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INDIAN DENTAL ACADEMY

Leader in continuing dental education


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I NDEX
1. INTRODUCTION
2. HORMONES
3. CLASSIFICATION AND MECHANISM
4. GROWTH HORMONES
5. THYROXINE HORMONE
6. PARATHYROID HORMONE
7. CALCITONIN
8. VITAMIN D 3
9. SEX STEROID
10. CORTICOSTEROID
11. PROSTAGLANDINS
12. BISPHOSPHONATES
13. VITAMINS
14. CONCLUSION
15. REFERENCES

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HORMONES IN RELATION
TO ORTHODONTICS
INTRODUCTION

Endocrine glands (Greek-I separate within)

secrets physiologically active substances

called HORMONES directly to blood

stream.

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Hormones in Greek means I excite
or arouse, was introduced by Starling
in 1905.
DEFINITION : Secretory product of
Endocrine glands released directly into
the circulation in small amount in
response to specific stimulus.On
delivery in circulation it produces response
on the target cells or organs.
HORMONES
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CLASSI FI CATI ON(on the basis of chemical nature)
1. STEROID TYPE

2. PROTIEN TYPE

3. DERIVATIVES OF TYROSINE

MECHANI SM
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GROWTH HORMONE (GH)
Protein hormone, secreted by acidophills
of anterior pitutary
Secretion is more during strenuous excercises
and deep sleep.
No specific target organ.
Anabolic harmone.
No direct action on bone but act thru
substance called STOMATOMADI N.

TWO TYPES:
1. Insulin like growth factor(IGF-1)
2. Insulin like growth factor(IGF-2)

GH carries almost all the metabolic activity with
IGF-1 .


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Normal concentration of GH ;
2 4 ng/ml in growing child
GH DEFI CI ENCY

Children with big skull with babyish face
Cephalometric studies :
Small size of ant. & post. Cranial base
Smaller mandibular dimensions
Small post. Facial height & mand.
height.

Study done on 13 pts. with pitutary deficiency,
Cephalometric finding were low as compared to normal

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HYPERSECRETI ON OF GH
1. GIGANTISM
2. ACROMEGALY


GIGANTISM

Occur during adolescence before
epiphysial closure.
Features:
Tall stature
Bilateral gynaecomastia
Large hand and feet
Associated features like:coarse hair,loss of libido,etc.


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A CEPHALOMETRIC STUDY

Done on two female pt. suffering from Gigantism.

FINDINGS:

Ant. facial height +3.5D to +6.85D

Post. facial height +3.75D to +4.95D

Post. cranial base was long

Ant. cranial base was normal

Face was broad with pronounced zygomatic
arches but relatively normal occlusion

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ACROMEGALY

Occur during adulthood after epiphyseal closure.
Usually a result of benign pitutary tumor.

Features :
Broad,thick nose
Thickening of the skin
Prominent brow
Coarsening of facial features
Prognathism : elongation and
widening of mandible (class 3 malocclution)
Serum level of IGF-1 was 10 times high.
Development of cross bite

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ELONGATION AND WIDENING OF MANDIBLE IN
ACROMEGALY
Mandibular growth in Acromegaly results from
appositional growth and hypertrophic changes
in the condylar cartilage.
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Study done by Chung Juhwang and Jung- yul cha

On orthodontic treatment with growth hormone
therapy in a 9 year old short stature child.
Conclusion at the end of the treatment :

1. High GH therapy affect growth of mand. more than the
growth of maxilla.
2. Amount and pattern of growth during high administration
are unpredictable.
3. High therapy rarely affect the dental maturity.

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THYROXI NE HORMONE (TH)
It has no specific target organ
Regulates the pace of metabolism thru interactions
with mitochondrial,nuclear & extra mitochondrial
processes.
Prenatal hypothyroidism
Development of bone & teeth are retarded
Later enamel defects in prenatally developed teeth are seen.
Some degree of mental retardation is seen.
After birth
Growth of cranium is retarded brachycephalic faces develop
Increased mental retardation.

