Clinical Implications of Hormonal Imbalance in Ortho / orthodontic courses by Indian dental academy

Clinical Implications OfClinical Implications OfHormonal ImbalanceHormonal Imbalance

In In OrthodonticsOrthodontics

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INTRODUTIONINTRODUTION

Cell function is controlled by 2 mechanisms :Cell function is controlled by 2 mechanisms :

1 Neural control : by spread of depolarization.1 Neural control : by spread of depolarization.

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


Endocrine : Endocrine : derived from a Greek word which means ‘I derived from a Greek word which means ‘I separate within’.separate within’.

Endocrine glands : Endocrine glands : ductless gland which release ductless gland which release physiologically active substances called physiologically active substances called Hormones Hormones directly directly into the bloodstream.into the bloodstream.


HormonesHormones : : is a greek word meaning ‘I exite or arouse’.is a greek word meaning ‘I exite or arouse’. The word was introduced by Starling in 1905.The word was introduced by Starling in 1905. Definition Definition : They are secretory products of ductless gland : They are secretory products of ductless gland

released directly into the circulation in small ammounts in released directly into the circulation in small ammounts in response to a specific stimulus and on delivery in circulation response to a specific stimulus and on delivery in circulation produces response on target cells and organs. produces response on target cells and organs.

Classified as :Classified as : 1 1 Steroids Steroids : Hydrophobic lipid soluble substances.: Hydrophobic lipid soluble substances. ( eg; Adrenocortical hormones, Sex hormones.( eg; Adrenocortical hormones, Sex hormones. 2 2 Proteins and PolypeptidesProteins and Polypeptides : water soluble and circulate unbound in : water soluble and circulate unbound in

plasma.plasma. ( eg; Anterior and Posterior pituitary hormones,Hypothalamic ( eg; Anterior and Posterior pituitary hormones,Hypothalamic

hormone,Parathyroid , Insulin ,Glucagon, Gastrin ,Secretin.hormone,Parathyroid , Insulin ,Glucagon, Gastrin ,Secretin. 3 3 Amino-acid derivativesAmino-acid derivatives : eg; Epinehrine, Nor epinephrine, Thyroid : eg; Epinehrine, Nor epinephrine, Thyroid

hormoneshormones. . www.indiandentalacademy.comwww.indiandentalacademy.com

Mechanism Of Hormone ActionMechanism Of Hormone Action Hormones interact with their target cells through specific Hormones interact with their target cells through specific

receptorsreceptors which are large protein molecules with specific which are large protein molecules with specific binding sites.binding sites.

They bring about their action by 2 meansThey bring about their action by 2 means - cAMP mediated activity.- cAMP mediated activity. - Transcription and Translation Effect - Transcription and Translation Effect


Endocrine DiseasesEndocrine Diseases- Manifestations of endocrine diseases are extremely varied reflecting the protean Manifestations of endocrine diseases are extremely varied reflecting the protean

effects of harmone deficiency or excess.effects of harmone deficiency or excess.- Most of the patients present with non-specific symptoms and duration of symptoms Most of the patients present with non-specific symptoms and duration of symptoms

is also variable.is also variable.- Apart from thyroid disease and diabetis mellitus endocrine diseases are very rare. Apart from thyroid disease and diabetis mellitus endocrine diseases are very rare.


Thyroid GlandThyroid Gland Highly vascular, bilaterally lobed, U shaped, located on the Highly vascular, bilaterally lobed, U shaped, located on the

trachea below larynx and inferior to the thyroid cartilage.trachea below larynx and inferior to the thyroid cartilage. Stimulates basal metabolism and controls general metabolism.Stimulates basal metabolism and controls general metabolism. Controls bodily growth and development by complementing Controls bodily growth and development by complementing

pituitary. pituitary. Thyroid gland secretes 3 hormonesThyroid gland secretes 3 hormones 1 T3 (Tri-iodo-Thyronine 81 T3 (Tri-iodo-Thyronine 8micro gm%)micro gm%) 2 T4 ( Thyroxine 0.15 micro gm%)2 T4 ( Thyroxine 0.15 micro gm%) 3 Calcitonin3 Calcitonin


Functions of thyroid Hormones(T3,T4)Functions of thyroid Hormones(T3,T4) Calorigenic action : stimulates heat production by increasing oxygen Calorigenic action : stimulates heat production by increasing oxygen

uptake in all the tissues.uptake in all the tissues.

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

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

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

Carbohydrte metabolism : has opposing effects on sugar level. Carbohydrte metabolism : has opposing effects on sugar level. www.indiandentalacademy.comwww.indiandentalacademy.com

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

Lipid metabolism : increases number of LDL receptors and Lipid metabolism : increases number of LDL receptors and thus promotes cholestrol metabolism.thus promotes cholestrol metabolism.

