Sudden improvement of insulin sensitivity related to an endodontic treatment.
BACKGROUND
Inflammation contributes to the pathogenesis of diabetes. A reciprocal relationship exists between diabetes and chronic periodontitis. This report describes the effects of an acute focal dental inflammation and subsequent endodontic treatment on the required insulin dosage of a 70-year-old man who had moderately controlled diabetes.


METHODS
Following an exacerbation of a combined endodontic-periodontic (endo-perio) lesion of tooth #3, the patient noticed a sudden increase in his insulin demand. After 3 weeks, the required dosage was approximately 100% greater. In association with hyperglycemic incidents, he reported a prickling sensation in this tooth. The radiograph showed circular bone loss around the tooth.


RESULTS
Just 1 day after the root-canal preparation, the insulin need decreased to approximately 50% of that required prior to treatment. Subsequently, an incision and systemic antibiotics were necessary because of the formation of a periodontal abscess. The insulin demand remained low despite this complication. Forty days after endodontic treatment, the insulin dosage was at a level comparable to that taken 4 weeks before the root-canal preparation.


CONCLUSIONS
This clinical case revealed a highly relevant correlation between insulin resistance and a local dental inflammation. To avoid an increase in insulin resistance, it seems important to attend to radically non-vital teeth as well as any other dental inflammation in diabetic patients.
Institute of Sports Medicine, University of Leipzig, Leipzig Sachsen, Germany. A.Schulze@uni-leipzig.de
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Schulze
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Schönauer
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Busse
D000368:Aged; D017742:Dental Care for Chronically Ill; D003924:Diabetes Mellitus, Type 2; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D010485:Periapical Periodontitis / Q000150:complications* / Q000628:therapy; D012390:Root Canal Therapy