Association between diabetes and the prevalence of radiolucent periapical lesions in root-filled teeth: systematic review and meta-analysis
- 1.4k Downloads
The question of whether diabetes mellitus can influence the outcome of root canal treatment (RCT) remains unclear. The aim of this systematic review and meta-analysis was to analyze scientific available evidence on the association between diabetes and the presence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).
The review question was as follows: in adult patients who had endodontically treated teeth, does the absence or presence of diabetes result in an increase in the prevalence of RPL associated to RFT? A systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus search was conducted using the following MeSH and keywords: Diabetes Mellitus OR Diabetes OR Diabetic OR Hyperglycemia, AND Endodontics, Periapical Periodontitis, Periapical Diseases, Apical Periodontitis, Periradicular Lesion, Periapical Radiolucency, Radiolucent Periapical Lesion, Root Canal Treatment, Root Canal Preparation, Root Canal Therapy, Root Filled Teeth, Endodontically Treated Teeth. Seven studies reporting data on the prevalence of RPL associated to RFT both in diabetic and control subjects were included.
After the study selection, seven epidemiological studies fulfilled the inclusion criteria, representing data from 1593 root canal treatments, 1011 in non-diabetic control subjects, and 582 in diabetic patients. The calculated pooled odds ratio (OR = 1.42; 95 % CL = 1.11–1.80; p = 0.0058) indicates that diabetic patients have higher prevalence of RFT with RPLs than controls.
Available scientific evidence indicates that diabetes is significantly associated to higher prevalence of periapical radiolucencies in endodontically treated teeth, being an important putative pre-operative prognostic factor in RCT.
Taking into account that diabetes is the third most prevalent chronic medical condition among dental patients, endodontic providers should be aware of the relationship between the outcome of endodontic treatment and diabetes.
KeywordsDiabetes mellitus Meta-analysis Periapical inflammation Persistent apical periodontitis Root canal treatment outcome Root-filled teeth
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The work was supported by the Department of Stomatology, Endodontics Section, University of Sevilla, Seville, Spain.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
- 9.Eriksen HM (1998) Epidemiology of apical periodontitis. In: Ørstavik D, Pitt Ford TR (eds) Essential Endodontology. Prevention and treatment of apical periodontitis. Blackwell Science, London, pp. pp.179–pp.191Google Scholar
- 10.Ørstavik D, Pitt Ford T (2007) Apical periodontitis: microbial infection and host responses. In: Ørstavik D, Pitt Ford TR (eds) Essential Endodontology. Prevention and treatment of apical periodontitis, 2nd edn. Wiley-Blackwell, London, UK, pp. pp:179–pp:191Google Scholar
- 12.Sundqvist G, Figdor D (1998) Endodontic treatment of apical periodontitis. In: Ørstavik D, Pitt Ford TR (eds) Essential Endodontology. Blackwell, Oxford, pp. pp:242–pp:277Google Scholar
- 20.Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2000) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 23(Suppl.1):S4–S19Google Scholar
- 23.Fouad AF, Huang GT-J (2015) Chapter 9: inflammation and Immunological response, in Ingle’s Endodontics 7th Ed. Rotstein I. Editor (in press)Google Scholar
- 31.Centre for Evidence Based Medicine (2005) Critical Appraisal for therapy articles. University of Oxford. Medical Sciences Division. Available at: http://www.cebm.net/wp-content/uploads/2014/04/RCT_Appraisal_sheets_2005_English.doc
- 35.Freemantle N (2000) CD: StatsDirect—statistical software for medical research in the 21st century. Bmj 321(7275):1536. http://www.statsdirect.com/
- 44.Falk H, Hugoson A, Thorstensson H (1989) Number of teeth, prevalence of caries and periapical lesions in insulin-dependent diabetics. Scand J Dental Res 97:198–206Google Scholar
- 51.Strindberg LZ (1956) The dependence of the results of pulp therapy on certain factors. Acta Odontol Scand 14(suppl 21):1–75Google Scholar
- 60.Pereira RF, de Oliveira da Mota MS, de Lima Coutinho Mattera MS, et al. (2015) Periapical lesions decrease Akt serine phosphorylation and plasma membrane GLUT4 content in rat skeletal muscle. Clin Oral Investig Nov 23. (Epub ahead of print)Google Scholar