(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
CHILDREN with growth hormone deficiency (GHD) have a higher risk of oral health problems.
These problems are reduced lower jaw bone growth; delayed dental age; and increased risk of tooth decay, according to a study published in the Journal of Clinical Medicine.
Johns Hopkins Medicine defines GHD, also known as dwarfism or pituitary dwarfism, as a condition caused by insufficient amounts of growth hormone in the body.
Children with GHD have abnormally short stature with normal body proportions.
GHD can be present at birth (congenital) or develop later (acquired).
The condition occurs if the pituitary gland makes too little growth hormone. It can be also the result of genetic defects, severe brain injury or being born without a pituitary gland.
In some cases, there is no clear cause identified. Sometimes, GHD can be associated with lower levels of other hormones, such as vasopressin (which controls water production in the body), gonadotropins (which controls the production of male and female sex hormones), thyrotropins (which control the production of thyroid hormones) or adrenocorticotrophic hormone (which controls the adrenal gland and related hormones).
Symptoms include low growth or absence of growth; short stature; absent or delayed sexual development during puberty; and headaches.
Symptoms of other pituitary hormone deficiencies that may co-exist with GHD: absent or delayed sexual development during puberty; increased urination and amount of urine; excessive thirst; facial abnormalities present in a small group of children with GHD, typically caused by pituitary defects.
The study looked at oral health outcomes in children with GHD following a search of the published literature from January 2000 through May 2021.
The study showed that dental age with respect to chronological age is delayed by one to two years, and that lack of vitamin D may increase the risk of tooth decay.
Noting that not only does GH affect oral health, but that it also exerts its function mainly by promoting insulin-like growth factor secretion, the study emphasized that both are major regulators of postnatal growth and development.
The study observed that findings from previous research show that linear body growth correlates with jaw growth.
Future studies need to investigate the risk of various oral health problems, as well as dental care fashioned specifically for children with GHD, the study concluded.
Diagnosis of GHD involves a physical exam and measurement of height, weight, arms and leg lengths. These are the first steps to diagnosis, in addition to thorough medical history.
Blood tests to measure the levels of growth hormone in the body as well as the levels of other hormones are also needed.
Imaging tests including X-rays and MRI of the head may be helpful in narrowing down the underlying disorder causing GHD by revealing abnormalities of the hypothalamus or the pituitary glands.
Some cases of GHD can be treated with the use of synthetic growth hormone under the supervision of a pediatric endocrinologist. If other hormone deficiencies exist, other hormones can be given in addition to synthetic growth hormone.
***
Dr. Joseph D. Lim is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; and Honorary Life Member of the Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
***
Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com/PN
