Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction

Abstract

Diabetes mellitus is a common systematic chronic disease amongst dental patients. The elevated glucose microenvironment can prolong the healing of tooth extraction sockets. Therefore, the promotion of healing up tooth extraction sockets is of great clinical importance to the patients with diabetes mellitus. The current evidence indicates the mechanism of the recovery period of extraction sockets in hyperglycaemia conditions from physiological, inflammation, immune, endocrine and neural aspects. New advancements have been made in varied curative approaches and drugs in the management of wound healing of tooth extraction sockets in diabetes. However, most of the interventions are still in the stage of animal experiments, and whether it can be put into clinical application still needs further explorations. Specifically, our work showed topical administration of plasma-rich growth factor, advanced platelet-rich fibrin, leukocyte- and platelet-rich fibrin and hyaluronic acid as well as maxillary immediate complete denture is regarded as a promising approach for clinical management of diabetic patients requiring extractions. Overall, recent studies present a blueprint for new advances in novel and effective approaches for this worldwide health ailment and tooth extraction sockets healing.

Keywords: dental extraction sockets; diabetic; healing; insulin-dependent diabetic; tooth extraction.

Figure 1

Main processes of wound healing occurring in the socket after tooth extraction depicted as four time-related phases.

Figure 2

Factors responsible for the healing process of diabetic extraction sockets. Diabetes inhibits mitotic growth factor expression through epigenetic mechanisms; difficulty in wound healing after tooth extraction is associated with diminished osteogenic differentiation of mesenchymal stem cells, activation of matrix metalloproteinase-9, persistent imbalance of RANKL/OPG ratio, and reduced expression of neuropeptides. Hyperglycemia affects hormone receptor conversion as well as the formation of new blood vessels, and impaired angiogenesis not only hinders bone formation but also affects the rate of wound healing. Diabetic wounds are characterized by chronic inflammation due to high levels of reactive oxygen species, dysregulated M1/M2 macrophage polarization, and pro-inflammatory chemokines. High glucose levels have a negative impact on macrophage function, mainly in the form of dysregulated levels of cytokine secretion such as TNF-α, IL-6 and IL-1β, in addition to the inability of neutrophils to function in the inflammatory response phases of wound healing, migration, chemotaxis and adhesion. MicroRNAs also influence the different phases of diabetic wound healing.