ENDOCRINE DISORDERS AND THEIR

EFFECTS IN ORTHODONTICS
JOURNAL CLUB PRESENTATION
Sunil Kumar Khare Rajendra Gupta, Amit Prakash
International Journal of Medical Dentistry, 2013;3(4);28-5

Guided by
Dr. A K Chandna
Dr. DK Agarwal Presented by
Dr. Preeti Bhattacharya Dr. Surabhi Saxena
Dr. Ankur Gupta JR1
Dr. Ravi Bhandari
Dr. Shivani Singh
 CONTENTS
• Introduction
• Growth hormone
– Dental development
– Deficiency
– Excess
• Insulin
– Orthodontic considerations
• Thyroxin hormones
• Sex- steroids
• Bisphosphonates
• Fluorides
• NSAIDs
• Conclusion
 INTRODUCTION

• The term ‘endocrine’ refers to ductless glands, they secrete

physiologically-active substances (hormones) directly into the
blood stream.
• Protein hormones and catecholamines act through intracellular
enzymes.
• Hormone which acts on a target cell- first messenger, it forms
the receptor-hormone complex, which in turn activates the
enzymes of the cell and causes formation of another substance,
called the second messenger or the intracellular hormonal
mediator, making the effects of the hormone to be manifested
inside the cells.
• Thyroid and steroid hormones act on the genes of the target
cells, hormones can enter the target cells and bind with the
receptor in either cytoplasm (steroid hormone) or nucleus
(thyroid hormone), forming the hormone receptor complex.
• This complex enters the nucleus and gets attached to
chromatin, the complex reacts with DNA, stimulates
transcription (i.e., formation of mRNA), then it enters the
cytoplasm, and directs the ribosomes to synthesize specific
proteins (translation).
• These proteins may be enzymes, structural proteins and
receptor proteins.
 GROWTH HORMONE

• Protein hormone, secreted by the acidophils of the anterior

pituitary gland.
• Secretory bursts occur especially at early hours of sleep and
throughout the night.
• No specific target organ.
• No direct action upon bones.
• Acts through a substance called somatomedin, stimulates the
liver to secrete somatomedin and is the main regulator of
childhood and adolescent growth.
• Undersized children secrete less GH.
• Pulse amplitude increased in growth spurt, with simultaneous
increase in plasma, often increasing to as high as 50ng/ml after
depletion of the body stores of proteins and carbohydrates
during prolonged starvation.
 DENTAL DEVELOPMENT

• Dental delay- less pronounced than height or bone delay.

• Harmoniously delayed- primary root resorption, secondary
tooth formation and eruptive movement display the same
degree of retardation.
• Influence on growth starts after 9 months of age, so that the
effect on the growth of primary teeth is very little known.
 GH DEFICIENCY

• Children show big skull with babyish face

• Intelligence is normal for their age.
• Cephalometric studies- small sizes of the anterior and
posterior cranial bases, smaller mandibular dimensions, small
posterior facial height, and small posterior mandibular height.
 GIGANTISM

• Cephalometric study.
• Anterior facial height- largest cephalometric dimension,
followed by posterior facial height.
• Acromegaly serum levels in these patients were very high, the
mean value being 10-fold higher than in normal adults.
• Mandibular growth is gradual and often noticed by the dentist
when crossbite has developed..
• Cartilaginous tissue gets larger.
• Ribs are thicker and the costochondral cartilage appears
hypertrophic.
• The hypertrophic articular cartilage and the growth of
chondrocytes in the articular cartilage may cause acromegalic
arthropathy.
• Mandibular growth in acromegaly results from both
appositional growth and hypertrophic changes in the condylar
cartilage.
 INSULIN

• Polypeptide hormone secreted by the beta cells of the

Langerhans islets of the pancreas.
• Non-obese man secretes approximately 50U/day, with a basal
plasma insulin concentration of 10-50 microns/ml, main
function is to maintain the blood glucose level.
• Deficiency- diabetes mellitus, excess- hypoglycemia.
• Diagnosed in 3-4% of the population treated in day-to-day
orthodontic practice.
 ORTHODONTIC CONSIDERATIONS

• No orthodontic treatment should be performed in a patient

with uncontrolled diabetes.
• A good oral hygiene is especially important with fixed
appliances.
• Daily rinses with fluoride-rich mouthwash- preventive
benefits.
• Candida infections should be well monitored.
• Diabetes related microangiopathy, resulting in unexplained
odontalgia, percussion sensitivity, pulpitis, or even loss of
vitality in sound teeth.
• Regularly check the vitality of the teeth involved.
• Advisable to apply light forces and not to overload the teeth
• Holtgrave and Donath- retarded osseous regeneration,
weakening of the periodontal fibers and microangiopathies in
the gingival areas.
• In adults, the orthodontist should obtain a full-mouth
(periodontal) examination and evaluation of the need for
periodontal treatment.
• The periodontal condition should be improved before starting
the treatment and should be monitored regularly.
• Type2 patients more stable than type1, as hypoglycaemic
reactions are more frequent in these patients.
• For a long treatment session, advised to eat a usual meal and
take the medication as usual.
• The orthodontist should confirm the meal and medication, to
avoid a hypoglycaemic reaction in the office.
• Patients with good metabolic control, without local factors, a
good oral hygiene, can be treated orthodontically.
 THYROXIN HORMONES

