Center of Proteomic and Biochemical Analyzes, Post graduation in Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasília, DF, Brazil.
Int Endod J. 2013 Aug;46(8):700-9. doi: 10.1111/iej.12072. Epub 2013 Feb 26.
Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.
糖尿病（DM）是最常见的代谢紊乱之一。DM 的特征是高血糖，导致伤口愈合困难和全身及口腔表现，这直接影响牙髓的完整性。实验和临床研究表明，未控制的糖尿病患者根尖周病变的患病率更高。本文回顾了 DM 对根尖周骨吸收的影响及其对这类患者牙科干预的影响，并在分子水平上分析了其病因和发病机制。患有糖尿病的牙髓往往表现出有限的牙侧支循环、免疫反应受损、感染牙髓（尤其是厌氧菌）或坏死的风险增加，此外还会出现牙痛和偶尔因缺血导致的牙髓坏死倾向。在分子病理学方面，高血糖是骨吸收的刺激因素，抑制成骨细胞分化，减少骨恢复。未控制的糖尿病与骨代谢之间的关系尚不清楚。关于糖尿病患者牙髓改变的分子知识可能提供新的治疗方向。了解糖尿病如何影响全身和口腔健康具有持久的重要性，因为它不仅可能导致全身并发症，而且还可能导致口腔疾病风险增加，对牙髓和根尖周组织产生重大影响。
