The Accuracy of Bone Assessment Distal to Lower Second Molars Using Panoramic Radiography: A Systematic Review and Meta-Analysis.

Panoramic radiography (OPG) evaluates mandibular third molar impaction (MTMI). This systematic review aimed to investigate the diagnostic accuracy of OPG in detecting bone loss distal to the lower second molars. The associated bone loss with different impaction positions and the most prevalent positions of MTMI were investigated as secondary outcomes. In January 2023, PubMed, Scopus, and Cochrane were searched to identify studies published between January 2012 and January 2023. Two examiners blindly selected the eligible studies for data extraction and quality assessment. Of 427 studies, 8 were suitable for data extraction. All studies reported bone loss distal to the second molar using OPG, ranging from 4.9 to 62.9%. The most frequent position of MTMI is mesioangular. The distal bone loss in the vertical and horizontal positions is statistically significant compared to typically positioned third molars and those that are fully erupted or impacted, but in a normal orientation (p-value 0.005 and 0.02, respectively). Bone loss was not statistically significant in the mesioangular position compared to other impacted positions (p-value 0.14). The risk of bias ranges between 66 and 88%. Despite its limitations, OPG is still considered a valuable tool to assess bone loss distal to the lower second molar in cases of an impacted mandibular third molar.

Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study.

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is to compare changes in bone level distal to the mandibular second molar (MSM) in patients with an extracted IMTM versus non-extracted IMTM using OPG. Methods: In this retrospective case-control study, 160 orthopantomograms (OPGs) of 80 patients who attended Dental Hospital of the University of Barcelona (HOUB) were randomly selected. Participants were stratified into a study group and control group. Results: Males and females experienced bone gain in the study group and bone loss in the control group. However, the difference in bone-level change was not statistically significant regarding gender in the study group. Within the study group, the age group of 29-39 years demonstrated significant (p-value = 0.042) bone gain after extraction compared to other age groups. However, the control group demonstrated bone loss in all age groups in which the difference is not statistically significant (p-value 0.794). Conclusions: Bone improvements distal to the MSM were observed after the extraction of an IMTM compared to when an IMTM was not extracted.

The prevalence of elongated styloid process in the population of Barcelona: a cross-sectional study & review of literature.

BACKGROUND: Styloid process (SP) is a cylindrical bony projection that originates from the inferior part of the petrous temporal bone just anteriorly to the stylomastoid foramen. Several nerves, muscles, and ligaments are related closely to the (SP). It is considered elongated when the measurement exceeds 30 mm. The overall prevalence of the styloid process is between 3.3% to 84.4%. The elongation of the styloid process (ESP) is associated with the manifestation of Eagle's Syndrome (ES) which is characterized by various types of pain in the head and neck region such as headache, tinnitus, otalgia, and trigeminal neuralgia. Eagle's syndrome occurs in 4-10.3% of individuals with an elongated styloid process (ESP). The objective of the study is to determine the prevalence of (ESP) in the patients who were treated in the Dental Hospital University of Barcelona (HOUB), to review the literature to spot the light on the different demographic data worldwide. METHODS: The archived panoramic image in the University of Barcelona dental Hospital were consecutively retrieved to investigate the prevalence of (ESP). Of all digital panoramic radiographs (OPG), 400 met the inclusion criteria and were furtherly analyzed. The results are correlated with the participant's gender, age, and occurrence. Age is subcategorized into three groups. A chi-square test is used to measure the significant differences and the P-value is set at < 0.05 for the level of significance. RESULTS: Among the included 400, we found 291 demonstrating (ESP). The prevalence of (ESP) which exceeds 30 mm is 72.75%. It is found that the most common morphological type is type 1 which is regarded as the uninterrupted (ESP) regardless of gender and age group. Concerning the calcification pattern, the most prevalent is the partial calcified (ESP) despite genders and age groups. CONCLUSION: (OPG) is a sufficient tool for the screening of the elongated styloid process. Regarding the prevalence, our results are considered higher than previously reported prevalence in different populations using (OPG) radiography tool. A study on a wider spectrum of the Spanish population is recommended to further investigate the correlation between the elongated styloid process and the occurrence of Eagle's syndrome.

