Verhulst Martijn J L, Loos Bruno G, Gerdes Victor E A, Teeuw Wijnand J
Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands.
Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands.
Front Endocrinol (Lausanne). 2019 Feb 18;10:56. doi: 10.3389/fendo.2019.00056. eCollection 2019.
Diabetes mellitus (DM) is associated with several microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases. The pathogenesis of these complications is complex, and involves metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, hypertension, and immune dysfunction. These disturbances initiate several damaging processes, such as increased reactive oxygen species (ROS) production, inflammation, and ischemia. These processes mainly exert their damaging effect on endothelial and nerve cells, hence the susceptibility of densely vascularized and innervated sites, such as the eyes, kidneys, and nerves. Since the oral cavity is also highly vascularized and innervated, oral complications can be expected as well. The relationship between DM and oral diseases has received considerable attention in the past few decades. However, most studies only focus on periodontitis, and still approach DM from the limited perspective of elevated blood glucose levels only. In this review, we will assess other potential oral complications as well, including: dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. Each oral complication will be briefly introduced, followed by an assessment of the literature studying epidemiological associations with DM. We will also elaborate on pathogenic mechanisms that might explain associations between DM and oral complications. To do so, we aim to expand our perspective of DM by not only considering elevated blood glucose levels, but also including literature about the other important pathogenic mechanisms, such as insulin resistance, dyslipidemia, hypertension, and immune dysfunction.
糖尿病(DM)与多种微血管和大血管并发症相关,如视网膜病变、肾病、神经病变和心血管疾病。这些并发症的发病机制复杂,涉及代谢和血流动力学紊乱,包括高血糖、胰岛素抵抗、血脂异常、高血压和免疫功能障碍。这些紊乱引发了多种损伤过程,如活性氧(ROS)生成增加、炎症和缺血。这些过程主要对内皮细胞和神经细胞产生损伤作用,因此血管密集和神经分布丰富的部位,如眼睛、肾脏和神经,易受影响。由于口腔也是血管密集和神经分布丰富的部位,因此也可能出现口腔并发症。在过去几十年中,DM与口腔疾病之间的关系受到了相当多的关注。然而,大多数研究仅关注牙周炎,并且仍然仅从血糖水平升高这一有限视角来研究DM。在本综述中,我们还将评估其他潜在的口腔并发症,包括:龋齿、口干、口腔黏膜病变、口腔癌、味觉障碍、颞下颌关节紊乱、灼口综合征、根尖周炎和种植体周围疾病。每种口腔并发症将简要介绍,随后评估研究其与DM流行病学关联的文献。我们还将详细阐述可能解释DM与口腔并发症之间关联的致病机制。为此,我们旨在拓宽对DM的认识,不仅考虑血糖水平升高,还纳入有关其他重要致病机制的文献,如胰岛素抵抗、血脂异常、高血压和免疫功能障碍。