Radiographic Assessment of Apical Periodontitis and Periodontal Bone Loss in Oral Squamous Cell Carcinoma: A Cross-Sectional Study.

BACKGROUND: Chronic oral inflammation has been implicated in oral squamous cell carcinoma (OSCC), but the role of apical periodontitis (AP) remains unclear. This study compared radiographic AP and periodontal radiographic bone loss (RBL), used as a surrogate for periodontal disease, between patients with OSCC and controls with benign oral lesions. METHODS: This retrospective cross-sectional study included 113 patients with biopsy-confirmed OSCC and 130 controls with benign oral lesions. Two calibrated examiners assessed panoramic radiographs for decayed, missing, and filled teeth (DMFT), AP, AP lesion size, endodontically treated teeth, and RBL. Multivariable logistic regression evaluated AP after adjustment for age, sex, cancer risk factors, periodontal RBL, and DMFT. Secondary analyses evaluated AP × RBL interaction and differences by OSCC stage. Exploratory analyses assessed OSCC and AP distributions across neighbourhood-level marginalization strata. RESULTS: After adjustment, AP was not statistically significantly associated with OSCC (adjusted OR, 1.43; 95% CI, 0.78-2.61; p=0.243). After accounting for AP, severe RBL (>33%) was more prevalent in OSCC than controls (38.9% vs. 20.8%, p=0.004) and was associated with OSCC (OR, 2.96; 95% CI, 1.36-6.44; p=0.006). No statistically significant AP × RBL interaction was detected. Among patients with OSCC, neither AP nor RBL was significantly associated with stage. CONCLUSION: Severe periodontal RBL was associated with OSCC after accounting for AP. AP was not statistically significantly associated with OSCC status or stage; however, confidence intervals do not exclude smaller AP-related associations. These findings highlight the importance of periodontal and endodontic assessment as components of pre-oncologic dental care.