Background: Periapical periodontitis, also known as periapical lesion, is a common dental disease, along
with periodontitis (gum disease). Periapical periodontitis is a chronic inflammatory disease, caused by endodontic
infection, and its development is regulated by the host immune/inflammatory response. Metabolic disorders, which are largely dependent
on life style such as eating habits, have been interpreted as a “metabolically-triggered” low-grade systemic inflammation and may interact
with periapical periodontitis by triggering immune modulation. The host immune system is therefore considered the common fundamental
mechanism of both disease conditions. Method: We have reviewed >200 articles to discuss the interrelationship between periapical lesions
and metabolic disorders including type 2 diabetes mellitus, hypertension, and non-alcoholic fatty liver diseases (NAFLD), and their
common pathological background in immunology/osteoimmunology and cytokine biology. Results: An elevated inflammatory state
caused by metabolic disorders can impact the clinical outcome of periapical lesions and interfere with wound healing after endodontic
treatment. Although additional well-designed clinical studies are needed, periapical lesions appear to affect insulin sensitivity and exacerbate
non-alcoholic steatohepatitis. Conclusion: Immune regulatory cytokines produced by various cell types, including immune cells
and adipose tissue, play an important role in this interrelationship.
Keywords: Periapical lesion, metabolic disorders, type 2 diabetes, hypertension, NAFLD, cytokines, inflammation, and immunity.
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