Restorative Dentistry and Endodontics

  • 제34권3호
  • /
  • Pages.169-176
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  • 2009
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  • 2234-7658(pISSN)
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  • 2234-7666(eISSN)
대한치과보존학회 (The Korean Academy of Conservative Dentistry)
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치수 치근단 병소의 전구 위험요인으로서의 제 2 형 당뇨의 역할에 관한 소고

THE ROLE OF TYPE 2 DIABETES AS A PREDISPOSING RISK FACTOR ON THE PULPO-PERIAPICAL PATHOGENESIS: REVIEW ARTICLE

  • 김진희 (치의학전문대학원 서울대학교) ;
  • 배광식 (치과보존과학교실 서울대학교) ;
  • 서덕규 (치과보존과학교실 연세대학교) ;
  • 홍성태 (치과보존과학교실 서울대학교) ;
  • 이윤 (치과보존과학교실 원광대학교) ;
  • 홍삼표 (구강병리학교실 서울대학교) ;
  • 금기연 (치과보존과학교실 서울대학교)
  • Kim, Jin-Hee (School of Dentistry, Seoul National University) ;
  • Bae, Kwang-Shik (Department of Conservative Dentistry, Seoul National University) ;
  • Seo, Deog-Gyu (Department of Conservative Dentistry, Yonsei University) ;
  • Hong, Sung-Tae (Department of Conservative Dentistry, Seoul National University) ;
  • Lee, Yoon (Department of Conservative Dentistry, Wonkwang University) ;
  • Hong, Sam-Pyo (Department of Oral Pathology, Seoul National University) ;
  • Kum, Kee-Yeon (Department of Conservative Dentistry, Seoul National University)
  • 발행 : 2009.05.31
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초록

당뇨(Diabetes Mellitus)란 혈당을 조절하는 인슐린의 분비나 기능에 장애를 야기하는 질환으로 인슐린 의존성 여부에 따라 제 1 형과 제 2 형으로 분류된다. 본 종설은 최근 증가 추세에 있는 제 2 형 당뇨가 치수 치근단 병소의 병인 과정에 전구 위험요인으로 작용할 수 있는지를 평가 하고자 문헌고찰을 통해 당뇨의 병인 과정에서 특징적으로 나타나는 혈관 합병증에 관해 알아보고, 부가적으로 제 2 형 당뇨 쥐 모델에서 인위적인 치수 감염 후 얻은 치근단 조직의 조직병리학적 분석을 시행하였다. 조직학적 관찰 결과 제 2 형 당뇨 쥐에서 대조군에 비해 치수 치근단 병소의 크기가 증가하였고, 치수 염증 반응도 심하게 나타난 것으로 보아 당뇨 자체가 숙주를 감염에 취약한 상태로 만드는 전구 위험요소로 작용하였음을 알 수 있었다. 이러한 이유로는 첫째, 당뇨 시 전반적으로 나타나는 혈관 내 죽상 침착(atheromatous deposits)에 의해 혈관내벽의 두께가 두꺼워져 미세 순환의 장애는 물론 탐식 세포의 기능 저하, 면역 세포의 혈류 이동이 차단되어 치수 감염 시 쉽게 치근단 병소로 이환될 가능성이 높고, 둘째 치수 혈관에서 특징인 측부 순환(collateral circulation)의 부재에 따른 살균성 다형핵 백혈구의 활동 억제를 포함한 미세 혈관계의 취약성으로 인해 치수 조직의 재생능이 저하되어 추가적인 감염원의 공격에 대한 방어 및 치유 저하를 더욱 심화시키기 때문인 것으로 사료된다. 따라서 제 2 형 당뇨 환자의 수복치료 시 치과의사는 당뇨조절 하에서 치수 조직의 자극을 최소화하기 위한 세심한 처치가 필요하다.

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type land 2 DM are most common form and the prevalence of the latter is recently increasing, The aim of this article was to assess whet her Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction w as larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 D M itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered, The function of polymorphonuclear leukocyte is also impair ed and the migration of immune cells is blocked, leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process, Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue un der control of BGL.

키워드

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피인용 문헌

  1. Pulp necrosis following luxated injury to teeth in a patient with uncontrolled type II diabetes mellitus: a case report vol.37, pp.1, 2012, https://doi.org/10.5395/rde.2012.37.1.61