Successful endodontic treatment improves glucose and lipid metabolism: a longitudinal metabolomic study

Apical periodontitis (AP) is one of the most prevalent dental diseases. Its presence can increase systemic inflammatory burden and is associated with cardiometabolic disorders including higher cardiovascular risks and impaired glycaemic control. There is currently a paucity of knowledge showing whether successful endodontic treatment is associated with systemic metabolic improvements. This study aims to identify the potential impact of successful endodontic treatment on patients' serum metabolomic profiles, and to evaluate how these impacts are associated with the metabolic syndrome (MetS) indicators, inflammatory biomarkers, as well as blood and intracanal microbiomes.

This self-controlled two-year longitudinal cohort study investigated the metabolic improvements associated with successful endodontic treatment in 65 AP patients using nuclear magnetic resonance (NMR) spectroscopy on serum samples. The samples were collected at 5 time points including pre-operative baseline and 3 month, 6 month, 1 year, and 2 year reviews.

Significant postoperative changes were observed in 24 (54.5%) metabolites. The results suggested improved glucose and lipid metabolism as well as reduced inflammatory burdens, as evidenced by a significant reduction in branched-chain amino acids at the 3 month review, a significant decrease in glucose and pyruvate at the 2 year review, a short-term reduction in cholesterol, choline, and fatty acid levels, and a progressive increase in tryptophan. In addition, strong associations were found between metabolic profile and clinical metabolic syndrome indicators, inflammatory markers, and pre-operative blood and intracanal microbiome, underscoring the systemic impact of AP and its treatment. A dynamic Bayesian model identified that metabolites associated with the tricarboxylic acid (TCA) cycle are the key regulators in the longitudinal alterations of the metabolic profiles.

Successful endodontic treatment in AP patients is associated with improved glucose and lipid metabolic profiles, and a reduction in systemic inflammation, suggesting a potential role in mitigating cardiometabolic disease risk.