Int J Stomatol ›› 2025, Vol. 52 ›› Issue (3): 397-404.doi: 10.7518/gjkq.2025035

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Progress in research on the relationship between diabetes mellitus and endodontic periapical disease

Yuzhi Li1(),Xu Su2,Xiaotao Chen2,Yong Zhang3()   

  1. 1.Dept. of Stomatology, Shihezi University School of Medicine, Shihezi 832000, China
    2.Dept. of Stomatology, Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi 830000, China
    3.Dept. of Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
  • Received:2023-12-14 Revised:2024-08-22 Online:2025-05-01 Published:2025-04-30
  • Contact: Yong Zhang E-mail:doctorliyuzhi@163.com;zhangyong_1019@163.com
  • Supported by:
    Xinjiang Uygur Autonomous Region Regional Collaborative Innovation Special Fund(2021E02071)

Abstract:

Diabetes mellitus not only affects several organs in the human body but also affects oral health, easily cau-sing the occurrence and aggravation of endodontic and periapical inflammation. In this context, the relationship between diabetes mellitus and endodontics and periapical diseases has become a major topic in dentistry, and the mechanism of its influence has been extensively explored. In this paper, the interactions between diabetes mellitus and endodontics and periapical disease and their mechanisms are reviewed to contribute to the research and diagnosis of diabetes mellitus combined with endodontics and periapical disease.

Key words: diabetes mellitus, endodontic disease, periapical disease

CLC Number: 

