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The Cochrane Database of Systematic... Jul 2023Apical vaginal prolapse is the descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available, but there are no guidelines to... (Review)
Review
BACKGROUND
Apical vaginal prolapse is the descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available, but there are no guidelines to recommend which is the best.
OBJECTIVES
To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse.
SEARCH METHODS
We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings and ClinicalTrials.gov (searched 14 March 2022).
SELECTION CRITERIA
We included randomised controlled trials (RCTs).
DATA COLLECTION AND ANALYSIS
We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site).
MAIN RESULTS
We included 59 RCTs (6705 women) comparing surgical procedures for apical vaginal prolapse. Evidence certainty ranged from very low to moderate. Limitations included imprecision, poor methodology, and inconsistency. Vaginal procedures compared to sacral colpopexy for vault prolapse (seven RCTs, n=613; six months to f four-year review) Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.31, 95% confidence interval (CI) 1.27 to 4.21, 4 RCTs, n = 346, I = 0%, moderate-certainty evidence). If 8% of women are aware of prolapse after sacral colpopexy, 18% (10% to 32%) are likely to be aware after vaginal procedures. Surgery for recurrent prolapse was more common after vaginal procedures (RR 2.33, 95% CI 1.34 to 4.04; 6 RCTs, n = 497, I = 0%, moderate-certainty evidence). The confidence interval suggests that if 6% of women require repeat prolapse surgery after sacral colpopexy, 14% (8% to 25%) are likely to require it after vaginal procedures. Prolapse on examination is probably more common after vaginal procedures (RR 1.87, 95% CI 1.32 to 2.65; 5 RCTs, n = 422; I = 24%, moderate-certainty evidence). If 18% of women have recurrent prolapse after sacral colpopexy, between 23% and 47% are likely to do so after vaginal procedures. Other outcomes: Stress urinary incontinence (SUI) was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I = 0%, moderate-certainty evidence). The effect of vaginal procedures on dyspareunia was uncertain (RR 3.44, 95% CI 0.61 to 19.53; 3 RCTs, n = 106, I = 65%, low-certainty evidence). Vaginal hysterectomy compared to sacral hysteropexy/cervicopexy (six RCTS, 554 women, one to seven year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.01 95% CI 0.10 to 9.98; 2 RCTs, n = 200, very low-certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 0.85, 95% CI 0.47 to 1.54; 5 RCTs, n = 403; I = 9%, low-certainty evidence). Prolapse on examination- there was little or no difference between the groups for this outcome (RR 0.78, 95% CI 0.54 to 1.11; 2 RCTs n = 230; I = 9%, moderate-certainty evidence). Vaginal hysteropexy compared to sacral hysteropexy/cervicopexy (two RCTs, n = 388, 1-four-year review) Awareness of prolapse - No difference between the groups for this outcome (RR 0.55 95% CI 0.21 to 1.44; 1 RCT n = 257, low-certainty evidence). Surgery for recurrent prolapse - No difference between the groups for this outcome (RR 1.34, 95% CI 0.52 to 3.44; 2 RCTs, n = 345; I = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 0.99, 95% CI 0.83 to 1.19; 2 RCTs n =367; I =9%, moderate-certainty evidence). Vaginal hysterectomy compared to vaginal hysteropexy (four RCTs, n = 620, 6 months to five-year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.0 95% CI 0.44 to 2.24; 2 RCTs, n = 365, I = 0% moderate-quality certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 1.32, 95% CI 0.67 to 2.60; 3 RCTs, n = 443; I = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 1.44, 95% CI 0.79 to 2.61; 2 RCTs n =361; I =74%, low-certainty evidence). Other outcomes: Total vaginal length (TVL) was shorter after vaginal hysterectomy (mean difference (MD) 0.89cm 95% CI 0.49 to 1.28cm shorter; 3 RCTs, n=413, low-certainty evidence). There is probably little or no difference between the groups in terms of operating time, dyspareunia and stress urinary incontinence. Other analyses There were no differences identified for any of our primary review outcomes between different types of vaginal native tissue repair (4 RCTs), comparisons of graft materials for vaginal support (3 RCTs), pectopexy versus other apical suspensions (5 RCTs), continuous versus interrupted sutures at sacral colpopexy (2 RCTs), absorbable versus permanent sutures at apical suspensions (5 RCTs) or different routes of sacral colpopexy. Laparoscopic sacral colpopexy is associated with shorter admission time than open approach (3 RCTs) and quicker operating time than robotic approach (3 RCTs). Transvaginal mesh does not confer any advantage over native tissue repair, however is associated with a 17.5% rate of mesh exposure (7 RCTs).
