Impact of Type 2 Diabetes Mellitus on Apical Periodontitis Size, Endotoxin Levels, and Bacterial Load in Root Canals with Necrotic Pulp.

INTRODUCTION

This clinical study was conducted to describe the endodontic microbiological profile of teeth with apical periodontitis in patients with type 2 diabetes mellitus (T2DM), focusing on bacterial count and endotoxin levels found in primary infection, as well as the size of periapical lesions, determined by cone-beam computed tomography (CBCT) analysis.

METHODS

Thirty-four patients were selected and divided into 2 groups: 17 with T2DM and 17 nondiabetic controls. Anamnesis, clinical examinations, and radiographic evaluations were performed. Root canal samples were collected using sterile/pyrogen-free paper tips. Endotoxins were quantified using limulus amoebocyte lysate assay, and bacterial counts (colony forming units/mL) were determined using anaerobic culture techniques. The periapical status of the teeth was assessed using the CBCT periapical index. Data were analyzed using Pearson correlation, simple linear regression, t-tests, and Chi-square tests (P < .05).

RESULTS

A larger size of periapical lesions (CBCT periapical index ≥4) was observed in patients with T2DM (64.8%) compared to controls (17.7%) (P < .05). There was a significant increase in the number of bacteria by culture and endotoxin levels in diabetic patients. A positive correlation was found between elevated endotoxin levels and the diameter of periapical lesions (P < .05).

CONCLUSIONS

This study supports the hypothesis that T2DM is associated with a greater microbial load and higher endotoxin levels, contributing to more severe periapical bone destruction, which may negatively affect endodontic treatment outcomes in these patients.