  • R781.3

TrendMD: 
1 Heald AH, Stedman M, Davies M, et al. Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data[J]. Cardiovasc Endocrinol Metab, 2020, 9(4): 183-185.
2 Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119.
3 Matoori S. Diabetes and its complications[J]. ACS Pharmacol Transl Sci, 2022, 5(8): 513-515.
4 Zhao MC, Xie YD, Gao WJ, et al. Diabetes mellitus promotes susceptibility to periodontitis-novel insight into the molecular mechanisms[J]. Front Endocrinol, 2023, 14: 1192625.
5 Xu XR, Xu JL, He L, et al. Comparison of the inflammatory states of serum and gingival crevicular fluid in periodontitis patients with or without type 2 diabetes mellitus[J]. J Dent Sci, 2023, 18(3): 1125-1133.
6 Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases[J]. Periodontol 2000, 2020, 82(1): 214-224.
7 Tibúrcio-Machado CS, Michelon C, Zanatta FB, et al. The global prevalence of apical periodontitis: a systematic review and meta-analysis[J]. Int Endod J, 2021, 54(5): 712-735.
8 Barutta F, Bellini S, Durazzo M, et al. Novel insight into the mechanisms of the bidirectional relationship between diabetes and periodontitis[J]. Biomedicines, 2022, 10(1): 178.
9 Li H, Meng Y, He SW, et al. Macrophages, chronic inflammation, and insulin resistance[J]. Cells, 2022, 11(19): 3001.
10 Debelian GJ, Olsen I, Tronstad L. Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an overview[J]. Ann Periodontol, 1998, 3(1): 281-287.
11 Rechenberg DK, Galicia JC, Peters OA. Biological markers for pulpal inflammation: a systematic review[J]. PLoS One, 2016, 11(11): e0167289.
12 Bender IB, Seltzer S, Yermish M. The incidence of bacteremia in endodontic manipulation: preliminary report[J]. Oral Surg Oral Med Oral Pathol, 1960, 13: 353-360.
13 Klotz MD, Gerstein H, Bahn AN. Bacteremia after topical use of prednisolone in infected pulps[J]. J Am Dent Assoc, 1965, 71(4): 871-875.
14 Bordagaray MJ, Fernández A, Garrido M, et al. Systemic and extraradicular bacterial translocation in apical periodontitis[J]. Front Cell Infect Microbiol, 2021, 11: 649925.
15 Braz-Silva PH, Bergamini ML, Mardegan AP, et al. Inflammatory profile of chronic apical periodontitis: a literature review[J]. Acta Odontol Scand, 2019, 77(3): 173-180.
16 Arruda-Vasconcelos R, Chiarelli-Neto VM, Louzada LM, et al. Quantitative analysis of culturable bacteria, levels of endotoxins, inflammatory mediators and substance P in teeth with symptomatic irrever-sible pulpitis and in teeth with vital normal pulp tissues[J]. Int Endod J, 2023, 56(7): 827-836.
17 Wang SM, Wang XQ, Bai F, et al. Effect of endo-dontic treatment on clinical outcome in type 2 diabetic patients with apical periodontitis[J]. Heliyon, 2023, 9(3): e13914.
18 Schmidt MI, Duncan BB, Sharrett AR, et al. Mar-kers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study[J]. Lancet, 1999, 353(9165): 1649-1652.
19 Anita NZ, Zebarth J, Chan B, et al. Inflammatory markers in type 2 diabetes with vs. without cognitive impairment; a systematic review and meta-ana-lysis[J]. Brain Behav Immun, 2022, 100: 55-69.
20 Cintra LT, Samuel RO, Azuma MM, et al. Apical periodontitis and periodontal disease increase serum IL-17 levels in normoglycemic and diabetic rats[J]. Clin Oral Investig, 2014, 18(9): 2123-2128.
21 Cintra LT, Samuel RO, Facundo AC, et al. Relationships between oral infections and blood glucose concentrations or HbA1c levels in normal and diabetic rats[J]. Int Endod J, 2014, 47(3): 228-237.
22 Stys LPA, Böttcher DE, Scarparo RK, et al. Serum levels of inflammatory markers and HbA1c in patients with type 2 diabetes and apical periodontitis: preliminary findings[J]. Aust Endod J, 2022, 48(1): 105-115.
23 Tavares BS, Tsosura TVS, Mattera MSLC, et al. Effects of melatonin on insulin signaling and inflammatory pathways of rats with apical periodontitis[J]. Int Endod J, 2021, 54(6): 926-940.
24 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.
25 Barcelos RCS, Rosa HZ, Roversi K, et al. Apical periodontitis induces changes on oxidative stress parameters and increases Na+/K+-ATPase activity in adult rats[J]. Arch Oral Biol, 2020, 118: 104849.
26 Borgnakke WS, Ylöstalo PV, Taylor GW, et al. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence[J]. J Clin Periodontol, 2013, 40(): S135-S152.
27 Jain A, Gupta J, Bansal D, et al. Effect of scaling and root planing as monotherapy on glycemic control in patients of type 2 diabetes with chronic perio-dontitis: a systematic review and meta-analysis[J]. J Indian Soc Periodontol, 2019, 23(4): 303-310.
28 Schulze A, Schönauer M, Busse M. Sudden improvement of insulin sensitivity related to an endo-dontic treatment[J]. J Periodontol, 2007, 78(12): 2380-2384.
29 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.
30 Catanzaro O, Dziubecki D, Lauria LC, et al. Diabetes and its effects on dental pulp[J]. J Oral Sci, 2006, 48(4): 195-199.
31 Moraru AI, GheorghiŢă LM, Dascălu IT, et al. Histological and immunohistochemical study on the dental pulp of patients with diabetes mellitus[J]. Rom J Morphol Embryol, 2017, 58(2): 493-499.
32 Puşcaşu CG, Ștefănescu CL, Murineanu RM, et al. Histological aspects regarding dental pulp of diabe-tic patients[J]. Appl Sci, 2021, 11(20): 9440.
33 Delamaire M, Maugendre D, Moreno M, et al. Impaired leucocyte functions in diabetic patients[J]. Diabet Med, 1997, 14(1): 29-34.
34 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.
35 Sinha K, Das J, Pal PB, et al. Oxidative stress: the mitochondria-dependent and mitochondria-independent pathways of apoptosis[J]. Arch Toxicol, 2013, 87(7): 1157-1180.
