Association between type II diabetes and apical periodontitis: a critical review and before/after study on the outcome of endodontic treatment in an emirati adult population
AlMutawa, Alaa Tariq
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The work presented here consists of two distinct parts. Part 1: A Critical Review of the literature Background: Diabetes has been found to be associated with increased risk of infections, impaired immune response and delayed wound healing. Studies have found that these complications contribute to an increased prevalence of periapical lesions and decreased endodontic success. Aim: To critically review the literature with regards to the association between apical periodontitis and diabetes. Materials and Methods: An extensive search was carried out using MEDLINE (ovid), Embase, Pubmed, The Cochrane Central Register Search of controlled trials, and Cochrane Reviews to identify suitable human-based studies. These studies included adult participants, a diabatic and a control group, and used a radiographic assessment of periapical radiolucency. Results: The critical review included 11 studies conducted between 1989 to April 2019. From these studies, 4 studies found a significantly higher prevalence of apical periodontitis in diabatic patients compared to non-diabatic patients before endodontic treatment while 7 studies found significantly higher prevalence of apical periodontitis after endodontic treatment in diabatic than non-diabatic cases. Conclusion: An association was found between diabetes and apical periodontitis before and after Endodontic treatment. Part 2: Association between Type II Diabetes and Apical Periodontitis before and after Endodontic Treatment in an Adult Population in the United Arab Emirates Background: Diabetes Mellitus is one of the most common systemic disorders. Diabetes Mellitus results in hyperglycemia which can affect the healing of the dental pulp. Clinical studies have shown a higher prevalence of periapical lesions in uncontrolled diabetes although the exact relationship is not clearly understood. Aim: To determine the association between Type II diabetes and apical periodontitis (AP) before and after Endodontic treatment in an adult population in the United Arab Emirates. The null hypothesis that Type II diabetes has no effect on the size of AP lesions was tested. Materials and methods: A sample of 50 patients with Type II diabetes were selected from a database in a specialist Endodontic unit who had received endodontic treatment on one tooth. These were matched in terms of age and gender with a non-diabetic control group who received Endodontic treatment on the same tooth. For each group, the size of the AP lesion was recorded using the Periapical Index (PAI) scoring system preoperatively and 1 to 4 years post endodontic treatment. The 50 diabetic patients were made up of 27 controlled and 23 uncontrolled (HbA1c value of 8% or higher) diabetics. Results: The mean PAI score for the uncontrolled diabetic group (n=23) prior to endodontic treatment was 3.3 compared to 2.3 for the matched non-diabetic control group. The Wilcoxon sign rank test revealed that this was statistically significant (p=0.002) indicating that uncontrolled Type II diabetes influences the size of the AP lesion. These figures were reduced to a mean PAI score of 1.9 in the uncontrolled diabetic group and 1.5 in the healthy control group in the post endodontic treatment periapical radiographs. The corresponding mean PAI value prior to endodontic treatment were 2.4 and 2.7 in the controlled diabetic patients and their matching control group respectively. The differences were not statistically significant (p=0.13). For the sample as a whole (n=50), the mean PAI value for both diabetic and non-diabetic groups reduced to 1.7 and 1.6 respectively post Endodontic periapical radiographs. The Wilcoxon sign rank test revealed a statistically significant improvement in healing in both these groups (p<0.001). PAI scores, prior to Endodontic treatment, were significantly higher in the uncontrolled diabetic group compared to the controlled diabetic group. In all cases the Endodontic treatment significantly reduced the size of the AP lesions.