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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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Vit and Hormone in Relation to Growth and Development / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
www.indiandentalacademy.com 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 www.indiandentalacademy.com CLASSI FI CATI ON(on the basis of chemical nature) 1. STEROID TYPE
2. PROTIEN TYPE
3. DERIVATIVES OF TYROSINE
MECHANI SM www.indiandentalacademy.com 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 STOMATOMADI N.
TWO TYPES: 1. Insulin like growth factor(IGF-1) 2. Insulin like growth factor(IGF-2)
GH carries almost all the metabolic activity with IGF-1 .
www.indiandentalacademy.com Normal concentration of GH ; 2 4 ng/ml in growing child GH DEFI CI ENCY
Children with big skull with babyish face Cephalometric 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
www.indiandentalacademy.com HYPERSECRETI ON OF GH 1. GIGANTISM 2. 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
www.indiandentalacademy.com ACROMEGALY
Occur during adulthood after epiphyseal closure. Usually a result of benign pitutary tumor.
Features : Broad,thick nose Thickening of the skin Prominent brow Coarsening of facial features Prognathism : elongation and widening of mandible (class 3 malocclution) Serum level of IGF-1 was 10 times high. Development of cross bite
www.indiandentalacademy.com ELONGATION AND WIDENING OF MANDIBLE IN ACROMEGALY Mandibular growth in Acromegaly results from appositional growth and hypertrophic changes in the condylar cartilage. www.indiandentalacademy.com 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.
www.indiandentalacademy.com www.indiandentalacademy.com THYROXI NE HORMONE (TH) It has no specific target organ Regulates the pace of metabolism thru interactions with mitochondrial,nuclear & extra mitochondrial processes. Prenatal hypothyroidism Development of bone & teeth are retarded Later enamel defects in prenatally developed teeth are seen. Some degree of mental retardation is seen. After birth Growth of cranium is retarded brachycephalic faces develop Increased mental retardation.
TH important for synthesis of IGF-1 Reduced facial height seen in children hypothyroidism of long duration. www.indiandentalacademy.com Orthodontic consideration TH administration leads to :
Increased bone remodelling Increased bone resorptive activity Reduced bone density This result in increased tooth movement during ortho. treatment. (study done by Sherazi,Dehpour,Jafari)
www.indiandentalacademy.com Study by Luis and Rita TH treated animals have less force induced Root resorption. www.indiandentalacademy.com PARATHORMONE(PTH) Polypeptide hormone,secreted by parathyroid glands. It mobilizes calcium and phosphorous from bones It 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 5 th day- appliance fitted(1 ounce force) 6 th 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 CALCI TONI N 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 VI TAMI N D - 3 Vit. D3 with parathyroid and cacitonin hormone regulates 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. www.indiandentalacademy.com 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)
www.indiandentalacademy.com 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) www.indiandentalacademy.com CORTI COSTEROI DS 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. www.indiandentalacademy.com PROSTAGLANDI NS(PG) They act by increasing number of osteoclasts and activating already existing osteoclasts on application of mechanical stress. www.indiandentalacademy.com BI SPHOSPHONATES 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.
www.indiandentalacademy.com CONCLUSI ON Most of the studies are done on squirrels, rats and monkeys And 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 .
www.indiandentalacademy.com VI TAMI NS I NTRODUCTI ON NUTRIENTS AND ITS FUNCTON
MACRONUTRIENTS
MICRONUTRIENTS www.indiandentalacademy.com HI STORY 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 DEFI NI TI ON 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. CLASSI FI CATI ON 1. Fat soluble vit. A, D,and K
2. Water soluble vit. B , C www.indiandentalacademy.com ROLE OF VI TAMI NS I N GROWTH AND DEVELOPMENT Certain CRITICAL PERIOD exist during development of organ characterized by HYPERPLASTIC AND HYPERTROPHIC GROWTH PHASES.Any dietary deficiency during these phases may cause irreversible changes like growth retardation & orofacial alteration in humans like:
1. Cleft lip and Palate 2. Reduced dental arch dimensions with inadequate spaces 3. Insufficient dental eruption 4. Short root and interosseous rotation of per. Teeth 5. Shorter mandible in ant. And post. Direction 6. Reduction in ascending ramus 7. Dentoalveolar inclinations in the incisor region 8. Reduction in mesio distal dimension of 3 rd molar. www.indiandentalacademy.com Vitamin A On jaws : Excess of vit A during critical growth period markedly inhibit the neural crest cell development and upset the normal balance b/w bone formation and resorption CLEFT PALATE Softening of cleft palate due to decrease in calcium deposition
www.indiandentalacademy.com On Peridontium : Leads to keratinizing metaplasia of epithelium I ncreased susceptibility to infection Disturbances in bone growth,shape and texture On teeth : Deficiency during matrix formation and matrix calcification leads to ENAMEL HYPOPLASI A(atrophy of ameloblasts) & hence increases caries susceptibility.
www.indiandentalacademy.com Vitamin D deficiency On jaws : Retarded jaw, teeth and condyle development Maxillary dysplasia Facial sutures difficult to close lead to openbite
On teeth : Hypoplastic changes during matrix calcification On Periodontium : Osteoporosis of alveolar bone and cemental dysplasia www.indiandentalacademy.com 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 al
www.indiandentalacademy.com VTAMI N 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 www.indiandentalacademy.com 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.
www.indiandentalacademy.com Guidelines for evaluation and assessment of Nutritional status R.D.A Physical appearance Clinical evaluation Biochemical analysis Anthropometrical data www.indiandentalacademy.com REFERENCES Human physiology- A.k.Jain,2 nd edition Text book of physiology Guyton,10 th edition Essentials of medical physiology Sembulingum, 2 nd edition Textbook of oral pathology Shafer Contemporary Orthodontics - Proffit Articles: 1. Endocrine regulation of craniofacial growth 2. 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);259-64,1999 5. 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 www.indiandentalacademy.com guided by: Dr. Sandesh Pai Dr. Madan www.indiandentalacademy.com