GHD May Lead to Deteriorated Oral Health Among Children

Children with growth hormone deficiency (GHD) were shown to have a higher risk of oral health problems vs healthy children or those treated with growth hormone (GH), reports new research in Journal of Clinical Medicine.

These problems include abnormal craniofacial morphology with reduced lower jaw bone growth, itself a risk factor for Angle’s class II occlusion; delayed dental age; and increased risk of dental caries. The investigation sough to broaden knowledge on craniofacial development, occlusion, dental age, dental caries, enamel defects, and tooth wear in children with GHD.

The authors of the review, who did a literature search of Scopus, MEDLINE-EbscoHost, and Web of Science for January 2000 through May 2021, were attempting to answer the question, “Are children diagnosed with GHD, when compared with heathy or GH-treated children, more often affected by oral health problems?” They used the following search terms: growth hormone deficiency AND (enamel OR tooth wear OR caries); growth hormone deficiency AND dental maturity; growth hormone deficiency AND craniofacial morphology; growth hormone deficiency AND craniofacial growth; growth hormone deficiency AND malocclusion.

Their final analysis covered 10 publications on mineralized tissues of the tooth–dental caries, dental maturity, malocclusion, and craniofacial growth or morphology, for 465 patients with GHD all younger than 18 years from North America, Asia, and Europe.

“Despite numerous studies and the seemingly clear effect of GH on dental development,” they wrote, “this process is still not well understood.”

In addition to the problems previously mentioned, their results show that up to 31% of children with GHD are affected by Angle’s class II occlusion, that dental age with respect to chronological age is delayed by 1 to 2 years, and that lack of vitamin D may increase the risk of dental caries. In fact, dental crowding, a large overjet, and a large overbite were seen in 44%, 14%, and 5%, respectively, of the children included in the papers on prevalence of malocclusion in GHD. Also, children from rural areas had a significant benefit to their oral health, as measured by the DMFT index (Decayed, Missing, Filled, Teeth), in that a 10-unit increase in vitamin D3 concentration “resulted in a decrease in the value of DMFT by 0.82 and a decrease in the value of DT component by 0.66.” Higher scores on the DMFT index equate to deteriorating oral hygiene.

Noting that not only does GH affect oral health, but that it also “exerts its function mainly by promoting insulin-like growth factor I (IGF-I) secretion,” the authors emphasized that both are “major regulators of postnatal growth and development.” They also pointed out that the studies in their analysis back up findings from previous research that show linear body growth correlates with jaw growth.

Future studies need to investigate the risk of various oral health problems, the authors concluded, as well as dental care fashioned specifically for children with GHD.

Reference

Torlińska-Walkowiak N, Majewska KA, Kędzia A, Opydo-Szymaczek J. Clinical implications of growth hormone deficiency for oral health in children: a systematic review. J Clin Med. Published online August 22, 2021. doi:10.3390/jcm10163733