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
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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 혈관 내벽의 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 당뇨 조절 하에서 치수 조직의 자극을 최소화하기 위한 세심한 처치가 필요하다.
Abstract
Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, ahormone that plays a vital role in controlling the blood glucose level (BGL). Type 1and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whether 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 histopath ologic 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 was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM 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 impaired 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 under control of BGL.
참고문헌 (44)
- "Diabetes. Newsweek, September 4, 2000", ~ (2000)
- Bender IB, "Diabetes and the dental pulp", J Endod, 29, pp.383~389 (2003)
- Soskolne WA, "The relationship between periodontal diseases and diabetes: an overview", Ann Periodontol, 91, pp.263~270 (2001)
- Mehmet I, "Dental lesions in adult diabetic patients", NY State Dent J, 73, pp.58~60 (2007)
- Mealey BL, "Impact of advances in diabetes care on dental treatment of the diabetic patient", Compend Contin Educ Dent, 19, pp.41~58 (1998)
- Campbell J, "Pancreatic islet ultrastructure, serum and pancreatic immunoreactive insulin in somatotrophic and mestasomatrophic diabetes in dogs", J Submicrosc Cytol, 13, pp.599~608 (1981)
- Yoon JW, "The role of viruses and environmental factors in the induction of diabetes", Curr Top Microbiol Immunol, 164, pp.95~123 (1990)
- Witko-Sarsat V, "Neutrophil -derived oxidants and proteinases as immuno-modulating mediators in inflammation", Med Inflamm, 3, pp.257~273 (1994)
- Schmid-Schonbein GW, "Viskoelastic deformation of white cells. Theory and analysis, in White cell mechanics: basic science and clinical aspects", pp.19~51 (1984), Alan R. Liss, Inc.
- Keith V, "Vasculature of the Dental pulp of atherosclerotic monkeys: Light and electron microscopic findings", J Endod, 20, pp.469~473 (1994)
- Vlassara H, "Recent progress in advanced glycation end products and diabetic complications", Diabetes, 46(2), pp.19~25 (1997)
- Cai H, "Endothelial dysfunction in cardiovascular disease. the role of oxidant stress", Circ Res, 87, pp.840~844 (2000)
- Sen CK, "Antixoidant and redox regulation of gene transcription", FASEB J, 10, pp.709~720 (1997)
- Matsubrara T, "Increased superoxide anion release from human endothelial cells in response to cytokines", J Immunol, 137, pp.3296~3298 (1986)
- Li PF, "Reactive oxygen species induce apoptosis of vascular smooth muscle cell", FEBS Lett, 404, pp.249~252 (1997)
- Griengling KK, "Angiotensin II stimulates NADH and NADPH oxidase activity in cultured vascular smooth muscle cells", Circ Res, 74, pp.1141~1148 (1994)
- Zalba G, "Vascular NADH", NADPH oxidase is involved in enhanced superoxide production in spontaneously hypertensive rats, 2000, pp.35, 1055~1061
- 김인주, "제 2형 당뇨병 모델 쥐에서 내피세포 의존성 혈관 이완 장애의 기전", Biowave, 6, pp.243~249 (2002), 혈관세포연구회
- Iijima R, "Novel biological function of sialic acid(N-acetylneuraminic acid) as a hydrogen peroxide scavenger", FEBS Lett, 561, pp.163~166 (2004)
- Iijima R, "Characterization of the reaction between sialic acid(N-acetylneuraminic acid) and hydrogen peroxide", Biol Pharm Bull, 30, pp.580~582 (2007)
- Russell B, "The dental pulp in diabetes mellitus", Acta Pathol Microbiol Scand, 70, pp.319~320 (1967)
- Bissada NF, "Histologic study of gingival and pulpal vascular changes in human diabetics", Egyp Dent J, 16, pp.283~296 (1970)
- Fouad AF, "Diabetes mellitus as a modulating factor of endodontic infections", J Dent Edu, 67, pp.459~467 (2003)
- Suchitra U, "In search of endodontic pathogens", Kathmandu Univ Med J, 4, pp.525~529 (2006)
- Robinson HBG, "Anochoretic effect in pulpitis", J Am Dent Assoc, 28, pp.268~ (1968)
- Orlando C, "Diabetes and its effects on dental pulp", J Oral Sci, 48, pp.195~199 (2006)
- Kawashima N., "Effect of NOS inhibitor on cytokine and COX2 expression in rat pulpitis", J Dent Res, 84, pp.762~767 (2005)
- Deguchi S, "Neutrophil-mediated damage to human periodontal ligament-derived fibroblasts: role of lipopolysaccharide", J Periodontal Res, 25, pp.293~299 (1990)
- Bhoola KD, "Bioregulation of kinins: kallikreins, kininogens, and kininases", Pharmacol Rev, 44, pp.1~80 (1992)
- Tiffany CW, "Bradykinin stimulates tumor necrosis factor and interleukin-1 released from macrophages", FEBS Lett, 247, pp.189~192 (1989)
- Bhoola KD, "Translocation of the neutrophil kinin moiety and changes in the regulation of kinin receptors in inflammation", Immunopharmacology, 33, pp.247~256 (1996)
- Weiss SJ, "Tissue destruction by neutrophils", N Eng J Med, 320, pp.365~376 (1989)
- Vlassara H, "Recent progress in advanced glycation end products and diabetic complications", Diabetes, 46, pp.19~25 (1997)
- Fouad AF, "PCR-based identification of bacteria in endodontic infections", J Clin Micro, 40, pp.1491~1501 (2002)
- 금기연, "감염 근관에서 중합효소연쇄반응법을 이용한 Eubacterium 균종의 동정", Restorative Dentistry and Endodontics, 28(3), pp.241~248 (2003), 대한치과보존학회
- Fouad AF, "Molecular characteristics of the presence of Eubacterium spp. and Streptococcus spp. in endodontic infections", Oral Microbiol Immunol, 28, pp.241~248 (2003)
- Sbordone L, "Periodontal status and selected cultivable anaerobic microflora of insulin-dependent juvenile diabetics", J Periodontol, 66, pp.452~461 (1995)
- Sbordone L, "Periodontal status and subgingival microbiota of insulin-dependent juvenile diabetics: a 3- year longitudinal study", J Periodontol, 69, pp.120~128 (1998)
- Ay S, "Assessment of mandibular bone mineral density in patients with Type 2 diabetes mellitus", Dentomaxillofac Radiol, 34, pp.327~331 (2005)
- Toshiaki K, "Periapical lesions in rats with streptozotocin- induced diabetes", J Endod, 22, pp.418~421 (1996)
- Iwama A, "The effect of high sugar intake on the development of periradicular lesions in rats with Type 2 diabetes", J Dent Res, 82, pp.322~325 (2003)
- Ward DT, "Functional, molecular, and biochemical characterization of streptozotocin-induced diabetes", J Am Soc Nephrol, 12, pp.779~790 (2001)
- Schneider L, "Diabetes and intestinal calcium absorption in rat", Am J Physiol, 223, pp.1319~1323 (1972)
- Soskolne WA, "The relationship between periodontal diseases and diabetes: an overview", Ann Periodontol, 91, pp.263~270 (2001)