Growth hormone deficiency: Its affect on teeth

I have a five-year-old son with growth hormone deficiency (GHD). I don't know if the GHD has contributed to his profound tooth decay. Our dentist has been unable to provide us with any insight. What can we do to prevent further problems?

Question:

Growth hormone, which stimulates cell division and bone growth, is secreted by the pituitary gland. Patients who have deficient secretions from the pituitary are said to have hypopituitarism. The incidence of this condition is about 1 in 10,000 people.

Symptoms of the disease may include fatigue, weakness, decreased appetite, headache, visual disturbances, low blood pressure, short stature, and slowed growth and sexual development in children.

Dental implications may include decreased facial and cranial base growth. An open bite (a gap between upper and lower teeth) may be apparent accompanied by delayed or incomplete tooth eruption and root formation. In addition to delayed dental development, the gingiva (gum tissue) may become overgrown, due to a lack of growth hormone releasing factor.

Sarnat et al. (1988) showed that growth hormone therapy did not accelerate dental age but it did assist bone growth. They also showed that the mandible (lower jaw) was smaller, hypodontia (missing teeth) was present in 30 percent of all patients in the study, and the width of the teeth appeared relatively small.

There is no indication in the literature I reviewed that growth hormone deficiency leads to increased cavities. In fact, one study suggests that the opposite is true (Sadeghi-Nejad et al. 1974).

At this point, treating your son's cavities and achieving a healthy oral condition should be the dental priority. To help achieve and maintain oral health, your son should brush his teeth at least twice daily and floss at least once per day.

You should be helping him with his oral hygiene efforts. Most children do not have the manual dexterity to brush and floss by themselves until after the age of seven years.

Disclosing tablets, which indicate any plaque left behind, may be helpful to maintain good oral hygiene. Topical fluoride rinses or gels will be helpful to strengthen his teeth and make them more resistant to cavities. More frequent professional dental cleanings, such as every three months instead of every six months, may also help.

References:

Sadeghi-Nejad et al., "Increased caries resistance in primary dentitions in children with growth hormone deficiency" Journal of Pediatrics 85 (5):644-648 (1974).

Krekmanova et al., "Dental maturity in children of short stature, with or without growth hormone deficiency" European Journal of Oral Sciences 105 (6)551-556 (1997).

Oikarinen et al., "Hereditary gingival fibromatosis associated with growth hormone deficiency" Br. J. Oral Maxillofacial Surg. 28(5):335-339 (1990).

Sarnat et al., "Comparison of dental findings in patients with isolated growth hormone deficiency treated with human growth HGH and in untreated patients with laron-type dwarfism" Oral Surg. Oral Med. Oral Pathol. 66(5):581-586 (1988).

Cameron et al., Handbook of Pediatric Dentistry, Mosby-Wolfe, London (1997).

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