The Impact of Endodontic Infections on the Pathogenesis of Cardiovascular Disease(s): A Systematic Review with Meta-analysis Using GRADE

Introduction: The purpose of this systematic review was to determine whether endodontic infections had an impact on the pathogenesis of systemic disease. Methods: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Em base, Cochrane, and PubMed databases were searched. In addition, the bibliographies, gray literature of all relevant articles, and textbooks were manually searched. There was no disagreement between the 2 reviewers. Results: Four articles met the inclusion criteria with a high risk of bias. Three articles were analyzed for quantitative synthesis. All these articles were regarding cardiovascular disease (CVD). There was low-certainty evidence that a lesion of endodontic origin can contribute to systemic disease, 95% confidence interval, risk ratio 1.2 (0.79-1.83). Owing to high heterogeneity among the studies, sub-group analysis was undertaken. The results reported more consistent outcome with risk ratio 0.95 (0.75-1.21) and low certainty. Therefore, the authors have limited confidence in the effect estimate, which indicates that the true effect may be substantially different from the estimate of the effect. Conclusions: Whether the presence of a lesion of endodontic origin may or may not have some impact on cardiovascular disease, the level of evidence is low, and our confidence in the assessment is low. This systematic review raised questions in the designs and analysis of the data, and further well-conducted longitudinal research would be required to make this causality claim.