Non-Cochrane · aetiology · PM42473275
Associations Between Imaging-Detected Pulp Calcification and Systemic Diseases: A Systematic Review, Thematic Analysis, and Meta-Analysis.
da Silva-Filho José Evando, Torres Paula Maria da Costa, Gurgel-Filho Eduardo Diogo · International endodontic journal · 2026 · PubMed · doi:10.1111/iej.70230
Findings
Population Dental patients undergoing imaging (panoramic, periapical, bitewing or CBCT)
48 findings
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Romano et al., 2024 | OR 2.69 [2.0, 3.6] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Ezoddini et al., 2011 | OR 2.64 [1.99, 3.5] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Khojastepour et al., 2013 | OR 2.6 [1.96, 3.43] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Srivastava et al., 2020 | OR 2.67 [2.0, 3.57] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Simsek et al., 2019 | OR 2.76 [2.1, 3.63] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Swathi et al., 2015 | OR 2.77 [2.1, 3.65] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Nayak et al., 2010 | OR 2.68 [2.0, 3.58] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Talla et al., 2014 | OR 2.77 [2.07, 3.71] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Kaabi et al., 2024 | OR 2.74 [2.04, 3.67] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Algan et al., 2025 | OR 2.72 [2.02, 3.66] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Horsley et al., 2009 | OR 2.71 [2.02, 3.63] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Alamoudi et al., 2023 | OR 2.75 [2.07, 3.67] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Araya et al., 2020 | OR 2.68 [2.01, 3.58] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Fairozekhan et al., 2025 | OR 2.72 [2.03, 3.64] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Alsweed et al., 2019 | OR 2.74 [2.07, 3.62] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Edds et al., 2005 | OR 2.65 [1.99, 3.52] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Sener et al., 2009 | OR 2.79 [2.11, 3.69] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Baghestani et al., 2025 | OR 2.72 [2.03, 3.65] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Bauss et al., 2008 | OR 2.69 [2.01, 3.59] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Moura et al., 1987 | OR 2.6 [2.0, 3.37] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Jawahar et al., 2021 | OR 2.57 [1.99, 3.32] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Mathew et al., 2019 | OR 2.28 [1.94, 2.68] GRADE not reported 21 studies |
| Any systemic condition | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Overall (all systemic conditions) | OR 2.69 [2.04, 3.54] Low Downgraded: risk of bias 22 studies · 12810 participants |
| Diabetes mellitus | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Diabetes mellitus | OR 2.3 [1.86, 2.84] Low Downgraded: risk of bias, imprecision 3 studies · 605 participants |
| Diabetes mellitus | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Fairozekhan et al., 2025 | OR 2.35 [0.96, 5.79] GRADE not reported 2 studies |
| Diabetes mellitus | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Araya et al., 2020 | OR 2.25 [1.67, 3.04] GRADE not reported 2 studies |
| Diabetes mellitus | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Baghestani et al., 2025 | OR 2.32 [0.56, 9.67] GRADE not reported 2 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Jawahar et al., 2021 | OR 1.62 [0.91, 2.88] GRADE not reported 4 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Sener et al., 2009 | OR 2.48 [0.41, 15.05] GRADE not reported 4 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Horsley et al., 2009 | OR 2.11 [0.32, 13.76] GRADE not reported 4 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Swathi et al., 2015 | OR 2.52 [0.46, 13.77] GRADE not reported 4 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Alsweed et al., 2019 | OR 2.46 [0.47, 12.95] GRADE not reported 4 studies |
| General cardiovascular disease | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Cardiovascular (General) | OR 2.14 [0.64, 7.18] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 2857 participants |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Srivastava et al., 2020 | OR 5.77 [2.8, 11.9] GRADE not reported 4 studies |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Ezoddini et al., 2011 | OR 4.67 [1.96, 11.13] GRADE not reported 4 studies |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Khojastepour et al., 2013 | OR 4.39 [1.72, 11.22] GRADE not reported 4 studies |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Cardiovascular (Atherosclerosis) | OR 4.7 [2.57, 8.6] Low Downgraded: risk of bias 5 studies · 517 participants |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Edds et al., 2005 | OR 4.75 [2.01, 11.2] GRADE not reported 4 studies |
