Vit and Hormone in Relation to Growth and Development / orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

INDEX

1. INTRODUCTION2. HORMONES3. CLASSIFICATION AND MECHANISM4. GROWTH HORMONES5. THYROXINE HORMONE6. PARATHYROID HORMONE7. CALCITONIN8. VITAMIN D 39. SEX STEROID10. CORTICOSTEROID11. PROSTAGLANDINS12. BISPHOSPHONATES13. VITAMINS14. CONCLUSION15. REFERENCES


HORMONES IN RELATION TO ORTHODONTICS

INTRODUCTION

Endocrine glands (Greek-”I separate within”)

secrets physiologically active substances

called HORMONES directly to blood

stream. www.indiandentalacademy.com

Hormones – in Greek means “I excite or arouse”, was introduced by Starling in 1905. DEFINITION : Secretory product of Endocrine glands released directly into the circulation in small amount in response to specific stimulus.On delivery in circulation it produces response

on the target cells or organs.

HORMONES


CLASSIFICATION(on the basis of chemical nature)1. STEROID TYPE

2. PROTIEN TYPE 3. DERIVATIVES OF TYROSINE

MECHANISM


GROWTH HORMONE (GH)GROWTH HORMONE (GH)

Protein hormone, secreted by acidophills of anterior pitutary Secretion is more during strenuous excercises and deep sleep. No specific target organ. Anabolic harmone. No direct action on bone but act thru substance called STOMATOMADIN.

TWO TYPES:TWO TYPES:1. Insulin like growth factor(IGF-1)2. Insulin like growth factor(IGF-2)

GH carries almost all the metabolic activity withIGF-1 . www.indiandentalacademy.com

Normal concentration of GH ;2 – 4 ng/ml in growing child

GH DEFICIENCY

Children with big skull with babyish faceCephalometric studies : Small size of ant. & post. Cranial base Smaller mandibular dimensions Small post. Facial height & mand. height.

Study done on 13 pts. with pitutary deficiency,Cephalometric finding were low as compared to normal


HYPERSECRETION OF GH

1. GIGANTISM2. ACROMEGALY

GIGANTISM

Occur during adolescence before epiphysial closure.Features: Tall stature Bilateral gynaecomastia Large hand and feet Associated features like:coarse hair,loss of libido,etc.www.indiandentalacademy.com

A CEPHALOMETRIC STUDY

Done on two female pt. suffering from Gigantism.

FINDINGS:

Ant. facial height +3.5D to +6.85D

Post. facial height +3.75D to +4.95D

Post. cranial base was long

Ant. cranial base was normal

Face was broad with pronounced zygomatic arches but relatively normal occlusion


ACROMEGALY

Occur during adulthood after epiphyseal closure.Usually a result of benign pitutary tumor.

Features :Broad,thick noseThickening of the skinProminent browCoarsening of facial featuresPrognathism : elongation and widening of mandible (class 3 malocclution)Serum level of IGF-1 was 10 times high.Development of cross bite


ELONGATION AND WIDENING OF MANDIBLE IN ACROMEGALY

Mandibular growth in Acromegaly results fromappositional growth and hypertrophic changesin the condylar cartilage.


Study done by Chung – Juhwang and Jung- yul cha

On orthodontic treatment with growth hormone therapy in a 9 year old short stature child.

Conclusion at the end of the treatment :

1. High GH therapy affect growth of mand. more than the growth of maxilla.2. Amount and pattern of growth during high administration are unpredictable.3. High therapy rarely affect the dental maturity.



THYROXINE HORMONE (TH)It has no specific target organRegulates the pace of metabolism thru interactionswith mitochondrial,nuclear & extra mitochondrial processes.Prenatal hypothyroidismDevelopment of bone & teeth are retardedLater enamel defects in prenatally developed teeth are seen.Some degree of mental retardation is seen.After birthGrowth of cranium is retarded – brachycephalic faces developIncreased mental retardation.

TH important for synthesis of IGF-1Reduced facial height seen in children hypothyroidism of long duration.


