Apical Periodontitis: A Hidden Non-Communicable Disease in Global Health - A Narrative Review of Longitudinal...

Apical periodontitis (AP) is a highly prevalent oral inflammatory disease increasingly recognized as a hidden noncommunicable disease with potential systemic consequences.

This narrative review integrates findings from longitudinal studies conducted in a well-characterized AP cohort to elucidate the links between AP and systemic health.

Evidence highlights AP as a reservoir for low-grade bacteremia and systemic inflammatory burden. Elevated baseline levels of inflammatory markers, including fibroblast growth factor-23, interleukin 1β, high-sensitivity C-reactive protein, and asymmetric dimethylarginine were observed in patients with AP, correlating with lesion size and microbial profiles in both the root canal and blood microbiomes. AP is also associated with altered metabolic syndrome indicators-including hemoglobin A1C, triglycerides, low-density lipoprotein, and changes in serum metabolomic profiles involving glucose, lipid, branched-chain amino acid, and tryptophan metabolism. Importantly, successful endodontic treatment resulted in significant reductions in inflammatory biomarkers, improved metabolic syndrome indicators, and restoration of glucose and lipid metabolism.

Collectively, these findings position AP as an important noncommunicable disease with effects extending beyond the oral cavity through its associations with systemic conditions and cardiometabolic risk. These observations highlight the importance of timely diagnosis and successful management of AP to support both oral and systemic health.