EXPLORANDO CONEXÕES ENTRE ALTERAÇÕES ÓSSEAS DEGENERATIVAS E INFLAMATÓRIAS E AS PATOLOGIAS PULPO-PERIAPICAIS

Abstract

Introduction: Pulpo-periapical pathologies are chronic inflammatory diseases with high global prevalence, mostly resulting from the progression of untreated dental caries. Beyond their local impact, these conditions contribute to the individual's systemic inflammatory burden. Conversely, systemic disorders affecting bone metabolism may modulate the host response to these oral infections. This dissertation investigated the connections between two classes of systemic bone alterations: one degenerative (osteoporosis) and the other inflammatory (rheumatic autoimmune diseases), and pulpo-periapical pathologies. The objectives were to assess the evidence regarding: 1) the association between osteoporosis and the occurrence of pulpo-periapical pathologies; and 2) the association between rheumatic autoimmune diseases and the occurrence of pulpo-periapical pathologies. Methods: This dissertation comprises two systematic reviews and meta-analyses, following the PRISMA 2020 recommendations. Comprehensive searches were conducted in MEDLINE/PubMed, Embase, Scopus, BVS-Bireme, Web of Science, SciELO, and Cochrane Library databases, as well as in the grey literature. Observational studies (cross-sectional, cohort, and case-control) comparing the occurrence of pulpo-periapical pathologies in individuals with osteoporosis (first study) or rheumatic autoimmune diseases (second study) versus healthy control groups were included in both studies. Data were extracted by independent reviewers. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool, and the certainty of evidence was evaluated using the GRADE system. Meta-analyses were conducted using random-effects models to calculate Odds Ratios (OR) with 95% Confidence Intervals (95% CI). Results: In the first study (Chapter II), the random-effects meta-analysis of six studies identified no significant association between osteoporosis and the presence of pulpo-periapical pathologies (unadjusted OR= 1.65; 95% CI: 0.80 to 3.41; I²=98.5%). The result remained insignificant in the adjusted analysis (OR= 1.96; 95% CI: 0.68 to 5.66). In the second study (Chapter III), the random-effects meta-analysis of thirteen studies demonstrated a positive and significant association between rheumatic autoimmune diseases and pulpo-periapical pathologies. This association was found in both the patient-level analysis (adjusted OR= 1.60; 95% CI: 1.20 to 2.12; I²=95.2%) and the tooth-level analysis (unadjusted OR= 1.74; 95% CI: 1.28 to 2.37; I²=69.4%). In both reviews, the certainty of evidence was classified as "Very Low" (GRADE), mainly due to the high risk of bias in primary studies, high heterogeneity, and imprecision of results. Conclusion: The findings of this dissertation regarding the investigated outcomes yielded contrasting results: in the first study (Chapter II), the systematic review and meta-analysis showed no association between osteoporosis (a degenerative condition) and pulpo-periapical pathologies; however, in the second study (Chapter III), a positive association was observed with rheumatic autoimmune diseases (inflammatory conditions). The biological plausibility of this result suggests the need for an integrated clinical approach for the prevention of pulpoperiapical pathologies in individuals with rheumatic autoimmune diseases. Furthermore, we suggest future longitudinal studies with greater methodological rigor to elucidate possible connections between osteoporosis and endodontic outcomes.