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Interrelationship Between Periapical Lesion and Systemic Metabolic Disorders

[ Vol. 22 , Issue. 15 ]


Hajime Sasaki, Kimito Hirai, Christine M. Martins, Hisako Furusho, Ricardo Battaglino and Koshi Hashimoto   Pages 2204 - 2215 ( 12 )


Background: Periapical periodontitis, also known as periapical lesion, is a common dental disease, along with periodontitis (gum disease). Periapical periodontitis is a chronic inflammatory disease, caused by endodontic infection, and its development is regulated by the host immune/inflammatory response. Metabolic disorders, which are largely dependent on life style such as eating habits, have been interpreted as a “metabolically-triggered” low-grade systemic inflammation and may interact with periapical periodontitis by triggering immune modulation. The host immune system is therefore considered the common fundamental mechanism of both disease conditions. Method: We have reviewed >200 articles to discuss the interrelationship between periapical lesions and metabolic disorders including type 2 diabetes mellitus, hypertension, and non-alcoholic fatty liver diseases (NAFLD), and their common pathological background in immunology/osteoimmunology and cytokine biology. Results: An elevated inflammatory state caused by metabolic disorders can impact the clinical outcome of periapical lesions and interfere with wound healing after endodontic treatment. Although additional well-designed clinical studies are needed, periapical lesions appear to affect insulin sensitivity and exacerbate non-alcoholic steatohepatitis. Conclusion: Immune regulatory cytokines produced by various cell types, including immune cells and adipose tissue, play an important role in this interrelationship.


Periapical lesion, metabolic disorders, type 2 diabetes, hypertension, NAFLD, cytokines, inflammation, and immunity.


Department of Immunology & Infectious Diseases, The Forsyth Institute, 245 First Street, Cambridge, MA 02494, U.S.A.

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