AUTHORS' CONCLUSIONS
Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, and postoperative SUI than a variety of vaginal interventions. The limited evidence does not support the use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. There were no differences in primary outcomes for different routes of sacral colpopexy. However, the laparoscopic approach is associated with a shorter operating time than robotic approach, and shorter admission than open approach. There were no significant differences between vaginal hysteropexy and vaginal hysterectomy for uterine prolapse nor between vaginal hysteropexy and abdominal hysteropexy/cervicopexy. There were no differences detected between absorbable and non absorbable sutures however, the certainty of evidence for mesh exposure and dyspareunia was low.
Topics: Female; Humans; Dyspareunia; Suspensions; Urinary Incontinence, Stress; Uterine Prolapse
PubMed: 37493538
DOI: 10.1002/14651858.CD012376.pub2 -
The Journal of Evidence-based Dental... Mar 2022To evaluate the effectiveness of CH as an intracanal medicament compared to no dressing and / or other intracanal medicaments to control postoperative pain in patients... (Meta-Analysis)
Meta-Analysis Review
Calcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.
OBJECTIVE
To evaluate the effectiveness of CH as an intracanal medicament compared to no dressing and / or other intracanal medicaments to control postoperative pain in patients with apical periodontitis requiring primary root canal therapy.
MATERIALS AND METHODS
We conducted electronic searches in PubMed, EMBASE, Scopus and Cochrane Library, Open Gray, and Google Scholar. A structured Population-Intervention-Comparison-Outcome of the review was as follows: Population: adults who presented with apical periodontitis requiring primary root canal therapy; Intervention: CH intracanal medicament; Comparison: no dressing/other intracanal medicaments; Main Outcome: Postoperative pain. We assessed the risk of bias using Cochrane criteria. Our outcome measures were intensity of pain on a validated scale reported as mean and standard deviation. We performed meta-analysis using the random-effects model. We rated the quality of evidence using GRADE.
RESULTS
We included 18 studies with 1192 participants. The overall risk of bias was moderate. We found a significant improvement in postoperative pain at 24 hours in favor of CH over no intracanal medication (4 trials, n = 226: standardised mean difference: -0.71; [95% confidence interval: -1.38, -0.03]; P = .04; I= 78%; moderate certainty evidence). Ledermix (Lederle Germany) (steroid-antibiotic) and chlorhexidine were significantly more effective than CH for controlling pain at 72 hours postprocedure (low certainty evidence). Silver nanoparticles were more effective than CH at 6 and 24 hours and combinations of CH with dexamethasone or lidocaine HCl were significantly more effective than CH alone at improving postoperative pain. Substantial heterogeneity limits the robustness of findings.
CONCLUSION
Limited evidence suggests that CH may be an effective intracanal medicament for controlling interappointment pain. Combination therapies appear to be more effective than using CH alone. Further research assessing the comparative effectiveness of interventions for managing postoperative pain following root canal therapy is warranted.
