once again, we help to improve one, we help to improve the other.
Applications in practice
For the dental team, there are two areas of focus. The first is our role in minimising the risk of infection and the chance of effective wound healing after endodontic (or any other) therapy. The second is understanding and educating our patients about the impact of their existing systemic health on the potential outcomes of any indicated dental treatment.
The clinical approach to any endodontic treatment should always incorporate steps to reduce the risk of reinfection. These might include correct and complete removal of infected dentine and existing restorations, adequate irrigation with an appropriate solution, properly drying the canals and effective disinfection of the canals with sodium hypochlorite.[viii]
To ensure treatment plans are created specifically for the patient and their systemic condition, a detailed medical history must be taken and kept up-to-date. This is especially important for geriatric patients who are more likely to present with systemic complications. Endodontic treatment can then be tailored accordingly, for example, considering the anaesthesia provided, the length of appointments needed and timing of dental appointments in relation to other medical activities or events.[ix]
Patient education
Aside from our clinical approach to treatment, endodontic or otherwise, patient education is crucial. We must continue to give patients the knowledge they need to really understand how their systemic health could impact their long-term dental health – and ultimately their quality of life.
This will often involve providing verbal and written information about their existing conditions, signposting them to reliable resources they can access at home, and cooperating with medical professionals to deliver multidisciplinary care where necessary. It remains essential to reinforce at least basic oral hygiene practises, encourage regular check-ups and review post-operative oral hygiene instructions for pre- and post-treatment. Other advice around diet, exercise and hydration may also prove useful for a wide range of different patients, helping them to look after both their oral and systemic health.
After all, the modern dentist is holistic in their approach and keen to help patients prevent disease in every manner possible. This includes supporting both dental and systemic health wherever possible.
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[i] Leng Y, Hu Q, Ling Q, Yao X, Liu M, Chen J, Yan Z, Dai Q. Periodontal disease is associated with the risk of cardiovascular disease independent of sex: A meta-analysis. Front. Cardiovasc. Med. 27 February 2023; 10 https://doi.org/10.3389/fcvm.2023.1114927
[ii] Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol 2000. 2007;44:127–153. doi: 10.1111/j.1600-0757.2006.00193.x.
[iii] Bingham CO 3rd, Moni M. Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol. 2013 May;25(3):345-53. doi: 10.1097/BOR.0b013e32835fb8ec. PMID: 23455329; PMCID: PMC4495574.
[iv] Haerian-Ardakani A, Eslami Z, Rashidi-Meibodi F, Haerian A, Dallalnejad P, Shekari M, Moein Taghavi A, Akbari S. Relationship between maternal periodontal disease and low birth weight babies. Iran J Reprod Med. 2013 Aug;11(8):625-30. PMID: 24639799; PMCID: PMC3941365.
[v] World Health Organization. Oral Health. March 2023. https://www.who.int/news-room/fact-sheets/detail/oral-health [Accessed June 2023]
[vi] Segura-Egea JJ, Cabanillas-Balsera D, Martín-González J, Cintra LTA. Impact of systemic health on treatment outcomes in endodontics. International Endodontic Journal. June 2023. https://doi.org/10.1111/iej.13789
[vii] Niazi SA, Bakhsh A. Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. Medicina (Kaunas). 2022 Jul 14;58(7):931. doi: 10.3390/medicina58070931. PMID: 35888650; PMCID: PMC9319780.
[viii] Giovarruscio M, Sauro S, Makeeva I, Foschi F. Strategies to reduce the risk of reinfection and cross-contamination in endodontics. Clinical Dentistry Reviewed. 2019;3:8 https://doi.org/10.1007/s41894-019-0047-7
[ix] Wynne C. Endodontics in Systemically Compromised Patients. Common Complications in Endodontics. 2017 Jul 31:263–92. doi: 10.1007/978-3-319-60997-3_12. PMCID: PMC7121600.
