Effect of Diabetes Mellitus on Each Phase of Tooth Extraction Socket Healing

Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia that occurs due to abnormalities in insulin secretion, insulin action, or both. The prevalence of DM in Indonesia in 2021 ranked 5th, with a prevalence of 19.5 million cases. 1 Tooth extraction is the act of removing the tooth from the socket, which involves bone and soft tissue in the oral cavity. The phases in the healing process after tooth extraction consist of: the coagulation and hemostasis phase; the inflammation phase; the proliferation phase; and the shaping and remodeling phase. DM affects each phase of wound healing so that the healing process is delayed. 2,3 To understand the mechanism of DM influence on each phase that plays a role in wound healing after tooth extraction, which is useful in helping to determine the target therapy. Hyperglycemic conditions in DM produce metabolic products through four pathways that can increase reactive oxygen species (ROS). Increased ROS causes endothelial dysfunction and affects the production of pro-inflammatory cytokines, so that the inflammatory process occurs more frequently and is prolonged. The proliferation phase is impaired because hyperglycemia increases apoptosis in fibroblasts and osteoblasts. In addition, it affects the RANKL/OPG ratio, which can interfere with the bone remodeling process after tooth extraction. Hyperglycemia-induced intracellular glucose metabolic products affect all stages of the inflammatory phase through various mechanisms.