国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (2): 231-237.doi: 10.7518/gjkq.2025009

• 综述 • 上一篇    下一篇

牙髓根尖周病与糖尿病相互关系及相关机制的研究进展

董馨璐(),许来俊,张剑英,陈敏慜()   

  1. 中南大学湘雅口腔医学院 湖南中南大学湘雅口腔医院牙体牙髓病科 口腔健康研究湖南省重点实验室 湖南省口腔重大疾病与口腔健康临床医学研究中心 长沙 410008
  • 收稿日期:2024-04-28 修回日期:2024-09-10 出版日期:2025-03-01 发布日期:2025-03-01
  • 通讯作者: 陈敏慜
  • 作者简介:董馨璐,硕士,Email:226812031@csu.edu.cn
  • 基金资助:
    湖南省自然科学基金(2022JJ40733);湖南省卫生健康委员会科研计划项目(202208015033);长沙市自然科学基金(kq2208180)

Progress in research on the correlation of inflammatory pulpal and periapical disease to diabetes mellitus and rela-ted mechanisms

Xinlu Dong(),Laijun Xu,Jianying Zhang,Minmin Chen()   

  1. Xiangya School of Stomatology, Central South University & Dept. of Endodontics, Hunan Xiangya Stomatological Hospital & Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha 410008, China
  • Received:2024-04-28 Revised:2024-09-10 Online:2025-03-01 Published:2025-03-01
  • Contact: Minmin Chen
  • Supported by:
    Natural Science Foundation of Hunan Province(2022JJ40733);Scientific Research Program of Hunan Provincial Health Commission(202208015033);Natural Science Foundation of Changsha(kq2208180)

摘要:

牙髓根尖周病是常见的口腔感染性疾病,可影响口颌系统的健康。近年来,有越来越多的研究报道牙髓根尖周病和糖尿病的关系,但二者相互影响的潜在机制仍未阐明。本文通过回顾近期文献,主要从糖尿病胰岛素抵抗、微生物免疫炎症反应、成骨与破骨的失衡和氧化应激等方面总结牙髓根尖周病与糖尿病的相关性和相互作用的可能机制,以期为糖尿病患者的牙髓根尖周病治疗提供理论基础和指导依据。

关键词: 牙髓病, 根尖周病, 糖尿病, 微生物, 免疫

Abstract:

Dental pulp and periapical diseases are prevalent infectious oral conditions that can affect the well-being of the stomatognathic system. In recent years, a growing number of studies have highlighted the correlations of pulp and periapical diseases to diabetes, but the mechanism underlying this correlation remains unclear. This review aims to present a comprehensive summary of the possible mechanisms, including insulin resistance, microbial immune inflammatory response, imbalance between osteogenesis and osteolysis, and oxidative stress. Ultimately, this review seeks to offer a theoretical framework and clinical guidance for the management of dental pulp and periapical diseases in individuals with diabetes mellitus.

Key words: dental pulp disease, periapical disease, diabetes mellitus, microorganism, immunity

中图分类号: 

  • R781.3

《儿童口腔早期矫治:基础、原则、策略》出版发行"

