Prevalência de periodontite apical em diferentes populações

Abstract

Apical periodontitis (AP) occurs due to microrganism invasion into the root canal system, and its prevalence modifies according to age, level of education, presence of systemic alteration, among other factors. Since there are many variables that can influence the prevalence of the disease, the objectives of this doctoral thesis were: (1) to describe the prevalence of AP and explore its association with clinical, radiographic, and sociodemographic characteristics in HIV+ patients; and (2) to revise the literature about the prevalence of AP in different populations and to undertake a meta-analysis to determine the prevalence of AP in the population worldwide, as well as the frequency of this lesions in all teeth, in non-treated and in root-treated teeth; to assess what factors can be associated to the variability of the results. In the first study, clinic and radiographic data of 59 HIV+ patients were collected. Presence of AP, presence and quality of the root-fillings, restorations, and crowns were evaluated using periapical radiograph (Rx); caries presence using clinical and Rx data, and viral load and CD4+ lymphocytes concentration using blood tests. The association between the outcome and independent variables were assessed using logistic regression with correction for clustering by the individuals. Seventy-one percent of the patients presented at least one AP. A family income lower than five minimum wage and having at least one root-filled tooth were associated with the prevalence of AP, whereas viral load and CD4+ lymphocytes concentration were not. In the second study, a search was undertaken in the main databases without any language restriction. A meta-analysis using the random effects model was carried out for the main and secondary outcomes, as well as for the subgroup analyses. The search identified 6175 articles, and 207 studies were included in full-text analysis. Fifteen studies were identified by manual search, and a total of 108 studies were included in the meta-analysis. The prevalence of individuals with ≥1AP was 52%; the prevalence of AP in all teeth was 5%, in non-treated teeth 3%, and in the root-filled teeth 40%. Samples recruited in dental care services or hospitals presented a higher prevalence of the lesion than samples from the general population. The prevalence of AP was higher in individuals with systemic alteration than in healthy individuals, and the use of panoramic to diagnose the AP decreased the prevalence of the lesion compared to the use of periapical Rx. The conclusions from the first study showed that the association between the prevalence of AP and the family income indicates that the endodontic disease in the present sub-population could be related to social problems and that public policies to prevent AP are needed. Through the results of the second study, it could be concluded that AP is a prevalent condition, and in general, 52% of the adult population worldwide have the disease. The presence of systemic alterations, location of recruitment of the individuals, type of Rx used to diagnose the AP were factors that influenced the prevalence of the endodontic disease.