The influence of type 2 diabetes on ectopic calcification within the dentine-pulp complex

To investigate the influence of Type 2 diabetes (T2D) on calcification within the dentine-pulp complex and examine the mRNA expression of mineralisation-associated genes in human dental pulp cells (hDPCs) cultured in a hyperglycaemic environment.

Extracted non-carious molar teeth were collected from patients with well-controlled T2D (n=10) and non-T2D (controls) (n=10). The pulp was histologically examined using special stains. Primary hDPC lines (n = 3) were established from non-T2D tissue explants and grown in media containing 5.5mM- (control), 12.5mM- (prediabetes) and 25mM- D-glucose (T2D) for 7, 14 and 21 days. A PrestoBlue assay assessed the hDPC metabolic response to hyperglycaemia. The expression of mineralisation-associated genes RUNX2, SPP1, SPARC, BGLAP, IBSP and DSPP were analysed using quantitative real-time polymerase chain reaction. Data analyses were performed using GraphPad Prism and one-way ANOVA at p < 0.05.

Diffuse amorphous calcifications and irregular predentine were consistently observed in T2D samples. Culturing hDPCs in 12.5 mM and 25 mM glucose significantly increased their metabolic activity. All genes were detected in hDPCs in the presence of hyperglycaemia over time. However, with the exception of RUNX2 which was initially downregulated in response to hyperglycaemia, all genes were expressed independent of glucose levels.

T2D is associated with pulp calcifications similar to other body sites. Diffuse fibro-dentine foci of calcifications resembled the appearance of an 'aged' pulp and the gene expression for markers of mineralisation was independent of glucose levels. Calcifications may form due to the effects of chronic inflammation and prolonged glucose exposure.