Treatment of recurrent aphtous stomatitis: A systematic review

Background: Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this systematic review is to know the last treatment approaches and their effectivity. Material and methods: we compared the outcome of different kind of treatments in terms of the improvement of the lesions, reduction of the size of those lesions and the time needed for their healing. Inclusion criteria were: clinical trials, articles written in English or Spanish and published less than 5 years ago. Results: we used the following keywords: "treatment", "aphtous stomatitis", "canker sores"; combined with Boolean operators AND y OR. We selected 28 articles for reading the whole text, and after applying the eligibility criteria, we selected 17 articles for our revision. Among all the treatments, we emphasize the barrier method based in compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, with which the difference in the 3rd and 7th day was of -6,29 ± 0,14 points in the pain score. The treatment with insulin and chitosan gel, brought a pain suppression on the third day, with no reactivation of the pain during the whole study. The application of a film composed of polyurethane and sesame oil with chitosan, brought a reduction in the size of the lesions of 4,54 ± 2,84mm on the 6th day compared with the situation before the beginning of the treatment. The different kinds of laser, which produced a reduction in the pain score just at the beginning of the treatment up to 8,1 ± 1,6 points, and a reduction of the size of the lesions of 4,42 ± 1,02mm on the 7th day. Conclusions: Besides the classic treatments for RAS, we have to take into account other treatment modalities, above all the different kinds of laser. (AU)

Effects of the Prior Use of Statins on Head and Neck Cancer Risk: A Hospital-Based Case-Control Study.

Mechanisms related to the potential beneficial effects of statins on cancer are mainly related to the inhibition of the mevalonate pathway. The purpose of this study was to assess the association between prior use of statins and the risk of head and neck cancer. A hospital-based case-control study was conducted at the Dentistry Hospital of the University of Barcelona, including 101 incident cases of head and neck cancer and 101 controls matched to cases by age and sex. Multivariate logistic regression models were used to assess the association between prior statin exposure and head and neck cancer risk. Of the 202 patients included in total, 28.2% had previously received prescriptions for statins. Prior use of statins was found in 25.7% of cases and 30.7% of controls. Exposure to statins was not associated with head and neck cancer risk (OR = 0.72; 95% CI 0.28-1.84; p = 0.49). There was also no time- or dose-dependent association. Similar trends were observed when analyzed by subsites of cancer and recurrence rate. Our findings do not support a beneficial effect of prior statin exposure on head and neck cancer risk. Future research relying on observational data should emulate randomized clinical trials before clinical implications for repurposing drugs can be drawn.

Frequency and type of digital procedures used for the intraoral prosthetic rehabilitation of patients with head and neck cancer: A systematic review.

STATEMENT OF PROBLEM: In spite of a digital workflow playing an important role in the intraoral prosthetic rehabilitation of patients with head and neck cancer, information about how it has been implemented and its clinical implications is sparse. PURPOSE: The purpose of this systematic review was to evaluate the use of a digital workflow in the intraoral prosthetic rehabilitation of patients with head and neck cancer by analyzing the frequency and type of the digital procedures used. MATERIAL AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The following terms were applied for the search conducted in the MEDLINE-PubMed, Cochrane, and SciELO databases: (prosthesis OR dental OR rehabilitation) AND (digital OR CAD-CAM OR intraoral scanner) AND (Cancer OR head neck). Articles that specified data on intraoral prosthetic treatment and analyzed the use of a digital workflow in the different prosthetic phases such as digital scanning and computer-aided design and computer-aided manufacturing (CAD-CAM) in patients with head and neck cancer were included. Data from the frequency and type of digital procedures were analyzed. RESULTS: Thirteen articles were included, and all had incorporated CAD-CAM techniques in at least 1 of the prosthetic treatment stages (scanning, design, and/or fabrication). Only 1 patient was rehabilitated by using a completely digital workflow. The most frequent prosthetic treatment was an obturator (82.6%). Regarding the image capture method, the most used method was cone beam computed tomography (CBCT) (60.9%). CONCLUSIONS: Most reports described the partial use of a digital workflow in the intraoral prosthetic rehabilitation of patients treated for head and neck cancer. A digital workflow is used for specific stages but not for the entire process. More studies are needed to evaluate digital systems, ideally comparing parameters with the conventional method, and to determine whether this technique has more relevant clinical implications.

Confinement by COVID-19 and Degree of Mental Health of a Sample of Students of Health Sciences.

BACKGROUND: In response to the global COVID-19 pandemic, most countries have taken important measures to control the spread of the virus, such as population confinement and the closure of universities. OBJECTIVE: The main objective of this study is to evaluate how the situation resulting from COVID-19 has affected the mental health of a group of health sciences students. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study with a sample of 160 people, conducted through an online survey of final-year students of dentistry, nursing and medicine at the Faculty of Medicine and Health Sciences of the University of Barcelona. RESULTS: A total of 82.4% of students reported having suffered stress, anxiety and distress due to the pandemic situation, and 83.10% of participants are worried about not knowing when the academic year will restart. CONCLUSIONS: Confinement has negatively affected the mental health of students.

