29 March 2023

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Impact of chronic drug intake on the cure of endodontic pathologies

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The relationship between systemic health and the pathogenesis or cure of endodontic disease has received much attention in the last two decades.

Several literature studies have documented this correlation, especially in chronic diseases such as diabetes mellitus (DM), cardiovascular diseases (CVD), kidney diseases, gastrointestinal diseases, and rheumatoid arthritis.

Recent systematic reviews have recognized the relationship between endodontic success and various systemic diseases, such as DM, CVD, human immunodeficiency virus infection, and drugs, such as oral bisphosphonates (BPs). Studies have also confirmed the possible influence of MD and CVD on the outcome of endodontics-treated teeth.

Most patients suffering from these diseases are treated for these and other conditions with potent drugs that have important biologic roles, including anti-inflammatory, antimicrobial, and osteoconductive roles, roles relevant to the pathogenesis or cure of pulpitis and apical periodontitis (AP).

Materials and methods

In a systematic review published in the Journal of Endodontics in October 2022, the authors evaluated the relationship between the chronic intake of systemic drugs and the incidence, prevalence, or recovery of endodontic pathologies. The authors conducted a comprehensive literature review using the electronic databases MEDLINE Ovid, Scopus, Embase, Cochrane, and PubMed. The team also performed a hand search and extracted articles based on the inclusion criteria.

Results

The investigators identified 2,470 primary screening articles and selected 12 studies for inclusion in the final review. Selected studies included nine cohort or cross-sectional studies and three case-control studies with a low to moderate risk of bias.

Some drugs have been associated with an increased or decreased prevalence of apical periodontitis, while others have been associated with an incidence of pulpal calcification or cervical root resorption.

The endodontic effects of some categories of drugs found by the authors based on the data obtained in this review are listed below.

Statins: have been shown to decrease the prevalence of PsA, improve PsA healing, and increase calcifications in the vital pulp.

BM monoclonal antibodies against RANKL: increase the prevalence of AP (not significant).

BM monoclonal antibodies against TNF-alpha: improve the healing of PA.

Metformin: decreases the prevalence of PA.

Bisphosphonates: decrease in the prevalence of A.

Antiresorptive drugs-denosumab: harm the increased prevalence of cervical root resorption.

Glucocorticoids: damage, higher prevalence of PsA, and increased calcifications in vital pulp (insignificant).

Conclusions

From the data in this review, the investigators concluded that chronic systemic drugs might affect the prevalence or recovery of endodontic diseases and conditions. However, the level of evidence is still low. This justifies the need for future longitudinal clinical trials on the role of chronic systemic drugs and drug monitoring when studying systemic diseases.