Oral health and severe systemic diseases: a retrospective study on clinical and radiographic parameters

This study aims to investigate the correlation between oro-periodontal health and the presence of severe systemic diseases, classified according to the American Society of Anesthesiologists (ASA) as ASA III-IV, compared to healthy patients or those with mild to moderate systemic conditions (ASA I-II). The main objective is to assess whether specific clinical and radiographic parameters, as observed through panoramic radiographs, can serve as predictive indicators of systemic risk, potentially offering screening tools within dental practice to support interdisciplinary diagnosis. MATERIALS AND METHODS A retrospective study was conducted on a sample of 501 digital panoramic radiographs (OPTs) of adult patients examined at the Azienda Ospedale Università di Padova. The cohort included individuals across various ASA classifications, with a balanced distribution in terms of age and gender. Seven oro-periodontal parameters were assessed: number of missing teeth, average bone loss, DMFT index (Decayed, Missing and Filled Teeth), presence of periapical lesions, bony or soft tissue neoformations, residual roots, and radiographic signs consistent with pericoronitis. The association between these parameters and systemic health status was analyzed using multivariate logistic regression models, adjusting for potential confounding factors such as age and lifestyle habits. RESULTS AND CONCLUSIONS Statistical analysis revealed a significant association between average bone loss and the presence of severe systemic diseases (p < 0.001), as well as between periapical lesions and systemic comorbidities (p < 0.001). Residual roots and pericoronitis also showed statistically significant associations (p < 0.05). Interestingly, the number of missing teeth was higher in the ASA I-II group (p = 0.035), possibly reflecting the influence of social or behavioral factors. The DMFT index and neoformations did not show significant associations. These findings suggest that average bone loss and periapical lesions may serve as key radiographic markers for identifying patients at increased systemic risk. CLINICAL SIGNIFICANCE Systematic monitoring of oro-periodontal parameters through routine radiographic evaluations may represent a valuable tool in the secondary prevention of systemic diseases. Early diagnosis and prompt treatment of oral infections-particularly in patients with complex clinical profiles-could help reduce the risk of systemic complications and improve overall patient quality of life. A multidisciplinary approach is therefore crucial in managing patients with comorbidities, promoting a comprehensive view of health.