Diabetes and apical periodontitis: A comprehensive narrative overview of their interconnectedness

Abstract Diabetes mellitus (DM) represents a significant global health challenge, impacting millions worldwide. Apical periodontitis (AP), a prevalent dental condition, can be influenced by systemic factors such as DM. This narrative review aimed to explore the impact of DM on AP. A comprehensive literature search spanning from 1989 to 2024 was conducted to identify relevant studies examining the DM-AP association. The key findings from these studies were distilled and presented in a format tailored specifically for endodontists. The results identified shared immune system pathways between DM and AP, highlighting a strong association between the two conditions. AP is more prevalent in diabetic patients compared to healthy controls. The healing of periapical lesions following primary endodontic treatment is significantly slower in diabetic patients, making DM a risk factor for endodontic outcomes. Glycemic control in diabetic patients plays a significant role in the success of endodontic treatment. However, no causal association between AP and DM has been confirmed. In conclusion, a strong association between DM and AP, with AP being more prevalent and slower to heal in diabetic patients, highlighting the importance of glycemic control, although no causal link between AP and DM was confirmed.