Association between Systemic Diseases and Apical Periodontitis

J Endod. 2016 Oct;42(10):1427-34. doi: 10.1016/j.joen.2016.07.007. Epub 2016 Aug 31.


Introduction: To date, the relationships between systemic diseases and periapical microbial infection remain unknown. Thus the purpose of this systematic review was to evaluate the relationship between host modifying factors and their association with endodontic pathosis.

Methods: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers.

Results: Sixteen articles were identified and included. The overall quality of the studies and the risk of bias were rated to be moderate. Only 3 studies demonstrated a low level of bias.

Conclusions: The results of this review suggest that there may be a moderate risk and correlation between some systemic diseases and endodontic pathosis. More prospective and longitudinal research in this area is warranted to determine greater specificity in these possible interactions to potentially decrease or minimize the effects of systemic disease on the formation of apical periodontitis.

Keywords: Correlation; endodontic pathosis; pathogenesis; systematic review; systemic diseases.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Biomarkers / metabolism
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / microbiology
  • Chronic Disease*
  • Hematologic Diseases / complications*
  • Hematologic Diseases / microbiology
  • Host-Pathogen Interactions
  • Humans
  • Longitudinal Studies
  • Periapical Periodontitis / complications*
  • Periapical Periodontitis / metabolism
  • Periapical Periodontitis / microbiology
  • Prospective Studies


  • Biomarkers