TH important for synthesis of IGF-1
Reduced facial height seen in children hypothyroidism
of long duration.
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Orthodontic consideration
TH administration leads to :

Increased bone remodelling
Increased bone resorptive activity
Reduced bone density
This result in increased tooth
movement during ortho. treatment.
(study done by
Sherazi,Dehpour,Jafari)

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Study by Luis and Rita
TH treated animals have
less force induced
Root resorption.
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PARATHORMONE(PTH)
Polypeptide hormone,secreted by parathyroid glands.
It mobilizes calcium and phosphorous from bones
It increases serum calcium level, and decreases
serum phosphorous.

Study done by Anthony and Richard on rats:
50U in 0.5cc solution injected in distal aspect of left central incisor
of 6 rats.
After 5
th
day- appliance fitted(1 ounce force)
6
th
day animal sacrificed and maxilla removed and examined.

Lat. Incisor treated with PTH moved more than the right lat. Incisor

Result ; PTH enhance ortho. Tooth movement if applied locally.


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CALCI TONI N
Peptide hormone, secreted by intra follicular or C- cells
in the thyroid gland.also called Thyrocalcitonin.

It flows in bloodstream and attracts Ca to bone, thus reducing
Serum calcium
.
It reduces bone resorption by reducing the no. of osteoclasts.

It is used in the treatment of Hypercalcemia and Osteoporosis.

Ortho consideration

It inhibit tooth movement and consequently delays
orthodontic treatment .
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VI TAMI N D - 3
Vit. D3 with parathyroid and cacitonin hormone
regulates the amount of Ca and phosphorous in human body.

It promotes interstitial Ca and phosphorous absorption

Vit.D3 increases the bone mass and thus reduces fractures
in osteoporosis .

It can be assumed that they can inhibit tooth movement.
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SEX HORMONES
They are steroidal hormone.

At puberty, the increase in GH and IGF-1 production is
sex hormone dependent.

Promotes protein synthesis in the body.

They regulate normal bone metabolism
(after menopause- osteoporosis)


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Role of sex hormone in dental & craniofacial development
Study by Spiegel & Sather in children with disorder of puberty:
in extreme early or late maturing children dental development
was slightly deviation to early and late development.

Keller,Satherand Hayles reported delayed facial growth
in Hypogonadism .
Estrogen directly stimulates the bone forming activity of osteoblasts.
Androgens also inhibit bone resorption &also modulate
growth of muscle system.

In Athletes excess use of drugs may effect the length
and the results of orthodontic treatment.
(study done by Ascraft,Southard and Tolley)
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CORTI COSTEROI DS
HYPERGLUCOCORTICOIDISM leads to short stature
and developed bone maturation.

Very small amount may decrease growth rate.

Skeletal IGF-1 synthesis decreased by Cortisol.

Cortisol has inhibitory effect on bone collagen synthesis

Cortisone accelerate the tooth eruption.
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PROSTAGLANDI NS(PG)
They act by increasing number of osteoclasts and activating
already existing osteoclasts on application of mechanical stress.
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BI SPHOSPHONATES
Characterized by high affinity for calcified tissues.

They are potent blockers of bone resorption.

They are used in treatment of hypercalcaemia and osteoporosis and
metabolic diseases that involve bone resorption

They act by decreasing no. of osteoclast cells.

Study done by Adochi,Igarashi,Mitani & shinobar on topical
application of bisphosponates on tooth movements in rats.
they find that movement was inhibited by topical application.

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CONCLUSI ON
Most of the studies are done on squirrels, rats and monkeys
And not on human beings so very little is known about the
effect on facial growth and development.


Further research is required to understand better about
the role of endocrine in orthodontic treatment for ortho.
practitioners .

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VI TAMI NS
I NTRODUCTI ON
NUTRIENTS AND ITS FUNCTON

MACRONUTRIENTS

MICRONUTRIENTS
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HI STORY
1. Luvin & Pakelharing : cessation of growth and death of animals
had been prevented on addition of small amt. of milk to there diet.
.
2. Eijikman(1906) : deficiency due to rice polishing Beri-Beri

3. Hopkins(1906-1912): growth promote substances in milk.

4. Hippo crates : ox liver and honey for night blindness.

5. Cod liver oil used in Manchester for rickets
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DEFI NI TI ON
Organic compounds essential in small amounts for the
normal growth and nutrition of human body.

