In the past, periodontal disease has received considerable interest as a risk factor for systemic diseases such as cardiovascular disease (CVD), diabetes mellitus, chronic liver disease and others. Endodontic infections have received less attention, despite the fact that many microbial pathogens are common to periodontal and endodontic disease. By conducting a systematic review of the literature, Khalighinejad et al from Case Western Reserve University, Ohio, endeavored to confirm a relationship between endodontics pathosis and systemic diseases.

Some studies have found an association between diabetes mellitus and significantly reduced endodontic treatment outcomes in teeth with preoperative infections.

Another study found that both diabetes mellitus and hypertension were associated with reduced survival of endodontically treated teeth. Systemic conditions and disorders can be considered modulating factors affecting oral infection progression rather than acting as causative etiologic factors.

The following question was posited for a systematic review of the existing literature regarding apical pathosis and systemic diseases: “When compared with medically healthy individuals, can systemic diseases modify and/or influence apical pathosis?” On the basis of the current best available evidence, the authors found a possible association between endodontic pathosis and CVD.


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

Khalighinejad N, Aminoshariae MR, Aminoshariae A, et al. Association between systemic diseases and apical periodontitis.
J Endod 2016;42:1427-1434.