Oral Manifestations of Endocrinal Disorders

8/13/2019 Oral Manifestations of Endocrinal Disorders

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Oral Manifestation of Pituitary Disorders

Patients with GH excess have a characteristic coarse

facial appearance because of the thick rubbery skin,

enlarged nose, and thick lips.


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They have macrognathia, disproportionate mandibular

growth manifesting as mandibular prognathism, and

generalized diastemata .


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They also have anterior open bite and malocclusion

because of the macrognathia and tooth migration.

Intraorally, excessive soft tissue growth usually

presents as macroglossia and hypertrophy of the

pharyngeal and laryngeal tissues, making the

patient susceptible to sleep apnea.


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Dental radiographs may demonstrate large pulp chambers

(taurodontism) and excessive deposition of cementum on the

roots (hypercementosis).


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Individuals with GH deficiency present with disproportionate

delayed growth of the skull and facial skeleton, giving them a

small facial appearance for their age.

Tooth formation and growth of the alveolar regions of the

jaws are abnormal and may be disproportionately smaller

than adjacent anatomic structures, leading to tooth crowding

and malocclusion.


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Eruption of primary and secondary dentition and

shedding of deciduous teeth are delayed.

Due to the dental anomalies and crowding, there is ahigh tendency for plaque accumulation, and

patients have difficulty maintaining good oral

hygiene. Therefore, these patients may be prone to

gingivitis and periodontal disease.


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Hyperadrenocorticism (Glucocorticoid Excess or Cushings Syndrome )

The primary orofacial feature of Cushings syndrome is a

round, moon face due to muscle wasting and accumulation

of fat.


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Surface capillaries in the face and other skin regions

become fragile, rendering them readily susceptible

to hematomas after mild trauma.

Long-standing Cushings syndrome produces

delayed growth and development, including skeletal

and dental structures.


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Many of the systemic findings of Cushings syndrome are

similar to those seen in patients on moderate- to high-dose

glucocorticoid therapy, and these patients are considered to beimmunosuppressed. Therefore, oral signs and symptoms of

immunosuppression can be seen, including oral candidiasis,

recurrent herpes labialis and herpes zoster infections, gingivaland periodontal diseases, and impaired wound healing.


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Hypoadrenocorticism(Glucocorticoid Deficiency or Addisons Disease)

The primary orofacial feature ofAddisonsdisease is unusual

skin pigmentation, most intensely over sun exposed areas.

The mucocutaneous junctions undergo increased

pigmentation, including the lips, but it can also occur on

intraoral mucosal surfaces such as the gingival margins,

buccal mucosa, palate, and lingual surface of the tongue


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The oral pigmentations appear as irregular spots that range

from pale brown to gray or black.

The treatment ofAddisonsdisease includes administration of

corticosteroids. This increases the risk of immunosuppression

with concomitant susceptibility to oral candidiasis, recurrentherpes labialis and herpes zoster infections, gingival and

periodontal diseases, and impaired wound healing.


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Hyperthyroidism-Hyperthyroidism can exacerbate the patients response to

dental pain and anxiety.

-Routine examination of the head and neck may disclose signs ofthyroid disease, including protrusion of the eyes, excesssweating, enlargement of the thyroid and difficulty inswallowing.

-Patients may have increased susceptibility to dental cariesand periodontal diseases.


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Hypothyroidism-In hypothyroidism, orofacial findings include facial

myxedema, enlarged tongue (macroglossia) and and a

hoarse voice.

- Compromised periodontal health, delayed tooth eruption,

delayed wound healing, Salivary gland enlargement, changes

in taste, and burning mouth symptoms have also been

reported.

Hashimotos thyroiditis has been associated with xerostomia

and impaired salivary output.


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Hypersecretion of female sex hormones commonly occurs in pregnancy:

Such as bilateral brown facial pigmentation (melasma),

which disappears after delivery of the newborn baby.

High levels of female sex hormones cause increased capillary

permeability, making them susceptible to gingivitis

(pregnancy gingivitis), gingival hyperplasia, and pyogenic

granuloma (pregnancy tumor). These factors may complicate preexisting periodontal

disease.


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Oral Manifestations of

Parathyroid Gland Disorders


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Hyperparathyroidism The primary clinical orofacial signs and symptoms of

hyperparathyroidism are reflections of the systemic effects

of hypercalcemia. Long-standing hypercalcemia causes

generalized osteoporosis, which is visible on dental

radiographs. Patients develop cortical resorption and

rarefactions, loss of trabeculation presenting as ground-

glassappearance.

Partial or total loss of lamina dura, lytic lesions, and

metastatic calcifications.


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Thinning and eventual loss of the cortical bone of the maxilla

and mandible may occur, especially on the lower border of

the mandible. Severe cases result in spontaneous mandibular

fracture

The lytic jaw lesions or brown tumors can increase in size,

causing the bony cortex to expand, ultimately becomingdestroyed. These tumors rarely expand into the periosteum

but can produce gingival swelling.


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Fully developed teeth are not affected except that they

appear more radiopaque.

Due to bony changes, the teeth become mobile, drift,

and cause malocclusion.

Increased periodontal pocketing, root resorption, and

dental pain.


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Hypoparathyroidism

In hypoparathyroidism, hypocalcemia produces increased

muscular and peripheral nerve irritability .Painful muscular

spasms affect oral and laryngeal muscles.

Despite low serum calcium levels, the maxilla and mandible

are abnormally dense, with well-calcified trabeculae.

If the hypoparathyroidism is part of an autoimmunepolyendocrinopathy syndrome, oral mucocutaneous

candidiasis may be present in an acute or chronic form.


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If hypoparathyroidism occurs when teeth are stilldeveloping, there will be abnormalities in the appearanceand eruption pattern. There may be enamel hypoplasia, andpoorly mineralized dentin.

Other dental findings include malformed teeth, anodontia,short blunt root apices, elongated pulp chambers (someoccluded by pulp stones, even in the primary dentition),impacted teeth, and mandibular exostoses.

If hypoparathyroidism occurs after dental development,there are no abnormalities seen in erupted teeth.


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Oral Manifestations of Endocrinal Disorders

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