Abstract
Introduction: Apical periodontitis can occur due to the host immune response, with the release of antibodies, cytokines, and chemokines by stress as a systemic risk factor. This systematic review aimed to investigate the relationship between stress and the severity of apical periodontitis.
Methods: A detailed search strategy was conducted on the “PubMed (MEDLINE), Web of Science (all databases), Scopus, ScienceDirect, EMBASE, and Cochrane Library” databases. Data were screened based on the eligibility criteria. Articles assessing the severity of apical periodontitis using different parameters in stress-induced animals in comparison with stress-free animals were selected. The risk of bias assessment was conducted using SYRCLE’s RoB tool. The GRADEpro tool was used to determine the overall quality of evidence.
Results: Four articles were selected after a full-text assessment. Animals under stress exhibited increased levels of inflammatory cells. The extension of the bone loss and the periapical lesion size differed according to the measurement and visualization methods. All the included articles had a high risk of bias. GRADEpro revealed that the overall certainty of evidence for the included studies was very low.
Conclusion: Under the limitations of this systematic review, an increasing effect of stress on the inflammatory infiltrate was reported in apical periodontitis. Future well-conducted animal studies are warranted to further elaborate on the effects of stress parameters on the severity of apical periodontitis with convenient experimental conditions and advanced evaluation methods.