Update on the management of anticoagulated and antiaggregated patients in dental practice: Literature review.

BACKGROUND: Oral antiplatelet and anticoagulant drugs are widely used in a large number of patients visiting the dentist, and there has been much controversy over the years towards their clinical management. The aim to carry out a literature review in order to develop an update on dental management in anticoagulated and / or anti aggregated patients, focusing on oral surgery. MATERIAL AND METHODS: A bibliographic search was carried out in PubMed on studies published between January 1, 2018, until December 10, 2020, using the keywords ("antiplatelet" OR "antiplatelets") AND ("dentistry"), and ("anticoagulant" OR "anticoagulants") AND ("dentistry"). RESULTS: The number of studies included in this review was 13, and the number of patients among all of them was 3.497 patients under treatment with some type of antithrombotic drug, who underwent different oral surgery treatments. CONCLUSIONS: There is a low risk of peri- and postoperative bleeding events during basic oral surgery treatments in antiplatelet or anticoagulated patients, which can be easily managed through the use of local haemostatic measures. Key words:Oral surgery, antiplatelet drugs, anticoagulant drugs, dental treatment.

Is Burning Mouth Syndrome a Neuropathic Pain Disorder? A Systematic Review.

AIMS: To conduct a systematic review compiling an update on the pathophysiology of burning mouth syndrome (BMS) by reviewing the theories and studies published in the last 5 years that consider BMS a neuropathic disease. METHODS: A literature review was carried out in April 2020 on the PubMed database by using the following MeSH terms: "(burning mouth OR burning mouth syndrome OR burning mouth pain OR sore mouth OR burning tongue OR oral neuropathic pain OR glossodynia OR stomatopyrosis) AND (etiopathogenesis OR etiopathological factors OR etiology)." RESULTS: The research carried out according to the methodology found 19 case-control studies (1 of which was in vivo) and 1 RCT. Of the 19 included studies, 8 showed an evidence score of 2-; 8 showed 2+; another 2 showed 2++; and 1 showed 1+. Quality studies on this topic are insufficient and heterogenous. CONCLUSION: In the pathogenesis of BMS, both peripheral and central neuropathies appear to play a pivotal role. Nevertheless, the balance between them varies from case to case and tends to overlap. BMS does not seem to be a result of direct damage to the somatosensory nervous system, but a dysfunction in it and in the brain network.

Analysis of Healthy Lifestyle Habits and Oral Health in a Patient Sample at the Dental Hospital of the University of Barcelona.

The association between general health and oral health has been studied over recent years. In order to evaluate the lifestyle and the presence of healthy habits, a descriptive observational study was conducted from December 2018 to April 2019 with 230 patients, aged from 18 to 65 years old, that attended the Dental Hospital of the University of Barcelona for the first time. A total of 230 participants were considered, 98 (43%) were men and 132 (57%) were women, with a mean age of 37 years old. Our hypothesis was that patients with healthy habits had a better oral status in comparison with patients with bad lifestyle habits. No statistically significant results were found regarding oral hygiene between gender, smokers and patients with systemic pathology. Regarding a healthy lifestyle (High adherence to dietary intake), no statistically significant results were found. No significant differences were found regarding physical activity between male and female patients. Our hypothesis wasn't confirmed; therefore, we cannot conclude that patients with healthy habits have better oral status in comparison with patients with bad lifestyle habits. Consequently, more prospective longitudinal studies should be carried out.

Systemic Antibiotic Prophylaxis to Reduce Early Implant Failure: A Systematic Review and Meta-Analysis.

Systemic antibiotics are routinely prescribed in implant procedures, but the lack of consensus causes large differences between clinicians regarding antibiotic prophylaxis regimens. The objectives of this systematic review are to assess the need to prescribe antibiotics to prevent early implant failure and find the most appropriate antibiotic prophylaxis regimen. The electronic search was conducted in PubMed/MEDLINE, Scielo and Cochrane Central Trials Database for randomized clinical trials of at least 3 months of follow-up. Eleven studies were included in the qualitative analysis. Antibiotics were found to statistically significantly reduce early implant failures (RR = 0.30, 95% CI: 0.19-0.47, p < 0.00001; heterogeneity I2 = 0%, p = 0.54). No differences were seen between preoperative or both pre- and postoperative antibiotic regimens (RR = 0.57, 95% CI: 0.21-1.55, p = 0.27; heterogeneity I2 = 0%, p = 0.37). A single preoperative antibiotic prophylaxis dose was found to be enough to significantly reduce early implant failures compared to no antibiotic (RR = 0.34, 95% CI: 0.21-0.53, p < 0.00001; heterogeneity I2 = 0%, p = 0.61). In conclusion, in healthy patients a single antibiotic prophylaxis dose is indicated to prevent early implant failure.