Topics: Adult; Calcium Hydroxide; Humans; Metal Nanoparticles; Pain, Postoperative; Randomized Controlled Trials as Topic; Root Canal Therapy; Silver
PubMed: 35219466
DOI: 10.1016/j.jebdp.2021.101680 -
Photodiagnosis and Photodynamic Therapy Mar 2020Any successful endodontic therapy requires elimination of the endodontic biofilms through meticulous root canal disinfection methods. Sodium hypochlorite (NaOCl) and... (Review)
Review
BACKGROUND
Any successful endodontic therapy requires elimination of the endodontic biofilms through meticulous root canal disinfection methods. Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are the most common effective irrigants, in removing smear-layer from the coronal and middle thirds of the dental canals but reduced considerably towards the apical one third. In recent years, newly alternative treatment modalities have been proposed, including high-power lasers and antimicrobial photodynamic therapy (aPDT). Our work was conducted to evalaute the outcome of root canal disinfection in relation to the efficacy of various treatment modalities. Furthermore, every effort was made to present an overview of the aPDT outcomes, as a model for this application, and to propose laser parameters protocol with positive results.
METHODS
The electronic databases PubMed was searched from January 2013- January 2019. Our inclusive criteria based on laser therapy applications, as a model for root canal disinfection. The search terms utilised various combinations as follows: photodynamic therapy or antimicrobial photodynamic therapy or photoactivated disinfection or light activated disinfection or laser activated disinfection or laser therapy, and endodontic.
RESULTS
The results of this systematic review concluded that the effectiveness of aPDT and various laser wavelengths protocols, in removing endodontic biofilms from infected root canals, remains unattainable.
CONCLUSIONS
Study concluded that the combination of aPDT with antimicrobial irrigants could provide a synergetic effect. However, due to the heterogeneity of the selected studies and their limitations, in terms of lack of standardised protocol or discrepancy in the methodology, authors suggest further validated approaches to achieve optimal outcomes.
Topics: Dental Pulp Cavity; Disinfection; Enterococcus faecalis; Photochemotherapy; Photosensitizing Agents; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite
PubMed: 31809911
DOI: 10.1016/j.pdpdt.2019.101611 -
Journal of the American Dental... Nov 2019An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and...
Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association.
BACKGROUND
An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.
TYPES OF STUDIES REVIEWED
The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework.
RESULTS
The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high.
CONCLUSION AND PRACTICAL IMPLICATIONS
Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
Topics: Adult; American Dental Association; Anti-Bacterial Agents; Evidence-Based Dentistry; Humans; Periapical Abscess; Toothache
PubMed: 31668170
DOI: 10.1016/j.adaj.2019.08.020 -
Stomatologija 2020The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines...
The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines (Google, Researchgate and PubMed) was carried out. The keywords used for search were sodium hypochlorite, injury, cellulitis, apical extrusion, ulcer, endodontics. Full text articles of the articles were collected from the year 2007 to 2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.
Topics: Accidents; Endodontics; Sodium Hypochlorite
PubMed: 32706342
DOI: No ID Found -
The Cochrane Database of Systematic... May 2024Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014.
OBJECTIVES
To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults.
SEARCH METHODS
We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication.
SELECTION CRITERIA
Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence.
MAIN RESULTS
There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.
AUTHORS' CONCLUSIONS
The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.
Topics: Adult; Humans; Acute Disease; Anti-Bacterial Agents; Bias; Drainage; Periapical Abscess; Periapical Periodontitis; Randomized Controlled Trials as Topic; Toothache
PubMed: 38712714
DOI: 10.1002/14651858.CD010136.pub4 -
Obstetrics and Gynecology Jun 2021To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).
DATA SOURCES
MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English.
METHODS OF STUDY SELECTION
From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded.
TABULATION, INTEGRATION, AND RESULTS
Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1-5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22-2.74 and RR 2.70, 95% CI 1.33-5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47-0.75 and RR 0.59, 95% CI 0.44-0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures.
CONCLUSION
Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1-5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019133869.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Observational Studies as Topic; Pelvic Organ Prolapse; Postoperative Complications; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Recurrence; Reoperation; Robotic Surgical Procedures; Sacrum; Surgical Mesh; Vagina
PubMed: 33957652
DOI: 10.1097/AOG.0000000000004393 -
International Urogynecology Journal Apr 2023This systematic review (PROSPERO:CRD42022275789) is aimed at comparing qualitatively the success, recurrence, and complication rates of sacrocolpopexy with concomitant... (Review)
Review
INTRODUCTION AND HYPOTHESIS
This systematic review (PROSPERO:CRD42022275789) is aimed at comparing qualitatively the success, recurrence, and complication rates of sacrocolpopexy with concomitant hysterectomy, hysteropexy, sacrospinous fixation (SSF) with and without vaginal hysterectomy (VH) and uterosacral fixation (USF) with and without VH.
