Influence of Glycemic Levels on Healing of Periapical Lesions in Type 2 Diabetic Patients Following Primary Nonsurgical Root Canal Therapy

Diabetes mellitus is defined as a group of metabolic disorders characterized by chronic hyperglycemia with disturbances in carbohydrates, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long-term damage, dysfunction and failure of various organs: eyes, kidneys, nerves, heart, and blood vessels . Diabetes Mellitus is broadly classified into two types. Diabetes due to reduced insulin secretion from islet cells of pancreas is are known as type 1 and Diabetes due to combination of insulin resistance , reduced or increased insulin secretion are known as type 2.

One of the main detrimental effects of diabetes is its downregulation of immune system. It affects the immune cell function, up-regulates cytokines from monocytes or leukocytes and down-regulates the various growth factors predisposing to chronic inflammation, progressive tissue breakdown and reduced tissue repair capacity . So body becomes increasingly susceptible to infections and worsens if the blood glucose levels are not brought back to normal range .Oral symptoms of uncontrolled diabetes may comprise a plethora of conditions, such as dry mouth, tooth decay, periodontal diseases, delayed wound healing, and increased incidence of infection following surgery.

Diabetes mellitus inhibits collagen fibril formation and also interferes with collagen cross-linking and may impair degradation of matrix proteins and subsequent tissue remodeling , leading to poor wound healing in diabetics. Poor wound healing is similar in diabetic dental pulp.

Apical periodontitis is a chronic inflammatory lesion of the periapical region caused due to release of infectious products from the infected root canal system in the case of necrotic non vital pulp. It is characterized by periapical bone loss which does not heal unless the irritating agent is removed.

Thus, pro-inflammatory status and impaired immune response associated with systemic diseases can affect the reparative response of the dental pulp and periapical healing.Periapical immune response localizes the infection within the confines of the root canal system and prevents its systemic dissemination. In the host immune system, neutrophil is the first defense line when pathogens invade. Diabetes mellitus seriously impairs the function and bactericidal activity of neutrophils.