Time-to-Treatment in Oral Cancer: Causes and Implications for Survival.

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant.

BACKGROUND: The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It's important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants. METHODS: An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic" AND "Dental implants" OR "Oral implants". RESULTS: After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67). CONCLUSIONS: The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.

Head and neck cancer and non-steroidal anti-inflammatory drugs: Systematic review and meta-analysis.

The objective was to assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on head and neck cancer (HNC) outcomes. A systematic review was conducted following the PRISMA guidelines. The MEDLINE and the Cochrane Central Register databases were searched. Risk of bias was assessed by the Cochrane Collaboration's tool and by the Newcastle-Ottawa Scale. Meta-analyses were performed with the RevMan software. Seventeen articles met the inclusion criteria. Quality scores for observational studies ranged between 5 and 8 stars and the RCT was assessed as high risk of bias. NSAIDs use was associated with a 13% risk reduction of HNC (OR: 0.87 95% CI 0.77-0.99). NSAIDs use was associated with a 30% reduced cancer-specific mortality and with a 40% decreased risk on disease-recurrence. NSAIDs may have a modest protective effect on HNC risk and a positive impact on cancer-specific survival and disease-recurrence. The findings do not support a protective role of aspirin on HNC outcomes.

COVID-19 and oral lesions, short communication and review.

BACKGROUND: The COVID-19 disease first appeared in December 2019 in Wuhan, China. The World Health Organization (WHO) declared the pandemic in March 2020, with 40 million cases and a million deaths in October 2020. COVID-19 also includes manifestations on the skin and mucous mucosal membrane. Objective: To evaluate the prevalence of the oral lesions associated to COVID-19 disease; and evaluate their clinical presentation and the hypothesized etiology. MATERIAL AND METHODS: An electronic literature search was performed in PubMed, Scopus and Índice Médico Español databases. The following combination of keywords and Boolean operators were used: "COVID-19 AND oral manifestations"; "COVID-19 AND oral lesions"; "COVID-19 AND mucosal lesions" ; "COVID-19 AND mucosal manifestations"; "SARS-COV-2 AND oral manifestations"; "SARS-COV-2 AND oral lesions"; "SARS-COV-2 AND mucosal lesions"; "SARS-COV-2 AND mucosal manifestations". Furthermore, the bibliography was reviewed to manually include additional articles. The risk of bias in individual studies was assessed by two blinded reviewers using the Joanna Briggs Institute (JBI) and the evidence levels of the articles found will be cataloged according to the level of evidence and grade of recommendation of Oxford Centre for Evidence-Based Medicine (CEBM). RESULTS: 249 articles were found in the Medline / Pubmed database. There are no additional articles in the Scopus and Índice Médico Español databases. We selected 14 articles plus 5 more articles due to manual searching. Patients presented a wide variety of oral manifestations. The most prevalent were lesions with a solution of continuity (n = 48, 73.85%) and the most frequent area was the tongue (n = 41, 52.56%). The preferred treatment for the lesions is a localized one by using rinses. CONCLUSIONS: To conclude, after the bibliographic review was performed, we can expect that the COVID-19 disease can cause cutaneous and mucosal lesions as secondary manifestations. Despite more studies being needed to confirm this. Key words:COVID-19, SARS-COV-2, oral lesions, oral manifestations.

Epstein-Barr Virus and Peri-Implantitis: A Systematic Review and Meta-Analysis.

The exponential growth in the use of dental implants in the last decades has been accompanied by an increase in the prevalence of peri-implant disease. It appears that viruses may have pathogenic potential for the development of this pathology. The objective of this systematic review is to study the possible association between the presence of Epstein-Barr virus and the development of peri-implantitis. An electronic search was conducted in PubMed/MEDLINE, Scielo and Embase databases for cross-sectional and case-control studies in humans published up to and including 4 January 2021. Five studies were included in the qualitative analysis. The meta-analysis did not show a statistically significant difference regarding the prevalence of Epstein-Barr virus in the peri-implant sulcus between implants with peri-implantitis and healthy implants. In conclusion, no association between the human herpesvirus 4 and peri-implantitis was found. Further research on this topic is essential to develop more effective treatments.

