Diabetes Mellitus And Inflammation: Proposed Hypothesis For Its Role In Odontogenesis

Diabetes mellitus (DM) is a multifactorial disease, where inflammation plays a primary role in the pathogenesis at molecular level. Sustained sterile chronic low grade inflammation present in DM patients throughout their body is termed "Metaflammation". Molecular studies reveal that these inflammatory cells undergo epigenetic changes and become an important etiological factor for diabetes mellitus, claiming DM to be one of the "Immunometabolic disorder". The metaflammation affects all the organs including kidney, neural cells, vascular cells, etc., at varying levels as indicated by sound literature sources. Its effect on odontogenic apparatus is not studied so far and from our previous studies and reviews, we hypothesize the following, 1) In DM, the inflammatory exudates are capable of causing hydropic degeneration within the tooth organ and the underlying ectomesenchyme, thereby affecting amelogenesis and dentin- pulp complex formation in varying degrees. 2) Also, they influence odontogenesis by causing vascular dysfunction and resulting alteration in growth factors cause hypomineralisation. 3) Hyperglycemia and oxidative stress in DM can directly create phenotypic alterations in dentition, both genetically and epigenetically, depending on the time and stage of tooth development.