Acromegaly: a prospective analysis of the oral and maxillofacial pathologies and its impact of disease duration
Burkhard Herrmann1,3, Florentine Mortsch1, Christian Berg1, Thomas Weischer2, Christopher Mohr2 & Klaus Mann1
Context: It is well established that clinical features of acromegaly concern the teeth and the jaw, but less is known about the degree of oral and maxillofacial pathologies and its impact of the disease duration.
Patients: Twenty-eight acromegalics (13 females, 15 males) with a mean age 49±11 (mean±S.D.) years (range 3170) were included in the study. Thirty-two percent had active disease, 39% were well-controlled under the somatostatin analogue octreotide, the dopamine agonist cabergoline, and the GH receptor antagonist pegvisomant, and 29% were cured.
Methods: All subjects undergone intensive and complex examinations of a plaster model and facial arch with articulator, an intra-oral bracket-pen registration, analysis of a digital picture, panoramic and lateral radiographs with cephalometry in comparison with a reference group (n=201).
Results: Panoramic radiographs revealed that 82% had an irregularity of the tooth position. At an average, 10±8 teeth of the denture were missing. Lacks between teeth were detected in 65% of the maxilla and in 73% of the mandible. Forty-two percent had a diastema mediale (0.9±1.1 mm). Overbite and overjet (vertical overbite) correlated with the disease duration (r2=0.2237; P=0.011 respectively r2=0.3364; P=0.015). Thirty-nine percent had paradontitis. Ninety-six percent had an asymmetric movement of the mandible. Fifty-seven percent had a prognathism. The protrusion of the mandible correlated significantly with the disease duration (r2=0.1784; P=0.028). The degree of the mandibular prognathism (SNB-angle) was higher in the acromegalic group (84±7° vs 81±3°, P<0.05). The ANB-angle indicates the relation between maxilla and mandible and was negative in the acromegalic group and positive in the controls (−0.3±5.0° vs 1.6±2.1°, P≤0.05) and correlated negative with the disease duration (r2=0.2553; P=0.0061). The mandibular angle was significantly greater in the acromegalic group (126±9° acromegalic group versus 121±7° control group, P=0.003). The length of the mandible correlated with the disease duration (r2=0.2801; P=0.0038). Eighty-six percent had an asymmetric face. The high of the midface was in the acromegalic group higher (6.1±0.7 vs 5.5±0.4 cm, P=0.0009) as well as the lower bony high of the face (9.5±1.0 acromegalics versus 6.9±0.5 cm controls, P=0.0009). The high of the lower bony face correlated as well with the disease duration (r2=0.3224; P=0.0016).
Conclusions: Patients with acromegaly suffer not only from cardiovascular, metabolic and neoplastic complications, but also from dental and jaw disorders. The high incidence of these manifestations and its relation to the disease duration requires a carefully work-up of oral and maxillofacial examinations in close collaboration with endocrinologists, dentists and dental surgeons.