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Eur .1 Oral Sci 1997: 105: S3I 556Printed in UK .Alt rigta.':
re.^crvaci
Copyrigtil C Eur J Oral Sci 1997
EUROPEAN JOURNAL OFOR.H.L SCIENCES
ISSN imi9-iS36
Dental maturity in children ofshort stature, with or
withoutgrowth hormone deficiency
Larisa Krekmanova,Jan Carlstedt-Duke,Mikael Bronnegard,Claude
Marcus, Eva Grondahl andThomas Modeer, Goran DahllofDepartments of
Pediatric Dentistry, Schoolof Dentistry, Pediatrics and
DiagnosticRadiology, Huddinge University Hospital,Karoiinsika
Institutet, Stookhoim, Sweden
Krekmanova L, Carlstedt-Duke J, Brimnegdrd M, Marcus C. Grimdahl
E,Modeer T, Dahllof G: Dental matutity in chikken of short stature,
with orwithout growth hormone deficiency. Eur J Oral Sei J997: 105:
551-556.e Eur J Oral Sci, i997
The aim of this investigation was to study dental maturity in
healthyprepubertal children of short stature {heighK - 2 SD), with
or without growthhormone jGH) deficiency, compared to healthy
controls. The GH-deficientgroup (GH level< 10,0 ng/\) included
29 children (11 female, 18 male) with amean age of 10,2 + 2,2
years. The GH non-deficient group consisted of 17children (5
female, 12 male) with a mean age of 8,5 + 2.1 years. All the
childrenwere evaluated for serum concentrations of IGF-l, alkaline
phosphatase(ALP), triiodthyronin (T3), thyroxine (T4),
thyroid-stimulating hormone(TSH), and fasting plasma insulin:
height and bone age were also recorded.Dental maturity was
determined from panoramic radiographs. The meandifference between
the dental and chronological ages was —0.67+: 0,89 years inthe
GH-deficient group compared to 0,23' +1.07 years in their controls:
in theGH non-deficient group the difference was —0.95 + 0,82 years
compared tocontrols 0,16+1.06 years in their controls. Compared to
chronological age.both bone and dental age were lower in the
GH-deficient and GH non-deficientgroups. It is concluded that
children of short stature, both GH-deficient andGH non-deficient,
exhibit a delayed dental age compared to their chronologicalage-
and sex-matched controls. A multiple stepwise regression analysis
showedthat the sittmg height and GH level were the only significant
factors associatedwith dental rnaturity.
Larisa Krekmanova, Department ofPediatric Dentistry, School of
Dentistry,Karoiinska Institutet, POB 4064, S-141 04Huddinge,
Sweden
Telefax: +46-8 7743395E-mail: Larisa,Krekmanovaeofa.ki,se
Key words: chiidren; dental maturity:growth hormone
deficiency
Aocepted for pyb!jcation August 1997
The growth hormone (GH) is the primary hormonethat stimulates
longitudinal bone growth (1), The.amount of secreted GH is
determined by 2 antagon-ists released from the hypothalamtis,
growth hor-mone-inhibiting hormone and growth hormonereleasing
hormone (2, 3), The release of GH isepisodical, with night and day
variations and secre-tion peaks predominantly at night-time. The
highestproduction of GH appears during puberty. In thepost-pubertal
period, an age-correlated decrease ofGH production is found (4,
5).
