Can apical periodontitis modify systemic levels of inflammatory markers? A systematic review and meta-analysis.

By Gomes MS, Blattner TC, Sant'Ana Filho M, Grecca FS, Hugo FN, Fouad AF, Reynolds MA.

Date: 01/2013
Journal: JOE


Answer the research question: Can apical periodontitis (AP) modify systemic levels of inflammatory markers (IM)?


  • The MEDLINE (Ovid), Embase, PubMed, and Cochrane Library databases were searched for human studies published between 1948 and 2012. Two independent reviewers rated the quality of each study (Newcastle-Ottawa Scale)
  • Quality Assessment and Data Extraction – The primary outcome variable was determined by the serum levels of different IMs in AP subjects versus the healthy control group or AP subjects before treatment versus AP subjects after treatment


  • 531 papers found. 0nly 20 were included: 9 were interventional, 8 cross-sectional and 3 case controls.
  • Thirty-one IM’s were analyzed [immunoglobulin (Ig) A, IgM, IgG, and C- reactive protein (CRP) most commonly studied]
  • Most studies showed several IMs (CRP, interleukin (IL)-1, IL-2, IL-6, assymetricaldimethylarginine, IgA, IgG, and IgM) elevated in pts with AP compared to controls
  • IMs CRP and IgE were also not significantly different before and after tx (p> 0.05)

Clinical Significance:

  • Available evidence suggests that AP is associated with increased levels of some systemic inflammatory mediators in humans.
  • Untreated AP may have a pro-atherogenic effect with a potential role in patient’s global vascular risk.
  • Suggests AP may contribute to systemic inflammation, and not be localized to the lesion