Orthodontic consideration

TH administration leads to :

Increased bone remodelling Increased bone resorptive activityReduced bone density This result in increased tooth movement during ortho. treatment.(study done by Sherazi,Dehpour,Jafari)


Study by Luis and Rita TH treated animals have less force induced Root resorption.


PARATHORMONE(PTH)

Polypeptide hormone,secreted by parathyroid glands.It mobilizes calcium and phosphorous from bonesIt increases serum calcium level, and decreases serum phosphorous.

Study done by Anthony and Richard on rats:50U in 0.5cc solution injected in distal aspect of left central incisor of 6 rats.After 5th day- appliance fitted(1 ounce force)6th day animal sacrificed and maxilla removed and examined.

Lat. Incisor treated with PTH moved more than the right lat. Incisor

Result ; PTH enhance ortho. Tooth movement if applied locally.www.indiandentalacademy.com

CALCITONIN

Peptide hormone, secreted by intra follicular or C- cells in the thyroid gland.also called Thyrocalcitonin.

It flows in bloodstream and attracts Ca to bone, thus reducing Serum calcium.It reduces bone resorption by reducing the no. of osteoclasts.

It is used in the treatment of Hypercalcemia and Osteoporosis.

Ortho consideration

It inhibit tooth movement and consequently delays orthodontic treatment . www.indiandentalacademy.com

VITAMIN D - 3

Vit. D3 with parathyroid and cacitonin hormoneregulates the amount of Ca and phosphorous in human body.

It promotes interstitial Ca and phosphorous absorption

Vit.D3 increases the bone mass and thus reduces fractures in osteoporosis .

It can be assumed that they can inhibit tooth movement.


SEX HORMONES

They are steroidal hormone.

At puberty, the increase in GH and IGF-1 production is sex hormone dependent.

Promotes protein synthesis in the body.

They regulate normal bone metabolism(after menopause- osteoporosis)


Role of sex hormone in dental & craniofacial development

Study by Spiegel & Sather in children with disorder of puberty: in extreme early or late maturing children dental development was slightly deviation to early and late development.

Keller,Satherand Hayles reported delayed facial growth in Hypogonadism . Estrogen directly stimulates the bone forming activity of osteoblasts. Androgens also inhibit bone resorption &also modulate growth of muscle system.

In Athletes excess use of drugs may effect the length and the results of orthodontic treatment. (study done by Ascraft,Southard and Tolley)


CORTICOSTEROIDS

HYPERGLUCOCORTICOIDISM leads to short stature and developed bone maturation.

Very small amount may decrease growth rate.

Skeletal IGF-1 synthesis decreased by Cortisol.

Cortisol has inhibitory effect on bone collagen synthesis

Cortisone accelerate the tooth eruption.


PROSTAGLANDINS(PG)

They act by increasing number of osteoclasts and activating already existing osteoclasts on application of mechanical stress.


BISPHOSPHONATES

Characterized by high affinity for calcified tissues.

They are potent blockers of bone resorption.

They are used in treatment of hypercalcaemia and osteoporosis and metabolic diseases that involve bone resorption

They act by decreasing no. of osteoclast cells.

Study done by Adochi,Igarashi,Mitani & shinobar on topical application of bisphosponates on tooth movements in rats. they find that movement was inhibited by topical application.


CONCLUSION

Most of the studies are done on squirrels, rats and monkeysAnd not on human beings so very little is known about the effect on facial growth and development.

Further research is required to understand better about the role of endocrine in orthodontic treatment for ortho. practitioners .


VITAMINS

INTRODUCTION

NUTRIENTS AND ITS FUNCTON

MACRONUTRIENTS

MICRONUTRIENTS


HISTORY

1. Luvin & Pakelharing : cessation of growth and death of animals had been prevented on addition of small amt. of milk to there diet..2. Eijikman(1906) : deficiency due to rice polishing – Beri-Beri

3. Hopkins(1906-1912): growth promote substances in milk.

4. Hippo crates : ox liver and honey for night blindness.

5. Cod liver oil used in Manchester for rickets www.indiandentalacademy.com

DEFINITION

Organic compounds essential in small amounts for the normal growth and nutrition of human body.

Integral part of co-enzymes and catalyze reactions

In absence of vit. Enzyme cannot effective and hence an abnormal channel of development results.