1 Duncan HF, Kirkevang LL, Peters OA, et al. Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3-level clinical practice guideline[J]. Int Endod J, 2023, 56(): 238-295.
2 Segura-Egea JJ, Cabanillas-Balsera D, Martín-Gon-zález J, et al. Impact of systemic health on treatment outcomes in endodontics[J]. Int Endod J, 2023, 56(): 219-235.
3 Lalla E, Papapanou PN. Diabetes mellitus and perio-dontitis: a tale of two common interrelated diseases[J]. Nat Rev Endocrinol, 2011, 7(12): 738-748.
4 Bendek MJ, Canedo-Marroquín G, Realini O, et al. Periodontitis and gestational diabetes mellitus: a potential inflammatory vicious cycle[J]. Int J Mol Sci, 2021, 22(21): 11831.
5 Gaeta C, Marruganti C, Ali IAA, et al. The presence of Enterococcus faecalis in saliva as a risk factor for endodontic infection[J]. Front Cell Infect Microbiol, 2023, 13: 1061645.
6 Siqueira JF Jr, Rôças IN. A critical analysis of research methods and experimental models to study the root canal microbiome[J]. Int Endod J, 2022, 55(): 46-71.
7 Limeira FIR, Arantes DC, de Souza Oliveira C, et al. Root canal treatment and apical periodontitis in a Brazilian population with type 1 diabetes mellitus: a cross-sectional paired study[J]. J Endod, 2020, 46(6): 756-762.
8 Srivastava KC, Shrivastava D, Nagarajappa AK, et al. Assessing the prevalence and association of pulp stones with cardiovascular diseases and diabetes mellitus in the Saudi Arabian population-a CBCT based study[J]. Int J Environ Res Public Health, 2020, 17(24): 9293.
9 Gonzalez Marrero Y, Kobayashi Y, Ihsan MS, et al. Altered prevalence of pulp diagnoses in diabetes mellitus patients: a retrospective study[J]. J Endod, 2022, 48(2): 208-212.e3.
10 Loureiro C, Buzalaf MAR, Pessan JP, et al. Proteomic analysis of infected root canals with apical periodontitis in patients with type 2 diabetes mellitus: a cross-sectional study[J]. Int Endod J, 2022, 55(9): 910-922.
11 Astolphi RD, Curbete MM, Chiba FY, et al. Periapical lesions decrease insulin signaling in rat skeletal muscle[J]. J Endod, 2015, 41(8): 1305-1310.
12 Pereira RF, de Oliveira da Mota MS, de Lima Coutinho Mattera MS, et al. Periapical lesions decrease Akt serine phosphorylation and plasma membrane GLUT4 content in rat skeletal muscle[J]. Clin Oral Investig, 2016, 20(7): 1625-1630.
13 Cintra LT, da Silva Facundo AC, Prieto AK, et al. Blood profile and histology in oral infections asso-ciated with diabetes[J]. J Endod, 2014, 40(8): 1139-1144.
14 Prieto AKC, Gomes-Filho JE, Azuma MM, et al. Influence of apical periodontitis on stress oxidative parameters in diabetic rats[J]. J Endod, 2017, 43(10): 1651-1656.
15 Chien WC, Fu E, Chung CH, et al. Type 2 diabetes mellitus and periodontitis: bidirectional association in population-based 15-year retrospective cohorts[J]. J Clin Endocrinol Metab, 2023, 108(11): e1289-e1297.
16 Shi NX, Kong CF, Yuan L, et al. The bidirectional relationship between periodontitis and diabetes: new prospects for stem cell-derived exosomes[J]. Biomed Pharmacother, 2023, 165: 115219.
17 Zhao M, Xie Y, Gao W, et al. Diabetes mellitus promotes susceptibility to periodontitis-novel insight into the molecular mechanisms[J]. Front Endocrinol (Lausanne), 2023, 14: 1192625.
18 Shapouri-Moghaddam A, Mohammadian S, Vazini H, et al. Macrophage plasticity, polarization, and fun-ction in health and disease[J]. J Cell Physiol, 2018, 233(9): 6425-6440.
19 Ying W, Fu WX, Lee YS, et al. The role of macrophages in obesity-associated islet inflammation and β‑cell abnormalities[J]. Nat Rev Endocrinol, 2020, 16(2): 81-90.
20 Blasco-Baque V, Garidou L, Pomié C, et al. Perio-dontitis induced by Porphyromonas gingivalis drives periodontal microbiota dysbiosis and insulin resistance via an impaired adaptive immune response[J]. Gut, 2017, 66(5): 872-885.
21 Gomes JMG, Costa JA, Alfenas RCG. Metabolic endotoxemia and diabetes mellitus: a systematic review[J]. Metabolism, 2017, 68: 133-144.
22 Ballato E, Deepika F, Prado M, et al. Circulating osteogenic progenitors and osteoclast precursors are associated with long-term glycemic control, sex steroids, and visceral adipose tissue in men with type 2 diabetes mellitus[J]. Front Endocrinol, 2022, 13: 936159.
23 An YN, Zhang HF, Wang C, et al. Activation of ROS/MAPKs/NF-κB/NLRP3 and inhibition of efferocytosis in osteoclast-mediated diabetic osteoporosis[J]. FASEB J, 2019, 33(11): 12515-12527.
24 Liu LS, Zhang C, Hu YJ, et al. Protective effect of metformin on periapical lesions in rats by decrea-sing the ratio of receptor activator of nuclear factor kappa B ligand/osteoprotegerin[J]. J Endod, 2012, 38(7): 943-947.
25 Uzunoglu-Ozyurek E, Önal G, Dökmeci S. Odonto/osteogenic differentiation of dental pulp stem cells of type 1 diabetic patients with mineral trioxide ag-gregate/1α, 25-dihydroxyvitamin D3 combination[J]. J Endod, 2022, 48(4): 516-526.
26 Alsamahi S, Milne TM, Hussaini H, et al. Type 2 diabetes and the clinically normal pulp: an in vitro study[J]. Int Endod J, 2022, 55(6): 660-671.
