Apical periodontitis and cardiovascular disease

Apical periodontitis – a chronic inflammatory disease of the periradicular tissues – is caused by the complex interactions between the root canal microbiota, microbial virulence factors and host immune response. Apical periodontitis manifests itself in different ways, ranging from completely asymptomatic – detected as a periapical radiolucency on a radiograph – to being symptomatic – presenting with pain and abscesses.

Apical periodontitis prevalence

Globally, apical periodontitis prevalence is 52 per cent, meaning that more than half of the world’s population has at least one affected tooth. The NHS in England and Wales has reported that over one million teeth received root canal treatment (RCT) between 2001 and 2004, costing the NHS around £50.5m. According to the American Association of Endodontists, more than 25m root canal treatments are performed each year in the United States and, in Europe, it is reported that almost 23m endodontic treatments are undertaken yearly. Therefore, the global burden of root canal treatment is high. Root canal treatment for apical periodontitis may also require reintervention, as failure rates are still unacceptably high (17 per cent primary RCT; 20 per cent re-treatment).