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Objective: To evaluate the prevalence of systemic chronic diseases among patients undergoing endodontic therapy in a University Department of Endodontology and to assess their potential implications for treatment planning and prognosis. Methods: A retrospective cross-sectional study analysis was performed on clinical records of patients aged > 18 years treated at the Department of Endodontics, University of Bologna. Data collected included demographic information, presence of chronic systemic diseases, endodontic disease and medication history. Descriptive statistics were used to estimate prevalence rates. Results: More than one third of patients (35%) presented with at least one systemic chronic disease or multiple comorbidities. Cardiovascular diseases (19.8%) were the most prevalent. Polypharmacy was observed in 32% of patients. Patients aged 40 years and older showed a significantly higher prevalence of systemic conditions compared to younger individuals. Conclusions: The study supports the finding that a high percentage of patients undergoing endodontic therapies present systemic chronic diseases, multiple comorbid conditions and polypharmacy. It is important to assess these factors and to customize endodontic treatment and decision-making. These realities are likely to become even more pronounced in the coming years, as global population aging continues apace.