Variation of vascular and blood indicators of early endothelial dysfunction after root canal therapy: A clinical and biomolecular study

Aim: Apical periodontitis (AP) is correlated with a higher risk of developing cardiovascular disease (CVD). No data currently exist to suggest that endothelial dysfunction (ED) improves after endodontic treatment in patients who have AP, despite a link between chronic AP and ED. This study was designed to investigate the expression of early ED markers in young adults with chronic AP, before and after root canal treatment.

Methodology: 41 subjects (20 controls and 21 patients with AP) were examined at enrolment. Patients with AP were also assessed 2 and 12 months after treatment. ENDO-PAT was used to measure endothelial flow reserve (EFR) and ELISAs were used to assess plasma levels of interleukin (IL)-1, IL-6 and TNF-alpha, vasoconstrictor ED endothelin (ET)-1, the circulating endothelial adhesion markers intercellular adhesion molecule-1 (ICAM)-1/ CD54 and soluble vascular cellular adhesion molecule- 1 (sVCAM)-1/CD106, soluble CD14, and the endothelial leukocyte adhesion molecule E-selectin.

Results: Baseline serum levels of ET-1, ICAM-1, E-selectin, IL-1, and sCD14 were elevated in patients with AP compared to the control group. There was no macroscopic evidence of reduced EFR in either group. Treatment for AP was associated with reduced inflammation and improved early ED, indicated by a lowering of IL-1, sCD14, ET-1, ICAM-1/ CD54 and E-selectin levels to resemble those of control subjects.

Conclusions: Early vascular ED may be driven by AP but is reversible with effective endodontic treatment.