Oral Lichen Planus and Dental Implants: Protocol and Systematic Review.

A systematic review was conducted to answer the following PICO question: "Can patients diagnosed with oral lichen planus (OLP) be rehabilitated with dental implants as successfully as patients without OLP?". A systematic review of the literature was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to gather available and current evidence of oral lichen planus and its relationship with dental implants. The synthesis of results was performed using a Binary Random-Effects Model meta-analysis. Summary measures were odds ratios (ORs), frequencies, and percentages comparing the survival rate of dental implants placed in patients with OLP vs. those in patients without OLP. The electronic search yielded 25 articles, after removing the duplicated ones, 24 articles were selected. Out of the 24 articles, only 15 fulfilled the inclusion criteria. According to the results of the meta-analysis, with a total sample of 48 patients with OLP and 49 patients without OLP, an odds ratio of 2.48 (95% CI 0.34-18.1) was established, with an I2 value of 0%. According to the Strength of Recommendation Taxonomy (SORT) criteria, level A can be established to conclude that patients with OLP can be rehabilitated with dental implants.

Evaluation of Bone Gain and Complication Rates after Guided Bone Regeneration with Titanium Foils: A Systematic Review.

Guided bone regeneration techniques are increasingly used to enable the subsequent placement of dental implants. This systematic review aims to analyze the success rate of these techniques in terms of bone gain and complications rate using titanium membranes as a barrier element. Electronic and hand searches were conducted in PubMed/Medline, Scielo, Scopus and Cochrane Library databases for case reports, case series, cohort studies and clinical trials in humans published up to and including 19 September 2020. Thirteen articles were included in the qualitative analysis. Bone gain both horizontally and vertically was comparable to that obtained with other types of membranes more commonly used. The postoperative complication rate was higher that of native collagen membranes and non-resorbable titanium-reinforced membranes, and similar that of crosslinked collagen membranes and titanium meshes. The survival rate of the implants was similar to that of implants placed in native bone. Due to the limited scientific literature published on this issue, more randomized clinical trials comparing occlusive titanium barriers and other types of membranes are necessary to reach more valid conclusions.

Apical periodontitis and glycemic control in type 2 diabetic patients: Cross-sectional study.

BACKGROUND: The objective of this study was to analyze the possible relationship between the glycemic control and the prevalence of apical periodontitis in type 2 diabetic patients. The null hypothesis was that apical periodontitis is not associated with glycemic control. MATERIAL AND METHODS: In a cross-sectional design, the radiographic records of 216 type 2 diabetic patients (65.0 ± 10.7 years), 117 men (54.2%) and women (45.8%), were examined. Glycated hemoglobin (HbA1c) was used to assess glycemic control, considering an HbA1c level < 6.5% as well-controlled diabetes. Apical periodontitis was diagnosed as radiolucent periapical lesions using the periapical index score. The Student t test, chi-square test, and logistic regression analysis were used in the statistical analysis. RESULTS: The average HbA1c value was 7.0 ± 2.2%. Forty seven (21.8%) had HbA1c levels under 6.5% (mean ± SD = 6.0 ± 2.2%), being considered well-controlled patients, and 169 (78.2%) had an HbA1c level ≥ 6.5% (mean ± SD = 7.8 ± 2.24%), being considered poor controlled patients. Forty four per cent of diabetics had apical periodontitis, 12.5% had root-filled teeth, and 52.3% had root filled teeth with radiolucent periapical lesions. No significant differences were observed in any of these three variables between patients with good or poor glycemic control. In the multivariate logistic regression analysis the presence of radiolucent periapical lesions in at least one tooth did not correlate significantly with HbA1c levels (OR = 1.4; 95% C.I. = 0.70 - 3.09; p = 0.31). CONCLUSIONS: The results reveal no association of glycemic control with the prevalence of apical periodontitis or root canal treatment in diabetic patients. Key words:Apical periodontitis, diabetes mellitus, endodontic medicine, glycated haemoglobin.

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study.

AIM: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. MATERIALS AND METHODS: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. RESULTS: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3-4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2-1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5-49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1-1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6-1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8-1.7; p = 0.49) were associated with MetS. CONCLUSIONS: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.