How Does GHD Affect the Oral, Dental Development of Children?

Children with growth hormone deficiency (GHD) showed abnormal craniofacial morphology with reduced mandibular dimensions, according to a recent review of published literature.

It is already known that GH is involved in the regulation of the postnatal dental and skeletal growth, but its effects on oral health have not been clearly defined and the process is not well understood. GH is secreted by the pituitary gland and works mainly by promoting insulin-like growth factor I (IGF-I) secretion, acting within the GH-IGF-I signaling axis, and is associated with tooth maturation and eruption.

The researchers said they wanted to provide more information about dental caries, tooth wear, developmental enamel defects, craniofacial growth and morphology, dental maturation, and tooth eruption in this group of children.

They conducted the review in Scopus, MEDLINE-EbscoHost, and Web of Science from 2000 to May 2021. From an initial list of 62 publications that matched for search criteria, 10 articles made the cutoff for further examination, including:

• 2 about mineralized tissues of the tooth-dental caries
• 2 about dental maturity
• 2 about malocclusion
• 6 about craniofacial growth or morphology

One paper was excluded because of inconsistent data, and 2 involved the same group of patients, and so some results were considered only once.

The final studies included children up to age 18, for a total of 465 patients.

The review, however, showed that some dental issues in GHD have not been adequately researched or discussed and at times the results of some studies have not always reached any sort of alignment.

“There has been little to evaluate dental conditions like tooth wear and enamel defects, although we can assume that the effect of growth hormone on the dentition and facial bones is complex,” the authors wrote.

Some studies point to a link between tooth wear and craniofacial morphology, as well between tooth wear and malocclusion. There was better evidence of delayed dental maturity and orthodontic issues, they said, with dental age delayed by GHD patients by about 1 to 2 years.

Children with GHD showed abnormal craniofacial morphology with reduced mandibular dimensions, with a resulting tendency towards Angle’s Class II occlusion, which affected up to 31% of patients.

One way to resolve the data problem, the authors suggested, would be to collect it before and after administering GH.

“The data are scarce and further studies would be valuable in evaluating the risk of various oral health problems and in organizing targeted dental care for this vulnerable group,” the concluded.

Reference

Torlinska-Walkowiak N, Majewska KA, Kedzia 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, 2022. doi:10.3390/jcm10163733