Clinical Implications of Hormonal Imbalance in Ortho / Orthodontic Courses by Indian Dental Academy

Clinical Implications Of
Hormonal Imbalance
In
Orthodontics
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INTRODUTION
Cell function is controlled by 2 mechanisms :

1 Neural control : by spread of depolarization.

2 Endocrinal control : by release of physiologically active
substances called harmones.

Endocrine : derived from a Greek word which means I
separate within.
Endocrine glands : ductless gland which release
physiologically active substances called Hormones directly
into the bloodstream.

Hormones : is a greek word meaning I exite or arouse.
The word was introduced by Starling in 1905.

Definition : They are secretory products of ductless gland
released directly into the circulation in small ammounts in
response to a specific stimulus and on delivery in circulation
produces response on target cells and organs.

Classified as :
1 Steroids : Hydrophobic lipid soluble substances.
( eg; Adrenocortical hormones, Sex hormones.
2 Proteins and Polypeptides : water soluble and circulate unbound in
plasma.
( eg; Anterior and Posterior pituitary hormones,Hypothalamic hormone,Parathyroid
, Insulin ,Glucagon, Gastrin ,Secretin.
3 Amino-acid derivatives : eg; Epinehrine, Nor epinephrine, Thyroid
hormones.

Mechanism Of Hormone Action
Hormones interact with their target cells through specific
receptors which are large protein molecules with specific
binding sites.
They bring about their action by 2 means
- cAMP mediated activity.
- Transcription and Translation Effect
Endocrine Diseases
- Manifestations of endocrine diseases are extremely varied reflecting the protean
effects of harmone deficiency or excess.
- Most of the patients present with non-specific symptoms and duration of symptoms
is also variable.
- Apart from thyroid disease and diabetis mellitus endocrine diseases are very rare.
Thyroid Gland
Highly vascular, bilaterally lobed, U shaped, located on the
trachea below larynx and inferior to the thyroid cartilage.
Stimulates basal metabolism and controls general metabolism.
Controls bodily growth and development by complementing
pituitary.
Thyroid gland secretes 3 hormones
1 T3 (Tri-iodo-Thyronine 8micro gm%)
2 T4 ( Thyroxine 0.15 micro gm%)
3 Calcitonin
Functions of thyroid Hormones(T3,T4)
Calorigenic action : stimulates heat production by increasing oxygen
uptake in all the tissues.

Protein metabolism : has got both anabolic and catabolic effects, in
physiological doses the anabolic effects are superior.

CVS : mayocardial cells are under the influence of sympathetic
nerve and the receptors are beta receptors which increase in response
to thyroid hamones.

CNS : contributes in myelination in axons of cortical neurons,
branching and development of dentrites and vascular bed of brain.

Carbohydrte metabolism : has opposing effects on sugar level.

On Vitamins : necessary for conversion of beta carotene to
Vit A and of Vit A to retinene.

Lipid metabolism : increases number of LDL receptors and
thus promotes cholestrol metabolism.
Growth and development : promotes protein synthesis and also
causes increased release and action of Growth Hormone.
Functions of Calcitonin
On Bones : lowers osteoclastic activity due direct
action of harmone on the bone (increases alkaline
phosphatase synthesis from the osteoblasts).
Maintains calcium level of bones in pregnant women.

Regulation of thyroid hormone secretion
Negetive feed back.
Cold
Somatostatin inhibits thyroid secretion
Thyroid Gland
1 Hypothyroidism : A failure of thyrotropic function on the part
of pituitary or an atrophy or destruction of the thyroid gland leads to an
inability of the thyroid to produce sufficient hormone to meet the
requirements of the body.

- Primary = failure of thyroid gland.
- Secondary = failure of pituitary gland.
- Tertiary = failure of hypothalamus.

Thyroid Gland
(A) Congenital Hypothyroidism : affects bones of
cartilagenous and intramembranous origin.
- Length of cranial base is short.
- Retardation in normal rate of deposition of calcium in the bones
and in the development of tooth buds in the fetus.

(B) Childhood Hypothyroidism
depending on time of onset , duration and severity
- Cretinism ( after birth till 7 to 8 years of age)
- Juvenile Myxedema (from 7to 8 years till the puberty)
General features : ( if not treated after 6 months of age)
- General and sexual growth stunted.
- Mental growth also hampered (idiot child)
- Protruding tongue and saliva dribbling.
- BMR is low and skin is cold and of yellow
color.
Cranio-facial and \Dental features
- Patient has large head and face with infantile
facial expression.
- Delayed ossification of tooth buds.
- Disharmonies in erruption of teeth.
- Open bite tendencies present.
- Generalized crowding deficient maxilla.
- Osteoporosis might be present.

(B) Childhood Hypothyroidism
( C ) Myxedema : seen in adults
- Goitre ( because of increase in TSH secretion)
- Puffiness of face and periorbital swelling
- Loss of scalp hair
- Drooping of upper eyelid
- Dry, thickened and yellow skin.

(D) Hashimoto`s Thyroditis. (Autoimmune disease)
2 Hyperthyroidism : Rare in children
GENARAL FEATURES
- Increase in rate of maturation and metabolic rate, hot and
moist skin.
- Exophthalamic goitre.
- Weigt loss, sleeping tachycardia.
CRANIOFACIAL AND DENTAL FEATURES
- Premature eruption, disturbed root resorption , early
eruption of permanent tooth.
- Fragile bone
- Premature erruption of tooth .
- Osteoporosis.

