The Impact of Diabetes Mellitus on Endodontic Treatment Outcomes: A Review

Diabetes mellitus (DM) is a long-lasting metabolic disorder defined by persistent hyperglycemia, negatively impacting endodontic outcomes.Hyperglycemia, when prolonged, creates advanced glycation end-products (AGE), resulting in microangiopathy and leading to impaired pulpal microcirculation, irreversible pulpitis, and pulpal necrosis.The diabetogenic immunomodulatory state likely accentuates pre-existing persistent periapical disease, also possibly delaying or interrupting healing, and augmenting apical periodontitis factors.Diabetes has chronic low-grade inflammation and an impaired neutrophil response.Factors that could negatively impact endodontic outcomes are factors such as microbial dysbiosis, host response, and impaired osseous healing.Medical management for the diabetic patient should include strict glycemic control, broad-spectrum intracanal antibiotics, minimally invasive chemomechanical debridement, and close postoperative monitoring.Understanding the biologic factors of the diabetes-endodontic interaction is the key to improved outcomes in this medically challenging population.