CLASSIFICATION

1. Fat soluble vit. – A, D,and K

2. Water soluble vit. – B , Cwww.indiandentalacademy.com

ROLE OF VITAMINS IN GROWTH AND DEVELOPMENT

Certain “CRITICAL PERIOD” exist during development of organcharacterized by HYPERPLASTIC AND HYPERTROPHIC GROWTHPHASES.Any dietary deficiency during these phases may cause irreversible changes like growth retardation & orofacial alteration in humans like:

1. Cleft lip and Palate2. Reduced dental arch dimensions with inadequate spaces3. Insufficient dental eruption4. Short root and interosseous rotation of per. Teeth5. Shorter mandible in ant. And post. Direction6. Reduction in ascending ramus7. Dentoalveolar inclinations in the incisor region8. Reduction in mesio – distal dimension of 3rd molar.


Vitamin A

On jaws : Excess of vit A during critical growth period markedly inhibit the neural crest cell development and upset the normal balanceb/w bone formation and resorption – CLEFT PALATESoftening of cleft palate due to decrease in calcium deposition


On Peridontium :Leads to keratinizing metaplasia of epitheliumIncreased susceptibility to infection Disturbances in bone growth,shape and texture

On teeth :

Deficiency during matrix formation and matrix calcification leads to ENAMEL HYPOPLASIA(atrophy of ameloblasts) & hence increases caries susceptibility.


Vitamin D deficiency

On jaws : Retarded jaw, teeth and condyle developmentMaxillary dysplasiaFacial sutures difficult to close lead to openbite

On teeth : Hypoplastic changes during matrix calcification

On Periodontium :Osteoporosis of alveolar bone and cemental dysplasia


Vitamin - C

Essential for dentin matrix formation which take prior to enamel matrix formation. Thereby deficiency of vit c may lead to enamel hypoplasia

On Teeth :

On Peridontium : Influence the metabolism of collagen fibers thereby affect Regeneration and Repair It interfere with bone formation & remodelling Its deficiency aggravates gingival response to plaque & worsen edema,enlargement and bleeding . Study by McCanlies et alwww.indiandentalacademy.com

VTAMIN B

Folic acid plays important role in formation of R.B.C in the bone marrow.Essential for utilisation of sugar, amino acids and making of antibodies.In pregnancy, it is needed for the division of all body cells.Without this no growth take place nor any healing.Deficiency in foetus can cause death,CLEFT LIP AND PALATE

Vit B12 : Deficiency may cause sore mouth and glossitis


Vitamin E

It prevents oxidation of Vit A

Needed for utilization of essential fatty acids

Deficiency cause anemia ,muscle degeneration and muscular dystrophy

Important in wound healing and prevent scarring in burn surgery, etc

Deficiency in fetus may cause hydrocephaly,joined finger and toes edema anemia and backward development.


Guidelines for evaluation and assessment of Nutritional status

R.D.A Physical appearance Clinical evaluation Biochemical analysis Anthropometrical data


REFERENCES

Human physiology- A.k.Jain,2nd edition Text book of physiology – Guyton,10th edition Essentials of medical physiology – Sembulingum, 2nd edition Textbook of oral pathology – Shafer Contemporary Orthodontics - Proffit Articles:1. Endocrine regulation of craniofacial growth2. Ortho. Treatment with GH – Chung jucha hwang jun yul (Am J orthod dentofacial orthop.2004;126;118-26)3. GH hormone receptors& IGF-1receptor – Angle orthod.2001 4. Effect of TH on ortho tooth movementin rats – Sharazi, Dehpour, Jafari.- J clin Pediatr dent. 23(3);259-64,19995. Effects of corticosteroid on osteoporosis – Ashcraft, southard, tolley ( Am J ortho. Dentofac. Orthop.1992; 102:310) Abstracts :1. Am J orthod vol55 no. 3 – use of PTH to assist ortho. tooth movement


guided by:guided by:Dr. Sandesh PaiDr. Sandesh PaiDr. MadanDr. Madan


Documents

Vit and Hormone in Relation to Growth and Development / orthodontic courses by Indian dental academy