Prevalence of Apical Periodontitis in Patients with Autoimmune Diseases under Immunomodulators: A Retrospective Cohort Study

Introduction: The aim of this retrospective cohort study was to investigate the prevalence of apical periodontitis (AP) in patients affected by autoimmune diseases (ADs) taking biologic medications (BMs). Methods: Ninety-nine patients (2440 teeth) with ADs referred to the university clinic for dental evaluation were investigated. The controls included 99 patients (2655 teeth) with no systemic diseases and taking no medications. The patients underwent a complete oral, dental, and radiographic examination for the presence of AP. The periapical index and the status of endodontic and restorative treatments were obtained. Statistics were based on descriptive analysis and continuous variables for the total sample and by subgroups. Adjusted odds ratios and 95% confidence intervals were calculated. Results: The prevalence of AP was 65.7% in the autoimmune diseases group (AI) and 46.5% in the controls (P <=.05). The association between smoking and AP was significant (P <= .05). Among the AI subgroups, rheumatoid arthritis patients at the tooth level had a lower probability of developing AP than patients with inflammatory bowel disease (P <= .05). Furthermore, each additional year of age implied a 11% risk of AP; women had a lower periapical index than men in both groups (P <= .05), and tocilizumab was associated with a reduced risk of AP compared with infliximab (P <= .05). Conclusions: Patients with ADs taking BMs had a higher prevalence of AP. These results indicate that the status of the patients' immune system may have an effect on the development and prevalence of AP.