Did you know that treating dental infections could potentially improve blood sugar control in people with diabetes?
Diabetes mellitus is a systemic condition characterised by chronic hyperglycaemia and low-grade inflammation. It affects numerous body systems, including oral health, where it has been linked to a higher prevalence of apical periodontitis (an inflammation around the root apex).
Research has shown that diabetic patients often experience delayed healing of apical periodontitis after root canal treatment (RCT), particularly when their blood sugar levels are poorly controlled. However, the evidence has remained inconclusive. Could addressing these infections improve not just oral health outcomes but also glycaemic control? This month, we explore the findings of a recent study that highlights the crucial connection between oral health and effective management of Type 2 Diabetes Mellitus.
Our Summary
TThis prospective cohort study sought to evaluate the outcomes of RCT in diabetic patients and its potential effects on glycated haemoglobin (HbA1c) levels. The research was conducted between 2016 and 2018 and involved patients who required non-emergency RCT.
Participants were divided into three groups:
- Patients without diabetes (control group)
- Diabetic patients with well-controlled blood sugar (HbA1c < 7%)
- Diabetic patients with poorly controlled blood sugar (HbA1c ≥ 7%)
The success of RCT was assessed 12 months after treatment using clinical criteria (an asymptomatic tooth without mobility) and radiological evaluation (periapical index ≤ 2).
Findings
The study revealed that diabetic patients with poorly controlled blood sugar levels were five times more likely to have persistent apical periodontitis after RCT compared to non-diabetic patients. This highlights the impact of hyperglycaemia on healing.
However, an interesting finding emerged: patients who underwent RCT experienced slight improvements in their blood sugar control. On average, diabetic participants showed a 0.62% reduction in HbA1c levels 12 months after treatment. This suggests a potential link between effective dental care and improved diabetes management.
Despite these promising observations, the study also noted less favourable outcomes in terms of lesion healing. For diabetic patients with poorly controlled blood sugar, radiographic evidence showed minimal reduction in lesion size.
While the study confirmed that diabetes, especially when poorly controlled, negatively affects the success of RCT, it also pointed to the potential benefits of treating dental infections for glycaemic control. These findings underscore the importance of oral health as part of an integrated approach to managing diabetes.
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Study Limitations
A limitation of the study was its duration. Since apical periodontitis healing can take over a year in some cases, a longer follow-up period could provide clearer insights into the full effects of RCT on diabetic patients.
About Dr. Jamal
Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.
Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.Dr. Jamal teaches on the Diploma in Orthodontics and Dentofacial Orthopaedics at the London Dental Institute.
Read More
Davidović B, Krunić J, Mladenović I, Stojanović N, Hannig M, Vitkov L. Effects of apical periodontitis treatment on hyperglycaemia in diabetes: A prospective cohort study. International Endodontic Journal. 2024 Apr 6.
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