| Atherosclerosis or vascular calcification | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Moura et al., 1987 | OR 4.24 [2.71, 6.63] GRADE not reported 4 studies |
| Renal or genetic specialised conditions (Marfan syndrome, kidney stones) | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Renal & Genetic (Specialised) | OR 2.76 [2.43, 3.13] Very low Downgraded: risk of bias, imprecision, indirectness 2 studies · 611 participants |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Kaabi et al., 2024 | OR 2.49 [1.25, 4.96] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Nayak et al., 2010 | OR 2.37 [1.21, 4.64] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Talla et al., 2014 | OR 2.57 [1.3, 5.08] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Alamoudi et al., 2023 | OR 2.56 [1.32, 4.97] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Algan et al., 2025 | OR 2.43 [1.21, 4.92] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Mathew et al., 2019 | OR 2.11 [1.75, 2.56] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) Leave-one-out sensitivity analysis: omitting Simsek et al., 2019 | OR 2.65 [1.5, 4.69] GRADE not reported 6 studies |
| Non-specific or multiple systemic conditions | Controls without the systemic condition (healthy or non-exposed) | Presence of imaging-detected pulp calcification (patient-level) General Systemic & Local | OR 2.44 [1.41, 4.24] Very low Downgraded: risk of bias, inconsistency, indirectness 7 studies · 8220 participants |
Included primary studies 35
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alamoudi 2023 Assessment of the Correlation Between Systemic Conditions and Pulp Canal Calcification: A Case-Control Study. PMID:37859878 | 2023 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Alsweed 2019 The Prevalence and Correlation of Carotid Artery Calcifications and Dental Pulp Stones in a Saudi Arabian Population. PMID:31311129 | 2019 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Araya 2020 matched by author and year (probable) | NR | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Baghestani 2025 Could carotid artery calcifications and pulp stones be an alarm sign for diabetes mellitus? A retrospective observational study DOI:10.1186/s12902-025-02005-z | 2025 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Bains 2014 Prevalence of Coronal Pulp Stones and Its Relation with Systemic Disorders in Northern Indian Central Punjabi Population DOI:10.1155/2014/617590 | 2014 | this review only | not stated | not extracted yet |
| Bauss 2008 Prevalence of pulp calcifications in patients with Marfan syndrome DOI:10.1016/j.tripleo.2008.06.029 | 2008 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Beytaş Alğan 2025 Association between pulp stones and systemic diseases: a retrospective study using digital panoramic radiographs in a Turkish population DOI:10.1186/s12903-025-06492-3 | 2025 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Çağlayan 2015 The osseous and dental changes of patients with chronic renal failure by CBCT DOI:10.1259/dmfr.20140398 | 2015 | this review only | not stated | not extracted yet |
| de Souza Romano 2024 Association between pulp stones and systemic diseases: A case-control study DOI:10.7322/abcshs.2022074.2137 | 2024 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Edds 2005 Pilot Study of Correlation of Pulp Stones with Cardiovascular Disease DOI:10.1097/01.don.0000168890.42903.2b | 2005 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Ezoddini-Ardakani 2011 DOI:10.1922/cdh_2633ardakani03 | NR | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Fairozekhan 2025 Prevalence of Pulp Stones in Patients Visiting the Dental Hospital of Imam Abdulrahman Bin Faisal University: A Correlative Retrospective… PMID:39981459 | 2025 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Gulsahi 2009 A radiographic assessment of the prevalence of pulp stones in a group of Turkish dental patients DOI:10.1111/j.1365-2591.2009.01580.x | 2009 | this review only | not stated | not extracted yet |
| Gunen Yilmaz 2019 The Relationship between carotid artery calcification and pulp stone among hemodialysis patients: A retrospective study DOI:10.4103/1319-2442.265449 | 2019 | this review only | not stated | not extracted yet |