27 Al-Anesi MA, Abu-Seida AM, El Ashry SH, et al. Influence of insulin on the healing of exposed dental pulp after pulp capping: an experimental study in a dog model[J]. Spec Care Dentist, 2021, 41(1): 49-59.
28 Azuma MM, Gomes-Filho JE, Prieto AKC, et al. Diabetes increases interleukin-17 levels in periapical, hepatic, and renal tissues in rats[J]. Arch Oral Biol, 2017, 83: 230-235.
29 Borgo Sarmento E, Helena Teixeira de Lima Ribeiro Andrade R, Cristina Gomes C, et al. Proinflammatory cytokine expression in apical periodontitis from diabetic patients[J]. Int J Dent, 2023, 2023: 4961827.
30 Samuel RO, Ervolino E, de Azevedo Queiroz ÍO, et al. Th1/Th2/Th17/treg balance in apical periodontitis of normoglycemic and diabetic rats[J]. J Endod, 2019, 45(8): 1009-1015.
31 Garlet GP, Cardoso CR, Campanelli AP, et al. The essential role of IFN-γin the control of lethal Aggregatibacter actinomycetemcomitans infection in mice[J]. Microbes Infect, 2008, 10(5): 489-496.
32 De la Torre-Luna R, Domínguez-Pérez RA, Guillén-Nepita AL, et al. Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients[J]. Eur J Clin Microbiol Infect Dis, 2020, 39(1): 131-138.
33 Soza-Bolaños AI, Domínguez-Pérez RA, Ayala-Herrera JL, et al. Presence of methanogenic archaea in necrotic root canals of patients with or without type 2 diabetes mellitus[J]. Aust Endod J, 2023, 49(3): 641-647.
34 Vázquez-Ramos VR, Pérez-Serrano RM, García-Solís P, et al. Root canal microbiota as an augmen-ted reservoir of antimicrobial resistance genes in type 2 diabetes mellitus patients[J]. J Appl Oral Sci, 2023, 30: e20220362.
35 Kimball JS, Johnson JP, Carlson DA. Oxidative stress and osteoporosis[J]. J Bone Joint Surg Am, 2021, 103(15): 1451-1461.
36 Jaganjac M, Milkovic L, Zarkovic N, et al. Oxidative stress and regeneration[J]. Free Radic Biol Med, 2022, 181: 154-165.
37 Lee YH, Kim GE, Song YB, et al. Davallialactone reduces inflammation and repairs dentinogenesis on glucose oxidase-induced stress in dental pulp cells[J]. J Endod, 2013, 39(11): 1401-1406.
38 Milosavljević A, DJukić L, Toljić B, et al. Melatonin levels in human diabetic dental pulp tissue and its effects on dental pulp cells under hyperglycaemic conditions[J]. Int Endod J, 2018, 51(10): 1149-1158.
39 Jiao Y, Ma S, Wang YR, et al. N-acetyl cysteine depletes reactive oxygen species and prevents dental monomer-induced intrinsic mitochondrial apoptosis in vitro in human dental pulp cells[J]. PLoS One, 2016, 11(1): e0147858.
40 Wu DN, Yan LY, Zheng CC, et al. Akt-GSK3β‑ mPTP pathway regulates the mitochondrial dysfunction contributing to odontoblasts apoptosis induced by glucose oxidative stress[J]. Cell Death Discov, 2022, 8: 168.
41 Takanche JS, Lee YH, Kim JS, et al. Anti-inflammatory and antioxidant properties of Schisandrin C promote mitochondrial biogenesis in human dental pulp cells[J]. Int Endod J, 2018, 51(4): 438-447.
42 Nagendrababu V, Segura-Egea JJ, Fouad AF, et al. Association between diabetes and the outcome of root canal treatment in adults: an umbrella review[J]. Int Endod J, 2020, 53(4): 455-466.
43 Cabanillas-Balsera D, Martín-González J, Montero-Miralles P, et al. Association between diabetes and nonretention of root filled teeth: a systematic review and meta-analysis[J]. Int Endod J, 2019, 52(3): 297-306.
44 Paljević E, Brekalo Pršo I, Vidas Hrstić J, et al. Healing of apical periodontitis in type Ⅱ diabetes mellitus patients: a prospective study[J]. Oral Dis, 2024, 30(5): 3422-3430.
45 Gupta A, Aggarwal V, Mehta N, et al. Diabetes mellitus and the healing of periapical lesions in root filled teeth: a systematic review and meta-analysis[J]. Int Endod J, 2020, 53(11): 1472-1484.
46 Liu XY, He GY, Qiu ZJ, et al. Diabetes mellitus increases the risk of apical periodontitis in endodontically-treated teeth: a meta-analysis from 15 studies[J]. J Endod, 2023, 49(12): 1605-1616.
47 Arya S, Duhan J, Tewari S, et al. Healing of apical periodontitis after nonsurgical treatment in patients with type 2 diabetes[J]. J Endod, 2017, 43(10): 1623-1627.
48 Uğur Aydın Z, Ocak MG, Bayrak S, et al. The effect of type 2 diabetes mellitus on changes in the fractal dimension of periapical lesion in teeth after root canal treatment: a fractal analysis study[J]. Int Endod J, 2021, 54(2): 181-189.
49 Laukkanen E, Vehkalahti MM, Kotiranta AK. Impact of systemic diseases and tooth-based factors on outcome of root canal treatment[J]. Int Endod J, 2019, 52(10): 1417-1426.
50 Martinho JP, Coelho A, Oliveiros B, et al. Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus[J]. Int Endod J, 2021, 54(10): 1687-1698.
51 Saghiri MA, Karamifar K, Fakharzadeh A, et al. Effect of diabetes on tubular density and push-out bond strength of mineral trioxide aggregate to dentin[J]. J Endod, 2020, 46(11): 1584-1591.
52 Saghiri MA, Aminsobhani M, Gutmann JL, et al. Effect of diabetes on rotary instrumentation of dentin[J]. J Endod, 2021, 47(8): 1301-1307.
53 Wang S, Wang X, Bai F, et al. Effect of endodontic treatment on clinical outcome in type 2 diabetic patients with apical periodontitis[J]. Heliyon, 2023, 9(3): e13914.
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