Growth is regulated by many hormones actingin concert. During
infancy and childhood, GH,insulin and thyroid hormone are of
majorimportance for growth and development, bothdirectly and via
insulin-like growth factor 1(IGF-l) (2), During puberty, the sex
hormones
also play a primary role in normal development(6),
The insufficient production of growth-promolinghormones, or the
lack of response by the targettissues can result in growth failure
and disturbancesin bone metabolism (7, 8), Subnormal GH secre-tion
is classified as either GH-deficiency orGH-insufficiency (2,
9),
Children with GH deficiency exhibit signs suchas short stature,
changes in orofacial development,and retarded dental maturity
(10-13). Most of thestudies on dental maturity in children
withGH-deficiency have been performed with smallgroups of
post-pubertal children with different med-ical diagnoses. The aim
of this investigation wastherefore to study dental maturity in
healthy prepu-bertal children of short stature with or
withoutGH-deficiency,
-
552 Kreknianova et al.
Patients and methods
This is the baseline investigation of a 2-year longit-udinal
study of dental maturity and craniofacialgrowth in children of
short stature (height
-
Dental maturity and growth hormone deficiency 5 5 3
Table I
Chronological age atid dental maturity scores (dental age) in
children of slwri stature with or u~ithoiit GH-defideney and
respectiveage- atid sex-matched controls: x= mean values, .sd =
statidard deviations
Methods for estimationof denta! maturity
chronological age (years)KATAJA et al. (15)LtUEQVIST &
LUNDBERG ( 1 6 )
GusTAVssoN & K O C H (17)
HA.WIKKO (18)
Short GH-deficient(n =
Si
10.29.49.08.98.9
29)
sd.
2.32.41.52.22.2
Controls{n--
x.
10.010.29.69.89.8
= 87)
sd.
2.2 n.s.2.4 n.s.2.0 n.s.2.3 n.s.2.3 n.s.
Short GH non-deficient(n =
8.57.88.67.47.3
• 1 7 )
sd j
2.12 71.52.62.6
Controls(n-
X,
8.88.99.48.48.4
= 51)
sd^
2.5 n.s.2.7 n.s.1.9 n.s.2.6 n.s.2.5 n.s.
Student MesL level of significance: n.s.^non significant.
Table 2
Comparison between dental malwiiy scores (denial age} and
chronological age in children of short stature nith or wiihout
GH-deJiciencyand respective age- and sex-matched eontrols; d=mean
difference between dental ages, and chronologiea! ages, sd=
standard deviations
Methods for estimationof denial maturity
KATAJA et al. (15)
LiLJEQVIST & L U N D B E R G ( 1 6 )
G u s T A V S S Q N .& K O C H ( 1 7 )
HA.AVIKKO 118)
ShorlGH-deficient
{/i = 29)
di sd.
-0.67 0.89-1.80 0.63-1.22 l.,08-1.40 0.92
Controls
di
0.23-0.87-O.,22-0.51
= 87)
sd.
1.07***1.20***1.14***0.95***
Short GHnon-deficient
(n=17)
d, sd.
-0 .95 0.82-1 .45 0.82-1.43 1.16-1.48 0.70
Controls(n =
d.
0.16-0 .70-0 .36-0.41
^51)
sd.,
1.06***0.98*1.07***1.06***
Contrast
/-value
0.6690.6160.1800.608
P
n.s.n.s.n.s.n.s.
Stodent /-test, level of significance: * = / '
-
5 5 4 Krekmanova et al.
The independent variables considered in the modelwere
chronological age, tooth length and width,weight, sitting height,
predicted adult height, max-imum peak GH during Arg-Ins test,
IGF-1, ALP.T3, T4, TSH, and RUS, i.e., bone age.
Statisticallysignificant correlations between dental age andsitting
height (P
-
Dental maturity and growth hormone deficiency 5 5 5
maturity according to K.\TAJA et al. (15) as thedependent
variable showed that the sitting heightand GH level were
significant variables enteringthe model. This finding indicates a
correlationbetween GH and dental maturity, which is inaccordance
with the concept that GH is the mainregulator of childhood and
adolescent growth (6).The fact that there were no significant
differencesin dental maturity between children of short staturewith
or without GH-deficiency and the suggestionthat GH level is
associated to dental maturity mayseem to be a paradox. However, the
definition ofGH deficiency at L E . WESTPHAL O. Growth hormone
treatmentof short stature. Ada Paediatr Scand (Suppli i989;
362;9-13.
7. ISAKSSON O. LiNDAHL A, NiLssOK A, IsGAARD .1. Mechanismof the
stimulator}' effect of growth hormone on longitudinalbone growth.
Endocr Rev 1987; 8; 426-438.
8. SHORE RM, CHESNEV R W . M.AZESS R B . ROSE PG. BARGMAN
GJ. Bone mineral status in growth hormone deficiency.J Pedtair
1980; %; 393-396.
9. ZADIK Z . CHATEW SA, RAITI S. KOWARSKI .\K. DO short
children secrete insufficietit growth hormone? Pediatrics1985;
76; 355-360.
10. CotlEN MM. Congenital, genetic, and endocrinologic
influ-ences on dental occlusion. Dent Clin North Am 1975;3;
499-514.
11. MYLLERNIAMI S, LEKKO H L , PERHEENTUPA .1. Dental matur-
ity in hypopituitarism, and denial response to
substitutiontreatment. Scand J Dent Res 1978: 86; 307-312.
