The Role of Autophagy in Angiogenesis and Oral Health: Implications for Periodontitis and Tissue Regeneration

The oral and maxillofacial regions are rich in vascular tissue, and the regeneration of dental pulp involves revascularization through in situ pulp. Angiogenesis plays a crucial role in the reconstruction of periodontal tissue and the alterations in the maxillofacial region. It is a vital physiological process during growth, tissue remodeling, and tissue repair. However, dysregulation of angiogenesis in the oral cavity can lead to the development and progression of oral submucous fibrosis (OSF), maxillofacial cancer metastasis, and other pathogenesis [114].

Several studies have demonstrated that autophagy is involved in the angiogenesis of periodontitis, skin wound healing, oral mucosa, and cancer in oral tissue. In particular, a previous study found a significant increase in HIF-1α and VEGF expression in gingival crevicular fluid and saliva of both chronic and aggressive forms of periodontitis [115]. The microenvironment of periodontitis also increases the autophagy level and angiogenin of PDLSCs [116]. Enhancing autophagy increased the tube formation ability of PDLSCs, while blocking autophagy decreased angiogenesis in PDLSCs. This could explain why periodontitis patients are more likely to experience gingival bleeding.