Page 19 - GP spring 2023

Type 2 Diabetes Mellitus Influence on
Post-Extraction Socket Healing

Authors: Nirali Thakor, Boss Lin, Angela M. De Bartolo, DDS and Analia Veitz-Keenan, DDS

Type 2 Diabetes Overview Post-extraction socket healing is a compli- Results:
Diabetes can be characterized by the in- cated four-stage process involving the blood After an extensive search, we selected three
ability to regulate blood glucose due to ei- clot phase, the inflammation phase of gran- studies to answer the clinical question.
ther insulin deficiency or resistance. Poor ulation tissue formation, the proliferation
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glycemic control can contribute to compli- phase with woven bone formation, and the The first study, Do preoperative glyco-
cations such as cardiovascular disease, ne- modeling and remodeling phase; however, sylated hemoglobin (HbA1C) and random
phropathy, retinopathy, and neuropathy. In with uncontrolled diabetes, there can be mi- blood glucose levels (RBG) predict wound
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Type 2 diabetes, there is impaired insulin crovascular changes that may be exhibited. 7 healing complications following exodontia
secretion and insulin resistance in periph- in type 2 diabetes mellitus patients, con-
eral tissues, such as adipose, muscle, and Diabetes and Dental Implications ducted by Krishnan et al. 2020, examined
liver. The decrease in insulin secretion is Whenever a dentist needs to perform surgi- the HbA1c and RBG values in Type 2 dia-
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due to the gradual decline in pancreatic be- cal procedures, a dilemma exists about how a betic patients compared to nondiabetic pa-
ta-cell function and reduced beta-cell mass, patient’s diabetes may affect wound healing. tients. From the sample population, 80.5%
evident before the onset of Type 2 diabe- We experienced a case where the patient re- were treated with oral hypoglycemics,
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tes. In addition, increased hepatic glucose quired several dental extractions and possible while 14% were on a combination of oral
production, due to both impaired insulin dental implants to replace the missing teeth, hypoglycemics and insulin. 10
action on the liver and excessive glucagon and there was concern about wound healing.
secretion, plays an integral and significant Overall, this study highlighted that there
role in the pathogenesis of type 2 diabetes. As mentioned above, diabetes is known to was a slight but not statistically significant
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Diabetes can be diagnosed with having cause delayed wound healing, which can increase in the risk of infectious complica-
an HbA1c over 6.5% or a Glucose Toler- complicate surgical and dental procedures tions in type 2 DM patients.
ance Test value of over 200 mg/dL. Some such as extractions and the placement of
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notable symptoms of Type 2 DM can in- dental implants in our patient’s case. This The second study, Comparison of Ex-
clude increased urination, extreme fatigue, review aims to explore the association be- traction Socket Healing in Non-Diabetic,
weight gain, increased thirst, and delayed tween patients with Type 2 DM of varying Prediabetic, and Type 2 Diabetic Patients,
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wound healing. levels of control and the effect on post-ex- conducted by Gadicherla et al. 2020, ob-
traction socket healing. served socket size dimensions in pre-dia-
Diabetes and Wound healing - betic, non-diabetic, and diabetic patients.
Pathophysiology Methodology: This study observed a difference in the
Delayed wound healing is most commonly For this review, we primarily utilized mean socket size seven days post-oper-
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triggered by hyperglycemia. Hyperglyce- electronic databases such as PubMed, Co- atively among the three groups, being
mia may cause damage to the cellular im- chrane, and TripDatabase. significantly higher for diabetic patients
mune response, inflammatory cytokines, when compared to non-diabetics. Compli-
and microcirculation during the healing This search aimed to find articles address- cations like swelling and infection were
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process. In uncontrolled diabetic indi- ing whether Type 2 Diabetes Mellitus also exhibited more in the diabetic group
viduals, the basement membrane thickens, (DM) influences post-extraction socket compared to the other two groups. All pa-
which is caused by the accumulation of healing. Thirty-eight articles discussed di- tients in the diabetic group were on oral
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advanced glycation end products (AGE). abetes, dental extractions, and socket heal- hypoglycemics. Compared to the non-dia-
High levels of AGE can impair fibroblast ing. Of the thirty-eight articles, thirty-two betic group, the diabetic group had a larg-
proliferation and the possible apoptosis of exhibited results that were relevant to Type er socket size than the diabetic group, and
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cells necessary in wound healing. More- 2 DM and post-extraction socket healing the results were statistically significant (P
over, fibroblasts express enhanced levels of outcomes. The search was further refined value of 0.011). Among the complications,
pro-inflammatory cytokines IL-6, IL-8, and to include prognosis in the search engine. swelling and infectious complications
matrix metalloproteinase (MMP) in diabet- Three studies that were utilized for this re- were evident in the diabetic group when
ic gingival wounds, leading to persistent in- view were prospective observational stud- compared to the non-diabetic group. 11
flammation that reduces the overall healing ies that examined the relationship between
prognosis. In vitro studies showed that Type 2 DM and post-extraction wound
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more involvement of MMPs such as MMP- healing. The third study, The healing of dental ex-
2 and MMP-9 in diabetic mice wounds To appraise the prospective observational traction sockets in patients with Type 2 di-
had a similar prognosis to that of wounds studies, validated critical appraisal forms abetes on oral hypoglycemics, conducted
caused by ulcers and burns that were diffi- were used to assess the methodology and by Huang et al. 2013, compared the healing
cult to heal. MMP-9 from diabetic wounds quality of the articles and to highlight the of dental extraction sockets in patients that
promoted apoptosis and rendered wounds potential biases and limitations that may were diagnosed with Type 2 DM compared
unhealable in mice, and the infection of have been present. Each article was divid- to non-diabetics. From the sample popula-
wounds will increase the MMP-9 activity, ed into study type, intervention and control, tion, 222 type 2 diabetic patients were on
facilitating macrophage infiltration and di- main outcomes, key results, and overall ap- oral hypoglycemics. This study concluded
minishing wound healing prognosis. 8,9 praisal and quality. no statistical differences between delayed

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