12. ELELSCHER-PETERS .A, ZIEGLER S. Untersuchungen tjberZahn-,
Skelett- und Langenalter bei patienten mit hypophy-sarem
mmderwuchs. Drsch Zaimartzl Z 1983: 38: 776-784.
13. TAK.INO K . OGIUCHI H . HIZUKA N . SANGU Y . SHIZUME K.
Oro-maxillofacial development in patients with GH defi-ciency
and normal short stature. Endocrinol Japon 1986;33; 655-664.
14. T.̂ NNER JM. WHITEHOUSE RM. .''kssesment of skeletal
mat-uration and prediction of adult height (TW 2 method).London;
Academic Press 1975.
15. K.WAJA M, NYSTROM M , AINE L. Dental maturity standardsin
southern Finland. Proc Pimt Dem Soc 1989; 85: 187-197.
16. LiLiEQViST B, LuNDBERG M. Skeletal and tooth develop-ment.
Acta Radial 1971; II; 97-111.
17. GusTAVSSON G, KOCH G . Age estimation up to 16 years ofaae
hased on dental development. Odontol Rerr 1974;25: 297-306.
18. HAAVIKKO K. Tooth formation age estimated on a fewselected
teeth. A simple method for clinical use. Proc FinnDent Soc 1974:
70; 15-19.
19. H.JiGG U, MATSSON L. Dental maturity as an indicator
ofchronological age; the accuracy and precision of
threetnethods.^fu/' J Orthod 1985: 7; 25-34.
20. STAAF V, MoRNSTAD H, WEEANDER U . Age estimationbased on
toolh development; a test of reliability andvalidity. Seand J Dent
Res 1991; 99; 281-286.
21. MoRNSTAD H, REVENTLID M , TEIVENS A. The validity offour
methods for age determination by teeth in Swedishchildren: A
multicentre study. Sn-ed Detit J 1995; 19;121-130.
-
5 5 6 Krekmanova et al.
22. SPILIOTIS BE, AUGUST GP, HUNG W, SONIS W, MENDELSONW, BEREU
BB. Growth hormone neurosecretory dysfunc-tion: A treatable cause
of short stature. J Am Med Assoc1984; 251: 2223-2230.
23. BERCU BB, ScHULMAN D, ROOT AW, SPILIOTIS BE. Growthhormone
(GH) provocative testing frequently does notreflect endogenous GH
secretion, J Clin Endocritml Metab1986: 63: 3:^709-716,
24. LARON Z. PERTZEL.IN A, K.URP M . Pituitary dwarfistn
withhigh serum levels of growth hortnone. Isr J med .Sci 1968:4:
883-894.
25. S.4RNAT H, KAPLAN I, PERTZELAN A. L.4R0N Z. Comparisonof
dental findings in patients with isolated growth hormonedeficiency
treated with hviman growth hormone (hGH)and in untreated patients
with Laron-type dwarfism. OralSurg Oral Med Oral Pathol 1988: 66:
581-586.
26. ITO RK, ViG KWL, GARN SM. HOPWOOD NJ, Loos PJ,SPALDING P M .
DEPUTY BS, HOARD BC. The influence of
growth (rhGH) therapy on tooth formation in idiopathicshort
statured children. Am ,/ Orthod and Dento Orthoped1993; 103: 4:
358-364,
27. RANKE MB, LiNDBEtJG A. Growth hormone treatment ofidiopathic
short stature: analysis o{ fhe database fromKIGS, the Kabi
Pharmacia International Growth Study.Aeta Paedr (Suppl). 1994; 604:
18-23.
28. GENENTECH CoLLABOR.wtvE STUDY GROUP. Idiopathicshort
statuie: Results of a one-year controlled study ofhuman growth
hormone treatment. J Pediatr 1989: 115:713-719.
29. Kosovvicz JMD, RZYMSKI KMD. Abnormalities of
toothdevelopment in pituitary dwarfistn. Oral Surg 1977'. 44:6:
853-863.
30. RiCHEY KA, McN.AMARA JA, WiLLHOT JJ, GARN SM, LoosPJ. Arch
dimensional changes in children with idiopathicshort stature
treated with recombitiant gowth hormone: afive-year study. .Angle
Orthod 1995; 65: 4: 293-300.