Integral part of co-enzymes and catalyze reactions

In absence of vit. Enzyme cannot effective and hence an
abnormal channel of development results.
CLASSI FI CATI ON
1. Fat soluble vit. A, D,and K

2. Water soluble vit. B , C
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ROLE OF VI TAMI NS I N GROWTH AND
DEVELOPMENT
Certain CRITICAL PERIOD exist during development of organ
characterized by HYPERPLASTIC AND HYPERTROPHIC GROWTH
PHASES.Any dietary deficiency during these phases may cause
irreversible changes like growth retardation & orofacial alteration in
humans like:

1. Cleft lip and Palate
2. Reduced dental arch dimensions with inadequate spaces
3. Insufficient dental eruption
4. Short root and interosseous rotation of per. Teeth
5. Shorter mandible in ant. And post. Direction
6. Reduction in ascending ramus
7. Dentoalveolar inclinations in the incisor region
8. Reduction in mesio distal dimension of 3
rd
molar.
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Vitamin A
On jaws :
Excess of vit A during critical
growth period markedly inhibit the
neural crest cell development and
upset the normal balance
b/w bone formation and
resorption CLEFT PALATE
Softening of cleft palate due to
decrease in calcium deposition


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On Peridontium :
Leads to keratinizing
metaplasia of epithelium
I ncreased susceptibility
to infection
Disturbances in bone
growth,shape and texture
On teeth :
Deficiency during matrix
formation and matrix calcification
leads to ENAMEL
HYPOPLASI A(atrophy of
ameloblasts) & hence increases
caries susceptibility.

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Vitamin D deficiency
On jaws :
Retarded jaw, teeth and condyle
development
Maxillary dysplasia
Facial sutures difficult to close lead
to openbite


On teeth :
Hypoplastic changes during matrix calcification
On Periodontium :
Osteoporosis of alveolar bone and cemental dysplasia
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Vitamin - C
Essential for dentin matrix formation
which take prior to enamel matrix formation.
Thereby deficiency of vit c
may lead to enamel hypoplasia
On Teeth :
On Peridontium :
Influence the metabolism of
collagen fibers thereby affect
Regeneration and Repair
It interfere with bone formation & remodelling
Its deficiency aggravates gingival response to plaque &
worsen edema,enlargement and bleeding .
Study by McCanlies et al

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VTAMI N B
Folic acid plays important role in formation
of R.B.C in the bone marrow.
Essential for utilisation of sugar,
amino acids and making of antibodies.
In pregnancy, it is needed for the division
of all body cells.Without this no growth
take place nor any healing.
Deficiency in foetus can cause death,
CLEFT LIP AND PALATE

Vit B12 :

Deficiency may cause sore mouth and glossitis
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Vitamin E
It prevents oxidation of Vit A

Needed for utilization of essential fatty acids

Deficiency cause anemia ,muscle degeneration and muscular
dystrophy

Important in wound healing and prevent scarring in burn surgery, etc

Deficiency in fetus may cause hydrocephaly,joined finger and toes
edema anemia and backward development.

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Guidelines for evaluation and assessment
of Nutritional status
R.D.A
Physical appearance
Clinical evaluation
Biochemical analysis
Anthropometrical data
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REFERENCES
Human physiology- A.k.Jain,2
nd
edition
Text book of physiology Guyton,10
th
edition
Essentials of medical physiology Sembulingum, 2
nd
edition
Textbook of oral pathology Shafer
Contemporary Orthodontics - Proffit
Articles:
1. Endocrine regulation of craniofacial growth
2. Ortho. Treatment with GH Chung jucha hwang jun yul
(Am J orthod dentofacial orthop.2004;126;118-26)
3. GH hormone receptors& IGF-1receptor Angle orthod.2001
4. Effect of TH on ortho tooth movementin rats Sharazi, Dehpour,
Jafari.- J clin Pediatr dent. 23(3);259-64,1999
5. Effects of corticosteroid on osteoporosis Ashcraft, southard, tolley
( Am J ortho. Dentofac. Orthop.1992; 102:310)
Abstracts :
1. Am J orthod vol55 no. 3 use of PTH to assist
ortho. tooth movement
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guided by:
Dr. Sandesh Pai
Dr. Madan
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