| Horsley 2009 Prevalence of carotid and pulp calcifications: a correlation using digital panoramic radiographs DOI:10.1007/s11548-008-0277-7 | 2008 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Jawahar 2021 Clinicopathological Correlation of Pulp Stones and Its Association with Hypertension and Hyperlipidemia: An Hospital-based Prevalence Study. PMID:35017969 | 2021 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Kaabi 2024 Pulp stones in unerupted teeth: a retrospective analysis using cone-beam computed tomography DOI:10.1186/s12903-024-04503-3 | 2024 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Kanjanabuch 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kanjanabuch 2011 Oral and radiographic findings in patients undergoing continuous ambulatory peritoneal dialysis. PMID:22043576 | 2011 | this review only | not stated | not extracted yet |
| Kansu 2009 Can dental pulp calcification serve as a diagnostic marker for carotid artery calcification in patients with renal diseases? DOI:10.1259/dmfr/13231798 | 2009 | this review only | not stated | not extracted yet |
| Khojastepour 2013 matched by author and year (probable) | NR | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Khojastepour 2013 Can dental pulp calcification predict the risk of ischemic cardiovascular disease? PMID:24910654 | 2013 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Mathew 2019 matched by author and year (probable) | NR | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Moura 1987 Pulpal calcifications in patients with coronary atherosclerosis DOI:10.1111/j.1600-9657.1987.tb00640.x | 1987 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Näsström 1985 Narrowing of the dental pulp chamber in patients with renal diseases DOI:10.1016/0030-4220(85)90159-8 | 1985 | this review only | not stated | not extracted yet |
| Nayak 2010 A radiographic correlation between systemic disorders and pulp stones DOI:10.4103/0970-9290.70806 | 2010 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Özakar İlday 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ozsin Ozler 2022 Oral health status of patients with inherited bone marrow failure syndromes DOI:10.1016/j.pdj.2022.06.003 | 2022 | this review only | not stated | not extracted yet |
| Patil 2013 DOI:10.7860/jcdr/2013/5460.3093 | NR | this review only | not stated | not extracted yet |
| Şener 2009 Calcifications of the pulp chamber: prevalence and implicated factors DOI:10.1007/s00784-008-0212-x | 2008 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Simsek 2019 DOI:10.23804/ejpd.2019.20.02.02 | NR | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Srivastava 2020 Assessing the Prevalence and Association of Pulp Stones with Cardiovascular Diseases and Diabetes Mellitus in the Saudi Arabian… PMID:33322604 | 2020 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Swathy 2015 Prevalence of pulp stones in patients with history of cardiac diseases DOI:10.5958/0974-360x.2015.00291.7 | 2015 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Talla 2014 A study on pulp stones in a group of the population in Andhra Pradesh, India: An institutional study. PMID:24778503 | 2014 | this review only | Presence of imaging-detected pulp calcification (patient-level) | not extracted yet |
| Vidyullatha 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing dental imaging examination (panoramic, periapical, CBCT or other modalities) | Dental patients, 19,057 patients and 175,241 teeth across 33 studies (n=33) |
| Intervention | Exposure: presence of pulp calcification and/or pulp stones confirmed by imaging (PECO exposure) | Systemic conditions including cardiovascular disease, diabetes mellitus, renal disease, genetic syndromes, other metabolic disorders, medication use (n=33) |
| Comparison | Patients without pulp calcification or with different degrees or types of calcification | Healthy or control individuals without the systemic condition (n=22 in meta-analysis) |
| Outcomes | Presence and strength of association between pulp calcification and systemic diseases (ORs, RRs or prevalence ratios); secondary: age, sex, comorbidities, imaging descriptors, imaging modality | Imaging-detected pulp calcification (pulp stones, pulp narrowing, obliteration); pooled OR 2.69 (95% CI 2.04 to 3.54), 22 studies |
| Study designs | Observational studies (cross-sectional, case-control, cohort, other original investigations) | Observational studies: cross-sectional, case-control, cohort; 33 studies from 10 countries (n=33) |
| Timing | Not specified | Not specified |