Chung Yi-Lun, Lee Jang-Jaer, Chien Hua-Hong, Chang Mei-Chi, Jeng Jiiang-Huei
Graduate Institute of Oral Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Dent Sci. 2024 Jul;19(3):1338-1347. doi: 10.1016/j.jds.2024.03.021. Epub 2024 Apr 5.
This longevity of life expectancy has indirectly led to an increase in the number of chronic diseases such as periodontitis, apical periodontitis (AP), and diabetes mellitus (DM) in the aging society, thus affecting people's quality of life. There is an interaction between periodontitis/AP and DM with a two-way relationship. Although type 1 and 2 diabetes (T1DM, T2DM) have different etiologies, glycemic control may affect the infection, inflammation and tissue healing of periodontitis and AP. Non-surgical periodontal treatment may influence the glycemic control as shown by decrease of HbA1c level in T2DM patient. However, the effect of periodontal treatment on glycemic control in T1DM and root canal treatment/apical surgery on T1DM and T2DM patients awaits investigation. DM may affect the periodontal and periapical tissues possibly via altered oral microbiota, impairment of neutrophils' activity and host immune responses and cytokine production, induction of oxidative stress etc. While periodontitis associated systemic inflammation and hyperlipidemia is suggested to contribute to the control of T2DM, more intricate studies are necessary to clarify the detailed mechanisms. The interactions between DM (T1DM and T2DM) and periodontitis and AP are therefore reviewed to provide a basis for the treatment of subsequent patients with pulpal/periodontal disease and diabetes. A two-pronged approach of medical and dental treatment is needed for the management of these patients, with emphasis on blood glucose control and improving oral hygiene and periodontal maintenance care, to ensure the best treatment outcome.
在老龄化社会中，预期寿命的延长间接导致了诸如牙周炎、根尖周炎（AP）和糖尿病（DM）等慢性疾病数量的增加，从而影响了人们的生活质量。牙周炎/AP与DM之间存在相互作用且呈双向关系。虽然1型和2型糖尿病（T1DM、T2DM）病因不同，但血糖控制可能会影响牙周炎和AP的感染、炎症及组织愈合。非手术牙周治疗可能会影响血糖控制，如T2DM患者糖化血红蛋白水平降低所示。然而，牙周治疗对T1DM患者血糖控制的影响以及根管治疗/根尖手术对T1DM和T2DM患者的影响尚待研究。DM可能通过改变口腔微生物群、损害中性粒细胞活性和宿主免疫反应及细胞因子产生、诱导氧化应激等方式影响牙周和根尖周组织。虽然牙周炎相关的全身炎症和高脂血症被认为有助于T2DM的控制，但仍需要更深入的研究来阐明详细机制。因此，对DM（T1DM和T2DM）与牙周炎和AP之间的相互作用进行综述，为后续牙髓/牙周疾病和糖尿病患者的治疗提供依据。对于这些患者的管理，需要采取医疗和牙科治疗双管齐下的方法，重点是控制血糖、改善口腔卫生和牙周维护护理，以确保最佳治疗效果。