Growth and development : promotes protein synthesis and also Growth and development : promotes protein synthesis and also causes increased release and action of Growth Hormone.causes increased release and action of Growth Hormone.

Functions of CalcitoninFunctions of Calcitonin On Bones : lowers osteoclastic activity due direct On Bones : lowers osteoclastic activity due direct

action of harmone on the bone (increases alkaline action of harmone on the bone (increases alkaline phosphatase synthesis from the osteoblasts).phosphatase synthesis from the osteoblasts).

Maintains calcium level of bones in pregnant women.Maintains calcium level of bones in pregnant women.


Regulation of thyroid hormone secretionRegulation of thyroid hormone secretion

Negetive feed back.Negetive feed back. ColdCold Somatostatin inhibits thyroid secretionSomatostatin inhibits thyroid secretion


Thyroid GlandThyroid Gland

11 HypothyroidismHypothyroidism : : A failure of thyrotropic function on the part A failure of thyrotropic function on the part of pituitary or an atrophy or destruction of the thyroid gland leads to an 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 inability of the thyroid to produce sufficient hormone to meet the requirements of the body.requirements of the body.

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


Thyroid GlandThyroid Gland

(A) (A) Congenital HypothyroidismCongenital Hypothyroidism : affects bones of : affects bones of cartilagenous and intramembranous origin.cartilagenous and intramembranous origin.

- - Length of cranial base is short.Length of cranial base is short. - Retardation in normal rate of deposition of calcium in the bones - Retardation in normal rate of deposition of calcium in the bones

and in the development of tooth buds in the fetus.and in the development of tooth buds in the fetus.

(B) (B) Childhood HypothyroidismChildhood Hypothyroidism depending on time of onset , duration and severitydepending on time of onset , duration and severity - - Cretinism ( after birth till 7 to 8 years of age)Cretinism ( after birth till 7 to 8 years of age) - Juvenile Myxedema (from 7to 8 years till the puberty)- Juvenile Myxedema (from 7to 8 years till the puberty)


General features : ( if not treated after 6 months of age)General features : ( if not treated after 6 months of age)- General and sexual growth stunted.General and sexual growth stunted.- Mental growth also hampered (idiot child)Mental growth also hampered (idiot child)- Protruding tongue and saliva dribbling.Protruding tongue and saliva dribbling.- BMR is low and skin is cold and of yellow BMR is low and skin is cold and of yellow color.color.Cranio-facial and \Dental featuresCranio-facial and \Dental features- Patient has large head and face with infantile Patient has large head and face with infantile facial expression.facial expression.- Delayed ossification of tooth buds.Delayed ossification of tooth buds.- Disharmonies in erruption of teeth.Disharmonies in erruption of teeth.- Open bite tendencies present.Open bite tendencies present.- Generalized crowding deficient maxilla.Generalized crowding deficient maxilla.- Osteoporosis might be present.Osteoporosis might be present.

(B) Childhood Hypothyroidism(B) Childhood Hypothyroidism


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

(D) Hashimoto`s Thyroditis. (Autoimmune disease)(D) Hashimoto`s Thyroditis. (Autoimmune disease)


22 Hyperthyroidism : Hyperthyroidism : Rare in childrenRare in children GENARAL FEATURESGENARAL FEATURES - - Increase in rate of maturation and metabolic rate, hot and Increase in rate of maturation and metabolic rate, hot and

moist skin.moist skin. - Exophthalamic goitre.- Exophthalamic goitre. - Weigt loss, sleeping tachycardia.- Weigt loss, sleeping tachycardia. CRANIOFACIAL AND DENTAL FEATURESCRANIOFACIAL AND DENTAL FEATURES - Premature eruption, disturbed root resorption , early - Premature eruption, disturbed root resorption , early

eruption of permanent tooth.eruption of permanent tooth. - Fragile bone - Fragile bone - Premature erruption of tooth .- Premature erruption of tooth . - - Osteoporosis.Osteoporosis.


Parathyroid GlandParathyroid Gland Usually consists of 4 glandular bodies about 8mm long Usually consists of 4 glandular bodies about 8mm long

embedded on the dorsal surface of the thyroid.embedded on the dorsal surface of the thyroid. Maintains normal level of diffusible Ca and Ph in blood Maintains normal level of diffusible Ca and Ph in blood

plasma.plasma. Important in metabolism plays leading role in calcification of Important in metabolism plays leading role in calcification of

tooth.tooth. Has little or no direct effect on growth or eruption.Has little or no direct effect on growth or eruption.


Functions of ParathormoneFunctions of Parathormone

It increases bone resorption by increasing the osteoclastic It increases bone resorption by increasing the osteoclastic acivity.acivity.