36 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.
37 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.
38 Farac RV, Morgental RD, Lima RK, et al. Pulp sensibility test in elderly patients[J]. Gerodontology, 2012, 29(2): 135-139.
39 Swift ML, Byers MR. Effect of ageing on responses of nerve fibres to pulpal inflammation in rat molars analysed by quantitative immunocytochemistry[J]. Arch Oral Biol, 1992, 37(11): 901-912.
40 Narengaowa, Kong W, Lan F, et al. The oral-gut-brain AXIS: the influence of microbes in Alzhei-mer’s disease[J]. Front Cell Neurosci, 2021, 15: 633735.
41 Khalid M, Petroianu G, Adem A. Advanced glycation end products and diabetes mellitus: mechanisms and perspectives[J]. Biomolecules, 2022, 12(4): 542.
42 Iwama A, Morimoto T, Tsuji M, et al. Increased number of anaerobic bacteria in the infected root canal in type 2 diabetic rats[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(5): 681-686.
43 Fouad AF, Barry J, Caimano M, et al. PCR-based identification of bacteria associated with endodontic infections[J]. J Clin Microbiol, 2002, 40(9): 3223-3231.
44 Shen ZS, Kuang SH, Zhang M, et al. Inhibition of CCL2 by bindarit alleviates diabetes-associated perio-dontitis by suppressing inflammatory monocyte infiltration and altering macrophage properties[J]. Cell Mol Immunol, 2021, 18(9): 2224-2235.
45 Insuela DBR, Ferrero MR, Gonçalves-de-Albuquerque CF, et al. Glucagon reduces neutrophil migration and increases susceptibility to sepsis in diabetic mice[J]. Front Immunol, 2021, 12: 633540.
46 Garber SE, Shabahang S, Escher AP, et al. The effect of hyperglycemia on pulpal healing in rats[J]. J Endod, 2009, 35(1): 60-62.
47 da Silva TA, de Araújo LP, Gobbo LB, et al. Outcome of root canal treatment of teeth with asymptomatic apical periodontitis treated with foraminal enlargement and 2% chlorhexidine gel: a retrospective cohort study[J]. J Endod, 2023, 49(8): 972-979.
48 Segura-Egea JJ, Jiménez-Pinzón A, Ríos-Santos JV, et al. High prevalence of apical periodontitis amon-gst type 2 diabetic patients[J]. Int Endod J, 2005, 38(8): 564-569.
49 Zhao HX, Shi DK, Wang GX, et al. High-normal free thyroxine level is related with decreased bone mineral density in nonobese male patients with type 2 diabetes over 50 years old[J]. Ther Adv Chronic Dis, 2023, 14: 20406223231195627.
50 Toker H, Balci Yuce H, Lektemur Alpan A, et al. Morphometric and histopathological evaluation of the effect of grape seed proanthocyanidin on alveolar bone loss in experimental diabetes and periodontitis[J]. J Periodontal Res, 2018, 53(3): 478-486.
51 Zhang XX, Wang MR, Wang XJ, et al. Relationship between periodontitis and microangiopathy in type 2 diabetes mellitus: a meta-analysis[J]. J Periodontal Res, 2021, 56(6): 1019-1027.
52 Suzuki R, Fujiwara Y, Saito M, et al. Intracellular accumulation of advanced glycation end products induces osteoblast apoptosis via endoplasmic reticulum stress[J]. J Bone Miner Res, 2020, 35(10): 1992-2003.
53 Jiang JJ, Zhao CY, Han TT, et al. Advanced glycation end products, bone health, and diabetes mellitus[J]. Exp Clin Endocrinol Diabetes, 2022, 130(10): 671-677.
54 Hofbauer LC, Busse B, Eastell R, et al. Bone fragility in diabetes: novel concepts and clinical implications[J]. Lancet Diabetes Endocrinol, 2022, 10(3): 207-220.
55 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.
56 Fouad AF. Diabetes mellitus as a modulating factor of endodontic infections[J]. J Dent Educ, 2003, 67(4): 459-467.
57 Yip N, Liu CW, Wu D, et al. The association of apical periodontitis and type 2 diabetes mellitus: a large hospital network cross-sectional case-controlled study[J]. J Am Dent Assoc, 2021, 152(6): 434-443.
58 Alghofaily M, Tordik P, Romberg E, et al. Healing of apical periodontitis after nonsurgical root canal treatment: the role of statin intake[J]. J Endod, 2018, 44(9): 1355-1360.
59 衣晓伟, 黄定明, 张岚. 糖尿病患者牙髓根尖周病的发病机制及临床管理[J]. 国际口腔医学杂志, 2018, 45(2): 214-218.
Yi XW, Huang DM, Zhang L. Pathogenesis and clini-cal management of apical periodontitis in diabetic patients[J]. Int J Stomatol, 2018, 45(2): 214-218.
60 Iwama A, Nishigaki N, Nakamura K, et al. The effect of high sugar intake on the development of periradicular lesions in rats with type 2 diabetes[J]. J Dent Res, 2003, 82(4): 322-325.
61 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.
62 孙熹, 张旗. 巨噬细胞极化在糖尿病合并根尖周炎中作用的研究[J]. 口腔医学研究, 2021, 37(5): 412-417.
Sun X, Zhang Q. Effect of macrophage polarization in apical periodontitis complicated with diabetes mellitus[J]. J Oral Sci Res, 2021, 37(5): 412-417.
63 Marconi DF, da Silva GS, Weissheimer T, et al. Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review[J]. Restor Dent Endod, 2022, 47(4): e40.
64 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.
65 Jakovljevic A, Duncan HF. Diabetes mellitus may negatively influence the outcome of conventional nonsurgical root canal treatment[J]. J Evid Based Dent Pract, 2020, 20(3): 101467.
66 Rudranaik S, Nayak M, Babshet M. Periapical hea-ling outcome following single visit endodontic treatment in patients with type 2 diabetes mellitus[J]. J Clin Exp Dent, 2016, 8(5): e498-e504.
67 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.
68 Löst C, Dummer PM. European Society of Endo-dontology: position statements[J]. Int Endod J, 2014, 47(6): 501.
69 Niazi SA, Bakhsh A. Association between endodontic infection, its treatment and systemic health: a narrative review[J]. Medicina, 2022, 58(7): 931.
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