Association between Pulpal Calcifications and Systemic Diseases: A Scoping Review

This scoping review aims to systematically map the current landscape of evidence on the association between pulpal calcifications in permanent teeth and systemic diseases. Pulpal calcifications, commonly detected on dental radiographs, have been proposed as potential markers or indicators of various systemic conditions, including cardiovascular diseases, renal disorders, metabolic disorders, and genetic syndromes. However, the literature on this topic is fragmented, with most existing evidence focused on individual disease categories rather than providing a comprehensive overview. The primary purpose of this scoping review is to consolidate and synthesize the existing literature to: (1) identify all systemic diseases that have been investigated in association with pulpal calcifications; (2) assess the strength and direction of reported associations; (3) describe the proposed biological mechanisms linking pulpal calcifications to systemic diseases; and (4) identify critical gaps in the literature that warrant future investigation. This review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The review will include both primary observational studies (cross-sectional, case-control, cohort studies, and case series) and secondary evidence (systematic reviews and scoping reviews) to provide a comprehensive evidence map. The research team consists of three reviewers: a principal investigator responsible for protocol development and final validation, a co-reviewer for study selection and data extraction validation, and a third reviewer for conflict resolution and quality assurance. Expected outcomes include: (1) a comprehensive map of the current literature organized by systemic disease category; (2) identification of the strength and direction of associations for each disease; (3) synthesis of proposed pathophysiological mechanisms; (4) clear identification of methodological, geographic, and population-based gaps; and (5) publication in a high-impact peer-reviewed journal (target: Journal of Endodontics or International Endodontic Journal) to disseminate findings to the scientific community. This prospective protocol registration on the Open Science Framework ensures transparency, prevents selective reporting bias, and establishes the research plan before data collection begins, in accordance with best practices for systematic and scoping reviews.