Parathyroid Gland
Usually consists of 4 glandular bodies about 8mm long
embedded on the dorsal surface of the thyroid.
Maintains normal level of diffusible Ca and Ph in blood
plasma.
Important in metabolism plays leading role in calcification of
tooth.
Has little or no direct effect on growth or eruption.

Functions of Parathormone
It increases bone resorption by increasing the osteoclastic
acivity.
Helps to convert Vit D into its active form calcitriol.
It acts on renal tubules to increase calcium reabsorbtion.

REGULATION OF PTH SECRETION

- Higher serum calcium level inhibits PTH secretion.
- Higher calcitriol level inhibits PTH secretion.
- Plasma phosphates and magnesium level also affect the PTH
secretion.
Parathyroid Gland
Hypoparathyroidism
Blood calcium may fall to as low as 7mg/100ml.
Painful contraction of skeletal muscles on little provocation.
Affects eruption of permanent teeth and resorption of decidous teeth.
Morphology of teeth is adversely affected :
- enamel formation is defective , teeth have white appearance which
turns brown due to stains .
- shows opaque areas and easily fractures because of poor
calcification.
Parathyroid Gland
Hyperparathyroidism
- Increase in blood calcium level leading to decalcification of bone.
- Early distortion of trabecular pattern.
- Disappearance of lamina dura is seen , formation of dentin and
cementum is affected.
- Teeth may become loose because of cortical bone resorption.

Pituitary Gland
Small body in the base of the brain which rest in sella tursica of the
sphenoid bone.
Avg weight is 0.5 to 0.6 gm .
.
Function of this gland depends on intimate relationship with
hypothalamic division of the CNS.
Hormones secreted by major endocrine glands
Anterior pituitary
Growth hormone (GH)
Thyroid stimulating hormone (TSH)
Adrenocotricotropic hormone (ACTH)
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin
Posterior pituitary
Antidiuretic hormone (ADH)
Oxytocin
Functions of Pituitary hormones
Growth Hormone : all actions are IGF mediated.
- Stimulates production of proteins,
- Increases blood sugar level.
- Increases lipolysis and thus FFA in the blood plasma.
- Increase calcium absorbtion from GIT and in turn increases
bone formation.

Prolactin :
- Synthesis of milk in females.
- Opposes the action of pituitary gonadotrophins.
Thyroid stimulating hormone :
- Synthesis of T3 and T4 harmones.

FSH, LH :
In males :
- formation of spermatozoan.
- synthesis of testosterone from testis.
In females :
- help in estrogen synthesis.
- causes ovulation, formation and maintainance of corpus leuteum.
ACTH :
- Synthesis of adrenal hormones.

Pituitary Gland
Hypopituitarism
- Stunted growth beause of failure of
epiphyseal growth.

CRANIO FACIAL AND DENTAL FEATURES
- Deficiency in early childhood causes stunted
sphenoid bone especially spheno-occipital
suture, naso-orbital configuration
.(CRETINISM)
- The nose is short, root of nose is depressed
and the nasal bridge broad and flat.
- In Lorain type hypopituitarism teeth size
is small.
-

Hypopituitarism
- In Mongolism facial and cranial anomalies present, especially
underdevelopment in the anteroposterior dimension. There is a progressive
mandibular prognathism with a comparatively large tongue, cross bite and
open bite.
-
Hyperpituitarism :
An increase in number of granules in the
acidophilic cells or an adenoma of anterior
lobe of pituitary is associated with
hyperpituitarism.

- If the increase occurs before the
epiphyses of the long bones are
closed Gigantism results.

Gigantism is characterized by a general
symmetric over growth of the body,
attaining a height of over 8 feet.
Muscles are weak ( contractile elements of
muscles do not develop)
The teeth in gigantism are proportional to
the size of the jaws. The roots may be
longer than normal.

Hyperpituitarism :

If the increase occurs later in life, i.e. after epiphyseal closure, Acromegaly
develops.
- Mandible because of acclerated condylar growth becomes very large
resulting in a prognathic face.
- Lips become very thick and size of tongue is also enlarged showing
indentations

Thymus
At birth thymus weighs 10-12 gms , during childhood and
adolscence 20-30gms but during old age it weighs arround 3-
6gms.
With overgrowth of thymus, general bodily growth is accelerated.
Hypertrophy of the thymus may result in delayed eruption of the deciduous
teeth and poor tooth calcification.
The teeth may appear of bluish white color and of uneven size.
Adrenal Gland
They are 2 small yellowish masses above or near the
kidneys consisting of an outer layer(cortical) and an
inner layer (medulla).
Adrenal cortex
Mineralocorticoids
Glucocorticoids
Sex hormone
Adrenal medulla
Adrenaline
Noradrenaline
Dopamine

The hypofunction of adrenal gland has no as such effect on
jaw bone and teeth.
The adrenocortic hyperfunction brings about decrease in
bony matrix into which calcium is deposited when bone is
formed, interfering with bone formation.
Height age, bone age and tooth eruption are accelerated.

Hypothalamus
Makes up the 3
rd
ventricle of the brain, provides neurogenic control to
the pituitary gland which controls the target glands ie; thyroid,
adrenals, gonads.
Tumors of hypothalamus may cause sexual precocity , dental age also
increases. Alveodental prognathism is present , dentition otherwise is
normal. Gingivitis is present.
Conclusion
Recognition of endocrine dysfunction is of
considerable aid in determinig the method and
efficacy of treatment in various malocclusions.
An orthodontist who suspects an endocrine
dysfuntion must insist on obtaining a diagnosis
from qualified source.

Thank you

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