Association of Apical Periodontitis and Diabetes in a Large Hospital Network

Objectives: Previous studies have shown an association between endodontic infections and type 2 diabetes mellitus (T2DM); however, these studies are underpowered, often failing to control for confounding variables. Our objective is to determine if there is an independent association between apical periodontitis and T2DM in a large data set available from a hospital network database.
Methods: Carolina Data Warehouse for Health (CDW-H) is a central data repository containing clinical, research, and administrative data sourced from UNC Health Care, including both Epic and Legacy hospital systems. An initial search of this database yielded a total of 5,995,011 patients, of whom 7,749 were diagnosed with apical periodontitis (ICD-10 codes K04.4-K04.8) between October 1^st, 2015 and September 30^th, 2018. These codes include the following diagnoses, acute apical periodontitis of pulpal origin, chronic apical periodontitis, periapical abscess with or without sinus, or radicular cyst. Patient demographics, T2DM, HbA1c%, periodontal disease, oral cellulitis, hypertension, atherosclerosis, renal disease, smoking status, BMI, metformin use, statin use, and hospital inpatient data were collected from their most recent visit. A control group of 7,749 patients were sampled from the remaining pool of patients in CDW-H for those without apical periodontitis and matched exactly to the age, race/ethnicity, and sex of each patient in the initial group. Multivariable logistic regression was used to estimate the association between T2DM and apical periodontitis after controlling for the effects of the aforementioned confounders.
Results: T2DM was associated with significantly greater odds of apical periodontitis (OR=2.0, 95% CI=1.7, 2.4). The use of metformin (OR=0.7, 95% CI=0.6, 0.9) or statins (OR=0.7, 95% CI=0.6, 0.8) was associated with lower odds of apical periodontitis.
Conclusions: Those with T2DM may have greater odds of having apical periodontitis even after controlling for demographic factors and potential confounding factors. Metformin and statin use may be associated with lower odds of apical periodontitis.