Endodontic flare-ups and postoperative pain in diabetic versus non-diabetic patients: systematic review

Aim To evaluate systematically the incidence of flare-ups and the occurrence and severity of postoperative pain following nonsurgical root canal treatment in patients with and without diabetes mellitus.Methods PubMed, Scopus, Web of Science, Embase, and the Cochrane Library electronic database were searched using explicit keywords to identify clinical studies concerning flare up post endodontic treatment for diabetic versus nondiabetic patients. Observational cohort, case control, cross sectional studies or clinical trials whether randomized or non-randomized were included. The ROBINS-I tool was utilized to assess risk of bias for non-randomized trials.Results A total of nine studies were assessed using ROBINS-I. One study was classified as having low risk of bias, six as having moderate risk, and two as having serious risk. Total of 381 diabetic patients and 871 nondiabetic were assessed at different follow- up time toward a maximum of 4 years. A higher incidence of postoperative flare-ups and pain was reported among diabetic patients compared with non-diabetic individuals. The controlled diabetic had comparable post-operative pain to non-diabetic patients.Conclusions Diabetes mellitus may be associated with an increased risk of postoperative pain and endodontic flare-ups following root canal treatment, although findings across the included studies were inconsistent. Evidence regarding the influence of glycaemic control remains limited.