Int J Med Sci 2014; 11(1):1-6. doi:10.7150/ijms.6663 This issue

Research Paper

Influence of Endodontic Treatment on Systemic Oxidative Stress

Francesco Inchingolo1,*,✉, Massimo Marrelli 2,4,*, Susanna Annibali6, Maria Paola Cristalli6, Gianna Dipalma2, Alessio Danilo Inchingolo7, Antonio Palladino7, Angelo Michele Inchingolo5, Marco Gargari8,*, Marco Tatullo2,3,4,*

1. Department of interdisciplinary Medicine, University of Bari, General Hospital, Bari, Italy;
2. Unit of Maxillofacial Surgery, Calabrodental, Crotone, Italy;
3. Department of Basic Medical Sciences, University of Bari, Bari, Italy;
4. Tecnologica Research Institute, Biomedical Section, Crotone, Italy;
5. Department of Surgical, Reconstructive, and Diagnostic Sciences, University of Milan, Milan, Italy;
6. Department of Stomatology and Maxillofacial Science - Oral Surgery Unit - University of Rome “Sapienza” Rome, Italy;
7. Medical School, University of Bari, Bari, Italy;
8. Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.
* These Authors equally contributed to this article.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
Inchingolo F, Marrelli M, Annibali S, Cristalli MP, Dipalma G, Inchingolo AD, Palladino A, Inchingolo AM, Gargari M, Tatullo M. Influence of Endodontic Treatment on Systemic Oxidative Stress. Int J Med Sci 2014; 11(1):1-6. doi:10.7150/ijms.6663. Available from

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Introduction: An increased production of oxidizing species related to reactive oral diseases, such as chronic apical periodontitis, could have systemic implications such as an increase in cardiovascular morbidity.

Based on this consideration, we conducted a prospective study to assess whether subjects affected by chronic periodontitis presented with higher values of oxidative stress than reference values before endodontic treatment, and whether endodontic treatment can reduce the oxidative imbalance and bring it back to normal in these subjects.

Materials and methods: The authors recruited 2 groups of patients from private studies and dental clinics: these patients were recruited randomly. The oxidative balance in both patients with chronic apical periodontitis (CAP) and healthy control patients was determined by measuring the oxidant status, using an identification of the reactive oxygen metabolites (d-ROMs) test, while the antioxidant status in these patients was determined using a biological antioxidant potential (BAP) test. Both these tests were carried on plasma samples taken from enrolled patients. Values were measured both before the endodontic treatment of the patients with chronic apical periodontitis, and 30 and 90 days after treatment, and compared to those obtained from healthy control patients.

Results: It was found that, on recruitment, the patients with chronic apical periodontitis exhibited significantly higher levels of oxidative stress than control patients, as determined by the d-ROMs and BAP tests. Furthermore, the d-ROMs test values were shown to decrease and the BAP test values to increase over time in patients with chronic apical periodontitis following endodontic therapy. As the levels of oxidative stress in these patients tended to reduce and return to normal by 90 days following treatment.

Conclusions: This study has demonstrated a positive association between chronic apical periodontitis and oxidative stress. Subjects affected by chronic apical periodontitis are exposed to a condition of oxidative stress, which is extremely dangerous to general health. Moreover, one can infer from these findings that through proper endodontic therapy, a good oxidative balance can be restored, thereby avoiding the risk of contracting the abovementioned diseases.

Keywords: Oxidative stress, chronic apical periodontitis, endodontic treatment.