High Prevalence of Apical Periodontitis in Patients with Inflammatory Bowel Disease: An Age-and Gender-matched Case-control Study

Abstract

Background: Deep carious lesions cause pulpitis, pulpal necrosis and, finally, apical periodontitis (AP). Root canal treatment (RCT) is the treatment of choice for AP, changing the tooth into a root-filled tooth (RFT). Several studies have linked AP and RFT to systemic diseases. Likewise, previous studies have also found an association among inflammatory bowel disease (IBD) and periodontal disease. This study aims to analyze the frequency of AP and RCT in IBD patients and healthy control subjects. Methods: An age-and gender-matched case-control study design was used. The study group (SG) included 54 IBD patients (28 with Crohńs disease, 26 with ulcerative colitis). Another 54 healthy subjects without IBD and age-and gender-matched were included in the control group (CG). The radiographic records were analyzed, and periapical radiolucencies were diagnosed as AP, using the periapical index (PAI). The statistical analysis was carried out using the Student t test, χ2 test, and multivariate logistic regression. Results: The presence of 1 or more teeth with radiolucent periapical lesions (RPLs) was found in 19 patients (35.2%) in the study group and in 9 subjects (16.7%) in the control group (P = 0.03). No differences were found among the 2 groups neither in the amount of teeth with AP nor in the number of RFTs (P > 0.05). However, multivariate logistic regression analysis adjusting for number of teeth and number of RFTs showed that patients with IBD have RPLs with higher likelihood than control patients (odds ratio, 5.7; confidence interval 95%, 1.7-19.1; P = 0.0048). Conclusions: Subjects with inflammatory bowel disease have higher prevalence of apical periodontitis. An oral health protocol should be established to address the higher prevalence of inflammatory oral processes.