Helps to convert Vit D into its active form Helps to convert Vit D into its active form calcitriol.calcitriol. It acts on renal tubules to increase calcium reabsorbtion.It acts on renal tubules to increase calcium reabsorbtion. REGULATION OF PTH SECRETION REGULATION OF PTH SECRETION

- Higher serum calcium level inhibits PTH secretion.Higher serum calcium level inhibits PTH secretion.- Higher Higher calcitriol calcitriol level inhibits PTH secretion. level inhibits PTH secretion.- Plasma phosphates and magnesium level also affect the PTH Plasma phosphates and magnesium level also affect the PTH

secretion. secretion.


Parathyroid GlandParathyroid Gland

Hypoparathyroidism Hypoparathyroidism Blood calcium may fall to as low as 7mg/100ml.Blood calcium may fall to as low as 7mg/100ml. Painful contraction of skeletal muscles on little provocation.Painful contraction of skeletal muscles on little provocation. Affects eruption of permanent teeth and resorption of decidous teeth.Affects eruption of permanent teeth and resorption of decidous teeth. Morphology of teeth is adversely affected :Morphology of teeth is adversely affected : - enamel formation is defective- enamel formation is defective , , teeth have white appearance which teeth have white appearance which

turns brown due to stains . turns brown due to stains . - shows opaque areas and easily fractures because of poor - shows opaque areas and easily fractures because of poor

calcification.calcification.


Parathyroid GlandParathyroid Gland HyperparathyroidismHyperparathyroidism - Increase in blood calcium level leading to decalcification of bone.- Increase in blood calcium level leading to decalcification of bone. - Early distortion of trabecular pattern.- Early distortion of trabecular pattern. - Disappearance of lamina dura is seen , formation of dentin and - Disappearance of lamina dura is seen , formation of dentin and

cementum is affected.cementum is affected. - Teeth may become loose because of cortical bone resorption.- Teeth may become loose because of cortical bone resorption.


Pituitary GlandPituitary Gland Small body in the base of the brain which rest in sella tursica of the Small body in the base of the brain which rest in sella tursica of the

sphenoid bone.sphenoid bone. Avg weight is 0.5 to 0.6 gm .Avg weight is 0.5 to 0.6 gm ... Function of this gland depends on intimate relationship with Function of this gland depends on intimate relationship with

hypothalamic division of the CNS.hypothalamic division of the CNS. Hormones secreted by major endocrine glandsHormones secreted by major endocrine glands Anterior pituitaryAnterior pituitary

Growth hormone (GH)Growth hormone (GH) Thyroid stimulating hormone (TSH)Thyroid stimulating hormone (TSH) Adrenocotricotropic hormone (ACTH)Adrenocotricotropic hormone (ACTH) Follicle stimulating hormone (FSH)Follicle stimulating hormone (FSH) Luteinizing hormone (LH)Luteinizing hormone (LH) ProlactinProlactin

Posterior pituitaryPosterior pituitary Antidiuretic hormone (ADH)Antidiuretic hormone (ADH) OxytocinOxytocin www.indiandentalacademy.comwww.indiandentalacademy.com

Functions of Pituitary hormonesFunctions of Pituitary hormones

Growth Hormone : all actions are IGF mediated.Growth Hormone : all actions are IGF mediated.- Stimulates production of proteins,- Stimulates production of proteins,- Increases blood sugar level.- Increases blood sugar level.- Increases lipolysis and thus FFA in the blood plasma.Increases lipolysis and thus FFA in the blood plasma.- Increase calcium absorbtion from GIT and in turn increases Increase calcium absorbtion from GIT and in turn increases

bone formation. bone formation.

Prolactin : Prolactin : - Synthesis of milk in females.Synthesis of milk in females.- Opposes the action of pituitary gonadotrophins.Opposes the action of pituitary gonadotrophins.


Thyroid stimulating hormone :Thyroid stimulating hormone :- Synthesis of T3 and T4 harmones.Synthesis of T3 and T4 harmones.

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


Pituitary GlandPituitary Gland

HypopituitarismHypopituitarism- - Stunted growth beause of failure of Stunted growth beause of failure of

epiphyseal growth.epiphyseal growth. CRANIO FACIAL AND DENTAL FEATURESCRANIO FACIAL AND DENTAL FEATURES- Deficiency in early childhood causes Deficiency in early childhood causes

stunted sphenoid bone especially spheno-stunted sphenoid bone especially spheno-occipital suture, naso-orbital configurationoccipital suture, naso-orbital configuration . .(CRETINISM)(CRETINISM)

- The nose is short, root of nose is depressed The nose is short, root of nose is depressed and the nasal bridge broad and flat.and the nasal bridge broad and flat.

