Apical periodontitis, atherosclerosis, and hypertension: correlation between inflammatory mechanisms and systemic repercussions - integrative review

Abstract

Background: Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide and are closely associated with chronic inflammatory processes and endothelial dysfunction. Apical periodontitis, an infectious inflammation affecting the tissues surrounding the dental apex, has been investigated for its potential systemic implications, particularly regarding hypertension and atherosclerosis. Objective: This study aimed to analyze, through an integrative literature review, the relationship between apical periodontitis, arterial hypertension, and atherosclerosis, with emphasis on the underlying inflammatory mechanisms. Material and Methods: This integrative review was conducted with searches in the Medline database via PubMed and Lilacs via the Virtual Health Library (VHL), using the descriptors “cardiovascular diseases and endodontics”. After screening and applying inclusion and exclusion criteria, 21 studies were selected for qualitative analysis. Results: The findings suggest that apical periodontitis may contribute to systemic inflammation through the release of inflammatory mediators such as interleukin-6, tumor necrosis factor-alpha, and C-reactive protein, biomarkers involved in the pathophysiology of arterial hypertension and atherosclerosis. Experimental and clinical studies indicated that periapical infections might exacerbate endothelial dysfunction, change lipid metabolism, and compromise the efficacy of biomaterials used in endodontic treatments, particularly in hypertensive patients. Conclusion: In conclusion, apical periodontitis appears to act as a modulating factor for cardiovascular risk, highlighting the need for an integrated approach between oral health and systemic health. Controlled clinical studies and longitudinal research are still necessary to establish possible synergistic relationships and guide evidence-based clinical practices.