Systemic Diseases Manifested in the Jaws PDF

Fajr College Oral Radiology Dentistry Program Semester (6) lecture #1 Systemic Diseases Manifested in the Jaws Dr.Hidayah Elyas  Definition Disorders of the  Endocrine system.  Bone metabolism.  Other systemic diseases Have an effect on form and function of...

Fajr College Oral Radiology Dentistry Program Semester (6) lecture #1 Systemic Diseases Manifested in the Jaws Dr.Hidayah Elyas  Definition Disorders of the  Endocrine system.  Bone metabolism.  Other systemic diseases Have an effect on form and function of bone and teeth. Endocrine Disorders  Hyperpituitarism  Hypopituitarism  Hyperthyroidism  Hypothyroidism  Hyperparathyroidism  Hypoparathyroidism  Diabetes Mellitus  Cushing’s Syndrome Metabolic Bone Diseases  Osteoporosis  Rickets and Osteomalacia  Hypophosphatasia  Hypophosphatemia  Renal Osteodystrophy  Osteopetrosis Other Systemic Diseases  Progressive Systemic Sclerosis (Scleroderma)  Sickle cell anemia  Thalassemia  A) Endocrine Disorders  Endocrine system: System of ductless glands Regulates body functions via hormones secreted into the bloodstream. 1- Anterior Pituitary Gland Hormone: Growth Hormone Overactive - Gigantism (children - very tall) - Acromegaly (adults - bones & skin thicken) Underactive - Dwarfism (very short)  1- Hyperpituitarism Acromegaly and Gigantism Results from hyper-function of the anterior lobe of the pituitary gland, which increases the production of growth hormone. Leading to growth of body tissues capable of growth  Gigantism: In children Generalized growth of soft tissues and bone but with normal proportions.  Acromegaly: In adults *Since most of the tissues had lost its capacity to grow some bones as the Mandible, Hands & feet are affected due to presence of cartilagenous articulating surfaces with growth potentials. *Also hypertrophy of soft tissues as lip, tongue occurs. Gigantism The man holding the baby in the photo is 8 ft, 2.5 inches tall Acromegaly  Radiographically: -Enlargement Ballooning) of the sella tursica - Enlargement of the paranasal sinuses especially the frontal sinus. - Diffuse thickening of the outer table of the skull.  Enlargement of the jaws especially the mandible with spacing of teeth, while overgrowth of posterior alveolar bone results in ant. open bite.  Enlargement of the tongue may result in fanning out of anterior teeth.  Profound growth in the condyle and ramus.  Hypercementosis and supereruption of the posterior teeth 2- Hypopitutarism  Reduced secretion of pituitary hormones.  People with this condition show dwarfism but have relatively well-proportioned bodies.  Marked failure of development of the maxilla and mandible  Radiographically: - Eruption of primary teeth are normal with delayed exfoliation. - Crowns of permanent teeth are normal but with delayed eruption for several years. Buds of third molars may be completely absent. - Small jaws with crowding and malocclusion.  B- Thyroid Gland Hormone: Thyroxin Overactivity (Too much hormone) - Increased metabolic rate - Increased food intake but loss of weight - Hyperthyroidism (Grave’s disease) - Goitre (swollen neck, maybe bulging eyes)  1- Hyperthyroidism Thyrotoxicosis and Graves’ disease Is a syndrome with excessive production of thyroxin in the thyroid gland. Occurs with toxic goiter (Graves’ disease).  Clinically *Increased metabolic rate of all body tissue *Tachycardia, increased blood pressure, sensitivity to heat, and irritability. *More in females. Radiographically: -In children Advanced rate of dental development and early eruption with premature loss of the primary teeth. -In adults| Generalized decrease in bone density. Thyroid Gland Hormone: Thyroxin Underactivity (Not enough hormone) - Hypothyroidism (Hashimoto’s disease) - Reduced metabolic rate - Low food intake but gain of weight - Myxoedema (when onset in adults) - Cretinism (when onset in children) - Can also cause a goitre 2- Hypothyroidism Myxedema and Cretinism Insufficient secretion of thyroxin  Myxedema: In adults Cretinism:In * Poor memory, children *Mental & physical *constipation retardation. *cold intolerance, *Delayed eruption & *large tongue, dental development. *sparse hair. *Small maxilla and mandible. Radiographically:  Mxyedema  Cretinism *Periodontal disease. Delayed closure of fontanelles & incorporation *Loss of teeth. of wormanian bones in *Teeth separation due sutures. to enlarged tongue. *Delayed ossificaton of base of skull. *External root resorption. Thinning of lamina dura. Short teeth. C-Parathyroid Glands Hormone: Parathyroid hormone (PTH) Underactivity - Low Blood calcium, High Bone Ca - Tetany Overactivity - High Blood calcium, Low Bone Ca - Osteoporosis 1- Hyperparathyroidism  There is an excess of circulating parathyroid hormone (PTH).  Increase bone remodeling in preference of osteoclastic resorption, which mobilizes calcium from the skeleton.  Increase in serum calcium and alkaline phosphatase.  Clinically: - Women more than men - 30-60 years. - Renal calculi, peptic ulcers, bone and joint pain. - Gradual loosening, drifting and loss of teeth Radiographic Features  The density of the jaws is decreased, and trabecular pattern is replaced by ground glass appearance.  Demineralization and thinning of cortical boundaries such as inferior border, mandibular canal, and the cortical outline of the maxillary sinus.  Partial or complete loss of lamina dura.  Teeth appear R.O in contrast to decreased bone density.  Brown nodes of HPT appear as multiple but separate radiolucent lesions in the jaws. 2- Hypoparathyroidism Insufficient secretion of PTH Hypocalcemia  Clinically: *Tetany Sharp Flexion of the *Bone & Muscles ankle joints and wrist. *Early closure of epiphysis (dis-proportioned short stature) *Sensory Paraethesia of the hands, feet abnormalities and around the mouth. Anxiety and depression. *Neurological abnormalities Radiographic Features  In P.A view Basal ganglia calcification.  Enamel hypoplasia, external root resorption, delayed eruption or root dilaceration.