• Lack in a specific target organ may affect every organ and

system and every biologic process.
• Common, and affect craniofacial and dental structures.
• Growth retardation in hypothyroidism, and reduced facial
height in children with prolonged untreated hypothyroidism.
• Thyroxin administration- increased bone remodeling,
increased bone resorptive activity and reduced bone density.
 PARATHORMONE

• Polypeptide hormone secreted by the parathyroid glands,

which increases serum calcium by releasing calcium from the
bone.
• May enhance orthodontic tooth movement by the local use of
PTH.
 CALCITONIN

• Peptide hormone secreted by the interfollicular or C-cells in

the thyroid gland, also called thyrocalcitonin.
• Flows into the bloodstream and attracts calcium to the bone,
thus reducing serum calcium.
• Also inhibits bone resorption by reducing the number of
osteoclasts.
• Used in the treatment of hypercalcemia and in osteoporosis.
• Considered as inhibiting tooth movement, a delay in the
orthodontic treatment can be expected
 VITAMIN D3

• Vitamin-D and its most active metabolite, vitamin-D3,

together with parathyroid hormone and calcitonin, regulate the
amount of calcium and phosphorus.
• Promotes intestinal Ca+2 and PO4 -3 absorption.
• Increases bone mass and thus reduce fractures in osteoporosis
patients.
• It inhibits tooth movement
 SEX-STEROIDS

• A slight increase in the growth rate is seen at the age of 6-8

years in most children, which is stimulated by adrenal
androgens.
• During puberty, an increase in GH production is seen.
• Several evidences indicate that this increase is sex-steroid
dependent.
• Estrogen directly stimulates the bone-forming activity of
osteoblasts, slower rate of orthodontic tooth movement.
• Androgens also inhibit bone resorption and modulate the
growth of the muscular system.
• The excessive use of these drugs by athletes, may affect the
duration and results of the orthodontic treatment.
 CORTICOSTEROIDS

• Hyperglucocorticoidism- short stature and bone maturation,

increasing relative weight.
• Very small amounts of medication can decrease the growth
rate.
• Skeletal IGF-I synthesis is decreased by cortisol, which has an
inhibitory effect on bone collagen synthesis.
• In the process of tooth eruption, however, cortisone has a
special effect, the eruption rate being accelerated
 PROSTAGLANDINS

• The precursor of PGs is the arachidonic acid, which is

metabolized by cyclo-oxygenase (cox) enzymes.
• PGs may act as important mediators of mechanical stress
during orthodontic tooth movement, they stimulate bone
resorption by increasing the number of osteoclasts and by
activating the already existing osteoclasts
 LEUKOTRIENES

• Exist metabolites of the arachidonic acid, produced when

metabolized by the lipoxygenase enzyme. Leukotrienes may
be also important mediators of orthodontic tooth movement.
• A study of Mohammed, Takikis and Dziak devoted to the role
of inhibitors of leukotrienes synthesis in orthodontic tooth
movement showed a significant reduction of orthodontic tooth
movement.
• Leukotrienes and PGs can cause enhanced tooth movements
 BISPHOSPHONATES

• Characterized by high affinity for calcified tissues.

• Potent blockers of bone resorption, successfully used in the
treatment of hypercalcemia, osteoporosis and, in the treatment
of metabolic bone diseases involving increased bone
resorption.
• Inhibition of the osteoclastic metabolism is caused by a
decrease in the number of osteoclasts, which may recommend
it for anchoring and retaining teeth under orthodontic
treatment.
 FLUORIDE

• One of the several trace elements that affect hard tissue

metabolism.
• Stimulates the growth and synthesis activity of osteoblasts and
bone formation, increases bone mass and mineral density.
• Even a very active preventive caries treatment with sodium
fluoride (NaF) during orthodontic tooth movement can affect
the duration of orthodontic therapy.
 NSAIDs

• Inhibit the cox activity.

• Salicylates’ action can be attributed to their inhibition of PG
synthesis.
• It is not recommended to patients undergoing orthodontic
treatment to take salicylates for long periods, as this might
possibly prolong the treatment
 CONCLUSIONS

• Most of the studies on hormones have been done on rats,

squirrels and monkeys and not on human beings;
consequently, very little is still known on the effects of
hormones on the development of face and craniofacial skeletal
and on the rate of orthodontic tooth movement in humans. The
role of endocrine disorders in orthodontics is still a great
mystery for an orthodontic practitioner and further research is
required to understand it better.
THANK YOU