Odontology. 2026 Jul 7. doi: 10.1007/s10266-026-01480-7. Online ahead of print.
ABSTRACT
Growing evidence suggests a potential association between apical periodontitis (AP), chronic diseases, and smoking habits. However, findings from individual studies and systematic reviews remain fragmented, and high-level synthesis of available meta-analyses is limited. This umbrella review aimed to comprehensively evaluate and synthesize evidence from published meta-analyses examining the association between AP, chronic diseases, and smoking. A systematic literature search was conducted across major electronic databases from inception to February 12, 2026, to identify relevant meta-analyses. Eligible studies included meta-analyses assessing the association between AP and chronic diseases or smoking, reporting pooled effect estimates. Data extraction was performed independently by two reviewers. Methodological quality was assessed using AMSTAR 2, and certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Pooled effect estimates were synthesized using random-effects models. A total of 15 meta-analyses were included in this umbrella review. Significant associations were identified between AP and several chronic conditions, as well as smoking habits. The pooled estimates indicated that diabetes mellitus (OR = 2.43, 95% CI: 2.03-2.90), cardiovascular disease (OR = 1.98, 95% CI: 1.30-3.00; RR = 1.32, 95% CI: 1.07-1.63), inflammatory bowel disease (IBD) (OR = 1.65, 95% CI: 1.27-2.15), and smoking (OR = 2.45, 95% CI: 1.98-3.02) were significantly associated with AP. The methodological quality of the included reviews varied, with most reviews rated as low quality (60.0%), followed by high quality (20.0%), moderate quality (13.3%), and critically low quality (6.7%); substantial heterogeneity was observed in some analyses. According to the GRADE assessments, the certainty of evidence varied from low to moderate. Evidence synthesized from meta-analyses suggests significant associations between AP and diabetes mellitus, cardiovascular disease, inflammatory bowel disease, and smoking. However, limitations in methodological quality and heterogeneity reduce the strength of the conclusions. High-quality prospective studies and rigorously conducted meta-analyses are needed to further clarify these relationships and strengthen the evidence base for clinical decision-making.
PMID:42412382 | DOI:10.1007/s10266-026-01480-7