Online first

Influence of growth hormone therapy on selected dental and skeletal system parameters

Maria Klatka 4  
Department of Orthodontics. Medical University, Lublin, Poland
Department of Conservative Dentistry and Endodontics. Medical University, Lublin, Poland
Department of Orthodontics. Medical University, Kiev, Ukraine
Department of Paediatric Endocrinology and Diabetology. Medical University, Lublin, Poland.
Growth hormone deficiency (GHD) is one of the main indications for growth hormone therapy. One characteristic of this disease is bone age delay in relation to the chronological age. Pituitary dysfunction negatively affects the growth and development of the jaws and teeth of the child. The secretion of endocrine glands regulates growth, development, and gender differentiation. It also controls the growth of bones and teeth, regulates metabolism of calcium and phosphate, proteins, lipids and carbohydrates. The primary role in the endocrine system is played by the pituitary gland which is responsible for the production of somatotropin [1]. Dysfunction of the pituitary gland has a negative effect on the growth and development of long bones in the body, and may have an adverse effect on the development of maxilla, mandible and dentition of a child. There is some information in the literature that dental age is delayed in short stature children; the replacement of deciduous teeth by permanent teeth is also delayed, and newly erupted permanent teeth often require orthodontic treatment. Applying hormonal therapy positively affects the process of replacement of dentition [2, 3, 4, 5, 6].

The aim of the study was to assess bone and dental age, as well as analyze the state of dentition in children diagnosed with GH deficiency treated with growth hormone, depending on the duration of treatment.

Material and Methods:
The study material consisted of 110 children (27 males, 83 females), hospitalized for somatotropin hypopituitarism in the Department of Paediatric Endocrinology and Diabetology at the Medical University of Lublin, Poland. The mean birth age was 13 years (156 months) with a standard deviation of 2 years and 6 months (30 months). 47 children (43%) started treatment with the growth hormone (group starting treatment) and 63 children (57%) whose treatment was started 2–3 years previously (group in the course of treatment). The control group consisted of 41 generally healthy children (15males, 25 females) with ENT problems, such as hypoacusis and a condition after nasal injury, hospitalized in the Department of Paediatric Otolaryngology at the Medical University of Lublin, Poland. The mean age was 11 years and 5 months (137 months) with standard deviation of 2 years and 5 months (29 months). Informed consent was obtained from the parents. The study was approved by the Bioethical Committee at the Medical University of Lublin (Resolution No. KE-0254 /216 /2012).

