Viral infections are associated with apical periodontitis: A meta-analysis of prevalence, clinical symptoms, and lesion sizes across 31 clinical studies.

OBJECTIVE

Bacteria and viruses are components of the oral microbiome and are linked to various oral diseases. Clinical observations indicate a higher prevalence of apical periodontitis (AP) during viral epidemics. However, research on this association is limited. This meta-analysis aimed to explore the relationship between viral infections and AP.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through systematic database searches, and data were extracted for eligible studies. Three validated quality assessment tools were used to ensure rigor. The pooled odds ratio (OR) with 95% confidence interval (CI) was calculated to quantify the strength of the association.

RESULTS

Out of 427 screened records, 31 studies comprising 1,341,636 participants met the inclusion criteria. The meta-analysis revealed that the prevalence of AP was 2.78 times higher in patients with viral infections compared to controls (95% CI = 1.88-4.12, p < 0.001). Infected individuals demonstrated more severe clinical symptoms (OR = 3.49, 95% CI = 2.07-5.90, p < 0.001) and significantly larger periapical lesions (OR = 3.84, 95% CI = 1.08-13.67, p < 0.05).

CONCLUSIONS

The evidence suggests a significant association between viral infections and AP, particularly in cases of viral co-infections.

CLINICAL RELEVANCE: These findings suggest that evaluating viral infections, particularly herpesviruses, could inform the clinical management of AP. However, further research is required to establish causality.