Viral Infections in Acute Apical Abscesses: Systematic Review and Meta-Analysis

Objectives: To comprehensively examine the available scientific literature to clarify the prevalence of viruses in acute apical abscesses.
Methods: PRISMA statement was followed. Original articles regardless of their date of publication were retrieved from PubMed, Google Scholar, Cochrane Library and DOAJ. Risk of bias was assessed with ROBINS-E, quality of evidence with GRADE guideline. In the case of qualitative data synthesis, a narrative type synthesis was used and in the case of statistical results, we employed random effects meta-analysis to estimate the pooled prevalence of viruses in acute apical abscesses.

Statistical heterogeneity was assessed using the Q-test and the I2 statistic. Subgroup analysis, publication bias, and sensitivity analysis were also conducted. All statistical analyses were performed in STATA 15.1. Data were presented according to the presence of viral infections expressed as a percentage.
Results: The search yielded a total of 8,708 manuscripts that after selection of title, abstract and full text yielded five articles for the final synthesis of results, of which four were taken from Pubmed and one from Google Academic. Two articles were conducted in Turkey, two in Brazil and one in Lebanon. The oldest was conducted in 2010 and the most recent in 2023.

The overall prevalence of viral infections was HPV 12% (95% CI: 6 to 19), HCMV 10% (95% CI: 1 to 29), EBV 6% (95% CI: 1 to 13), HHV 16% (95% CI: 3 to 33), and HHV-6 6% (95% CI: 1 to 13). Regarding stratified analysis by geographic region, prevalence of viral infections in acute apical abscesses was found to be 21% (95% CI: 31 to 43) for Asia and 84% (95% CI: 72 to 93) for Latin America. Regarding the certainty of the overall assessment this was shown to be high, and not serious in Study Design, Risk of Bias, Inconsistency and Indirectness Imprecision.
Conclusions: It is important to study viral prevalence in acute apical abscesses as a measure to make this infection more visible, and the potential role of oral health specialists in detection and treatment. This study is unique in its kind and the results of this research can infer in health policies by promoting the detection of different viral genes in dental practice, as well as in health promotion campaigns that address the consequence of the presence of these viruses in the oral cavity.