Chronic apical periodontitis beyond infection: the impact of diet and lifestyle factors.

Aim: This study aimed to investigate whether chronic apical periodontitis (CAP) is influenced not only by microbial infection but also by systemic biomarkers, lifestyle, and dietary patterns. Methods: An observational cross-sectional design was applied on a cohort of adult patients, who underwent radiographic diagnosis, blood and saliva collection for oxidative stress and advanced glycation end products (AGEs) analysis, and also completed structured dietary and lifestyle questionnaires. Results: Biochemical analyses revealed no significant differences in oxidative stress or advanced glycation end products between CAP and non-CAP groups, suggesting that systemic markers may not adequately reflect localized periapical inflammation. Similarly, smoking habits and physical activity did not show relevant associations with disease presence.By contrast, diet emerged as a significant determinant. Higher consumption of fried potatoes, refined products such as croissants and white rice, and acidic fruits like oranges was associated with increased risk of CAP. Conversely, regular consumption of breakfast cereals demonstrated a protective effect, reducing disease likelihood. These associations were confirmed in multivariate analysis, highlighting the independent role of specific dietary patterns. Conclusion: CAP appears to be shaped not only by infection but also by everyday nutrition, with fried and acidic foods favoring disease, while wholegrain cereals provide resilience. These findings emphasize the importance of integrating nutritional guidance into dental care to complement conventional endodontic therapy.