Maria Klatka   
Department of Paediatric Endocrinology and Diabetology. Medical University, Lublin, Poland.
1. Maria G Vogiatzi, Kenneth C Copeland. Niskie dziecko. Pediatrics In Review. 1998; 2/4: 4–11.
2. Kjellberg H,Beiring M, Wikland K. Craniofacial morphology, dental occlusion, tooth eruption and dental maturity in boys of short stature with or without growth hormone deficiency. Eur J Oral Sci. 2000; 108: 359–367.
3. Cantu G, Buschang PH, Gonzalez JL. Differential growth and maturation in idiopathic growth-hormone-deficient children. Eur J Orthod. 1997; 19: 131–139.
4. Ito RK, Vig KWL, Garn SM, Hopwood NJ, Loos PJ, Spalding PM, et al. The influence of growth hormone therapy on tooth formation in idiopathic short statured children. Am J Orthod Dentofac Orthop. 1993; 103: 358–364.
5. Krekmanova L, Carlstedt-Duke J, Bronnegard M, Marcus C, Grondahl E, Modeer T, et al. Dental maturity in children of short stature with or without growth hormone deficiency. Eur J Oral Sci. 1997; 105: 551–556.
6. Garn SM, Lewis AB, Blizzard RM. Endocrine factors in dental development. J Dent Res 196; 44: 243- 248.
7. Romer T. Zaburzenia wzrastania i dojrzewania płciowego. Medical Tribune Polska, Warszawa 2011.
8. Kiworkowa-Rączkowska E, Różyło-Kalinowska. Value of clinical and radiological evaluation of dentalage. Ace of Dentistry 2006; 4(1): 15–19.
9. Łabiszewska-Jaruzelska F. Ortopedia Szczękowa. Zasady i praktyka. PZWL 1995. p. 24.
10. Melkowska M. Symptoms of endocrine diseases in dental patients. Dent Med Probl. 2011; 48(2): 229–235.
11. Wites M, Kalukin J, Niżankowska-Jędrzejczyk A, Loster BW. Prediction of the growth spurt based on panoramic radiograhps. J Stomatol. 2011; 64: 875–886.
12. Flores-Mir, Mauricio FR, Orellana MF, Major PW. Association between growth stunting with dental age development and skeletal maturation stage. Angle Orthod. 2005; 75: 935–940.
13. Różyło-Kalinowska I, Kolasa-Rączka A, Kalinowski P. Relationship between dental age according to Demirjian and cervical vertebrae maturity in polish children. Eur J Orthod. 2011; 33: 75–83.
14. Proffit WR, Almeida MA, Lee PCF. What controls the daily rhythm of tooth eruption? In: Davidovitch Z. Biological mechanisms of tooth eruption, resorption & replacement by implant. Birmingham, AL:EBSCO Media; 1994. p. 335–370.
15. Risinger RK, Proffit WP. Continuous overnight observation of human premolar eruption. 1996; 41: 779–789.
16. Li H, Bartold PM, Zhang CZ. Growth hormone and Insulin-like growth factor I induce bone morphogenetic 2 and 4: A mediator role in tooth and bone formation. Endocrinology 1998; 139: 3855.
17. Smid JR, Rowland JE, Young WG, Coschigano KT, Kopchick JJ, Waters M. Mouse molar dentin size, shape in dependent on growth hormone status. J Dent Res. 2007; 86(5): 463–468.
18. Kostecka L, Wąsikowa R. Retrospektywna kompleksowa ocena efektów leczenia dzieci z somatotropinową niedoczynnością przysadki. Endokrynologia, Diabetologia i Choroby Przemiany Materii Wieku Rozwojowego 2005; 11: 161–169.
19. Kędzia A, Korman E, Obara-Moszyńska M, Rabska-Pietrzak B. Efekt leczenia hormonem wzrostu pacjentów z niedoczynnością somatotropinową w wieku dojrzewania. Endokrynologia Polska 2005; 56: 3246–251.
20. Hilczer M. Ocena czynników prognostycznych skuteczności leczenia hormonem wzrostu u dzieci z somatotropinowa niedoczynnością przysadki. Clin Exp Med Lett. 2006; 47: 7–44.
21. Korpal-Szczyrska M, Dorant B, Kamińska H. Ocena wzrostu końcowego pacjentów z somatotropinową niedoczynnościa przysadki leczonych hormonem wzrostu. Endokrynologia, Diabetologia i Choroby Przemiany Materii Wieku Rozwojowego 2006; 1: 31–34.
22. Schonau E, Westermann F, Bauch F. A new and accurate prediction model for growth response to growth hormone treatment in children with growth hormone deficiency. Eur J Endocrinol. 2001; 144: 13–20.
23. Kawala B, Matthews-Brzozowska T, Bieniasz J, Noczyńska A. Dental and skeletal age in children with growth hormone deficiency treated with growth hormone – preliminiary report. Pediatric Endocrinology, Diabetes and Metabolism 2007; 13(4): 210–212.
24. Kawala B, Łopott M, Kubasiewicz P. Wpływ terapii hormonem wzrostu na wybrane parametry zębowe i cefalometryczne. Stom Wsp. 2006; 2: 18–22.
25. Edler RJ. Dental and skeletal ages in hypopituitary patients. J Dent Res. 1977; 56: 1145.
26. Bevis RR, Hayles AB, Isaacson RJ. Facial growth response to human growth hormone in hypopituitary dwarfs. Angle Orth. 1977; 47: 193.
27. Van Erum R, Mulier G, Carels C. Craniofacial growth and dental maturation in short children born small for gestational age: effect of growth hormone treatment. Horm Res. 1998; 50: 141.
28. Cruz-Landelra A, Linares-Agrote J, Martinez-Rodriguez M, Sol Rodriguez-Calvo M, Otero X, Conchelo l: Dental age estimation in Spanish and Venezuelan children. Comparison of Demirjian and chail-let’s scores. int. J legal Med. 2010; 124: 105–112.
29. Chaillet N, Nyström M, Demirjian D. Comparison of dental maturity in children of different ethnic origins: international maturity curves for clinicians. J Forensic Sci. 2005; 50: 1164–1174.
30. Al-Tuwirqi A, Holcombe T, Seow WK. A study of dental development in caucasian population compared with a non-caucasian population. Eur Arch Paediatr Dent. 2011; 12: 26–30.
31. Różyło-Kalinowska I, Kiworkowa-Rączkowska, Kalinowski P. Dental age in central Poland. Forensic Sci Int. 2008; 174: 207–216.
32. Zatylna N, Rogowska K, Kozanecka A. Porównanie wieku zębowego dziewcząt i chłopców w wieku 6–12 lat z zastosowaniem metody Demirjiana. Dent Med Probl. 2013; 50(1): 64–70.
33. Maber M, Liversidge HM, Hector MP. Accuracy of age estimation of radiographic methods using developing teeth. Forensic Sci int. 2006; 159: 68–73.
34. Liversidge HM, Chaillet N, Mörnstad H, Nyström M, Rowlings K, Taylor J, et al. Timing of Demirjian’s tooth formationstages. Ann Hum Biol. 2005; 33: 454–470.
Copy url