- In Lorain type hypopituitarism – teeth size - In Lorain type hypopituitarism – teeth size is small.is small.


- -

HypopituitarismHypopituitarism- In Mongolism – facial and cranial anomalies present, especially - In Mongolism – facial and cranial anomalies present, especially

underdevelopment in the anteroposterior dimension. There is a progressive underdevelopment in the anteroposterior dimension. There is a progressive mandibular prognathism with a comparatively large tongue, cross bite and mandibular prognathism with a comparatively large tongue, cross bite and open bite.open bite.

--


Hyperpituitarism :Hyperpituitarism : An increase in number of granules in the An increase in number of granules in the

acidophilic cells or an adenoma of anterior acidophilic cells or an adenoma of anterior lobe of pituitary is associated with lobe of pituitary is associated with hyperpituitarism.hyperpituitarism.

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

Gigantism is characterized by a general Gigantism is characterized by a general symmetric over growth of the body, symmetric over growth of the body, attaining a height of over 8 feet.attaining a height of over 8 feet.

Muscles are weak ( contractile elements of Muscles are weak ( contractile elements of muscles do not develop)muscles do not develop)

The teeth in gigantism are proportional to The teeth in gigantism are proportional to the size of the jaws. The roots may be longer the size of the jaws. The roots may be longer than normalthan normal..


Hyperpituitarism : Hyperpituitarism :

If the increase occurs later in life, i.e. after epiphyseal closure, If the increase occurs later in life, i.e. after epiphyseal closure, AcromegalyAcromegaly develops.develops.

- Mandible because of acclerated condylar growth becomes very large - Mandible because of acclerated condylar growth becomes very large resulting in a prognathic face.resulting in a prognathic face.

- Lips become very thick and size of tongue is also enlarged showing - Lips become very thick and size of tongue is also enlarged showing indentationsindentations


ThymusThymus At birth thymus weighs 10-12 gms , during childhood and At birth thymus weighs 10-12 gms , during childhood and

adolscence 20-30gms but during old age it weighs arround 3-adolscence 20-30gms but during old age it weighs arround 3-6gms.6gms.

With overgrowth of thymus, general bodily growth is accelerated. With overgrowth of thymus, general bodily growth is accelerated. Hypertrophy of the thymus may result in delayed eruption of the deciduous Hypertrophy of the thymus may result in delayed eruption of the deciduous teeth and poor tooth calcification.teeth and poor tooth calcification.

The teeth may appear of bluish white color and of uneven size. The teeth may appear of bluish white color and of uneven size.


Adrenal GlandAdrenal Gland They are 2 small yellowish masses above or near the They are 2 small yellowish masses above or near the

kidneys consisting of an outer layer(cortical) and an kidneys consisting of an outer layer(cortical) and an inner layer (medulla).inner layer (medulla).

Adrenal cortexAdrenal cortex MineralocorticoidsMineralocorticoids GlucocorticoidsGlucocorticoids Sex hormoneSex hormone

Adrenal medullaAdrenal medulla AdrenalineAdrenaline NoradrenalineNoradrenaline DopamineDopamine


The The hypofunctionhypofunction of adrenal gland has no as such effect on of adrenal gland has no as such effect on jaw bone and teeth.jaw bone and teeth.

The adrenocortic The adrenocortic hyperfunction hyperfunction brings about decrease brings about decrease in bony matrix into which calcium is deposited when bone is in bony matrix into which calcium is deposited when bone is formed, interfering with bone formation. formed, interfering with bone formation.

Height age, bone age and tooth eruption are Height age, bone age and tooth eruption are accelerated.accelerated.


HypothalamusHypothalamus

Makes up the 3Makes up the 3rdrd ventricle of the brain, provides neurogenic control to ventricle of the brain, provides neurogenic control to the pituitary gland which controls the target glands ie; thyroid, the pituitary gland which controls the target glands ie; thyroid, adrenals, gonads.adrenals, gonads.

Tumors of hypothalamus may cause sexual precocity , dental age also Tumors of hypothalamus may cause sexual precocity , dental age also increases. Alveodental prognathism is present , dentition otherwise is increases. Alveodental prognathism is present , dentition otherwise is normal. Gingivitis is present. normal. Gingivitis is present.


ConclusionConclusion

Recognition of endocrine dysfunction is of Recognition of endocrine dysfunction is of considerable aid in determinig the considerable aid in determinig the method and efficacy of treatment in method and efficacy of treatment in various malocclusions.various malocclusions.

An orthodontist who suspects an An orthodontist who suspects an endocrine dysfuntion must insist on endocrine dysfuntion must insist on obtaining a diagnosis from qualified obtaining a diagnosis from qualified source.source.


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Clinical Implications of Hormonal Imbalance in Ortho / orthodontic courses by Indian dental academy

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