METHODS
A systematic search was performed using Embase, PubMed, Scopus, and Cochrane databases for studies published from 2011, on women with apical pelvic organ prolapse requiring surgical interventions. Risk of bias was assessed via the National Institutes of Health study quality assessment tool. The primary outcomes are the success and recurrence rate of each technique, for ≥12 months' follow-up. Findings were summarised qualitatively.
RESULTS
A total of 21 studies were included. Overall significant findings for a high success and low recurrence rate are summarised as: minimally invasive sacrocolpopexy (MISC) is superior to abdominal sacrocolpopexy (ASC); sacrospinous hysteropexy (SSHP) is superior to USF + VH, which is superior to uterosacral hysteropexy and mesh hysteropexy (MHP). Significant findings related to complications include: MISC recorded a lower overall complication rate than ASC except in mesh exposure; USF + VH tends to perform better than SSHP and SSF, with SSHP performing better than MHP in faecal incontinence and overactive bladder rates.
CONCLUSION
There is no evidence to conclude that hysterectomy is superior to uterine-sparing approaches. MISC should be considered over ASC given similar efficacy and reduced complications. Superiority of MHP is unproven against native tissue hysteropexy. Further studies under standardised settings are required for direct comparisons between the surgical management methods.
Topics: Female; Humans; Gynecologic Surgical Procedures; Treatment Outcome; Pelvic Organ Prolapse; Uterus; Hysterectomy
PubMed: 36462058
DOI: 10.1007/s00192-022-05408-x -
Reviews in Cardiovascular Medicine Mar 2022A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies.
METHODS
The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed.
RESULTS
The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02-2.29, = 0.039; I2 = 75.0%; < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67-2.29, = 0.494; I2 = 82.1%; < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71-2.27, = 0.413; I2 = 69.1%; = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity.
CONCLUSIONS
Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up.
REGISTRATION
PROSPERO database (CRD42020204379).
Topics: Adult; Aged; Cardiovascular Diseases; Case-Control Studies; Cross-Sectional Studies; Databases, Factual; Female; Humans; Male; Middle Aged; Periapical Periodontitis
PubMed: 35345267
DOI: 10.31083/j.rcm2303100 -
Journal of Endodontics Nov 2023This systematic review aimed to examine a potential link between apical periodontitis (AP) and gastrointestinal diseases (GIDs). (Review)
Review
INTRODUCTION
This systematic review aimed to examine a potential link between apical periodontitis (AP) and gastrointestinal diseases (GIDs).
METHODS
The protocol of the review has been registered in PROSPERO (CRD42022330771). The following engines were used with the aim of searching for relevant literature: PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and grey literature, from inception to May 2022. There were no language restrictions included. Study selection, data collection, and synthesis have been performed by 2 independent reviewers. For the purpose of estimating the quality of studies, the Newcastle-Ottawa Scale was used.
RESULTS
Four matched case control studies, as well as a single longitudinal cohort study were included in the final review. These were published between 2012 and 2017, and comprised 537 participants whose age range was 18 to 87 years. It was not possible to perform a meta-analysis due to different study designs and evaluated outcomes of included studies. Except for one study that was categorized as "Good," overall, for 4 out of 5 studies the quality was assessed as "Fair".
CONCLUSIONS
This review highlighted sparse knowledge present in the literature concerned with the association between AP and GIDs. Available evidence reveals a potential link between impaired endodontic status, assessed by the number of root-filled teeth with periapical radiolucency, and GIDs. More research is needed to ascertain this association.
Topics: Humans; Periapical Periodontitis; Gastrointestinal Diseases; Adult; Aged; Aged, 80 and over
PubMed: 37558178
DOI: 10.1016/j.joen.2023.07.024