Objective: Maxillofacial manifestations of acromegaly are well described (prognathism, inter-dental space enlargement, occlusion disorder, macroglossia, prominent cheekbones…)  but the dental and periodondal impact of this disease has been poorly investigated. The scientific literature on this topic is scarce, with controversies about gingival and cement enlargement. Our goal is to describe the oro-dental state of these patients as precisely as possible and to study the impact of acromegaly on patients reported oral health related quality of life (OHRQoL) at the same time.
Methods: We prospectively assessed the oro-dental status of acromegalic patients, whether cured or not. After collecting the characteristics of their disease, patients answered the GOHAI questionnaire assessing their OHRQoL, as well as the AcroQoL questionnaire assessing the acromegaly-specific quality of life and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam Computed Tomography if necessary) by the same experienced specialist.
Results: 29 patients aged 59.1±16.0 years were included, 52% had controlled acromegaly. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0±7.8. 55% of patients had a gingivitis and 62% had a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis were found, probably because the frequency of a protective thick gingival biotype was increased (9/29, 31%). Contrary to previous reports [2;3], no case of generalized gingival hypertrophy or diffuse hypercementosis were observed. According to the Add-GOHAI score, 30% of patients only had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11 patients (37.8%) had bulky oral bony outgrowths (OBO) such as large maxillary or mandibular tori and multiple vestibular exostosis.
Conclusions: 1. The unsatisfactory OHRQoL reported by patients contrasts with a rather good objective oro-dental state.
2. Huge OBO could be helpful signposts for the diagnosis of acromegaly, especially when a patient visits a dentist for another non-specific acromegaly-related oral symptom (occlusion disorder, temporo-mandibular joint pain…).
3. Taking our results into account, we advocate annual oral examination for acromegalic patients, as for the rest of the population.
References:  Chanson P. and Salenave S. Acromegaly. Orphanet J Rare Dis. 2008;3:17.
 Çapoglu I. et al. Gingival Enlargement in Acromegaly. Endocrine. 2002;18, 20710.
 Kashyap RR. et al. Dental patient with acromegaly: a case report. Journal of Oral Science. 2011;53, 1336.
18 - 21 May 2019
European Society of Endocrinology