Dental Health and the Endocrines

An Outline of Endocrines

These Glands are of Utmost Importance in

Development of Good Teeth as Well  asMaintenance of General Health,

Says Dr. A. Budner Lewis* in

“DENTAL HEALTH AND THE ENDOCRINES”

                To the general dental practitioner, a discussion of the relationship of endocrine organs to oral disease seems somewhat far fetched and theoretical. Nevertheless, in spite of the fact that the development of this subject has only reached a theoretical stage, dysfunction of these glands must be considered as a contributing factor to dental disease and derangement because of the very nature of the action of their secretions.

Secondary manifestations of systemic disorders many times are found in the oral cavity, and this paper, in dealing with endocrines and the teeth will review somewhat briefly and comprehensively some observations which have already been made correlating glandular disturbances with conditions of teeth and surrounding structures. It is hoped that the reader might be encouraged to doing a little observing on his own account and thereby possibly help work out a problem which has a sort of vague establishment as a causative factor of dental disease.

The glands of internal secretion have to do with life itself—its form, growth, function, balance and neurasthenic control. These organs function as an interrelated, interdependent set-up with a very minute amount of secretion or hormone of one having a decided effect upon the activity of other glands.

One of the distinguishing characteristics of living material is the physiologic action of anabolism (building up) and catabolism (breaking down) and the glands of internal secretion practically control the entire process. In our modern approach to dental problems, the mouth and its members are considered a part of the general make-up of the body and so any abnormal condition affecting this physiologic action might have secondary manifestations in the oral tissues.

With these few thoughts in mind let us consider some of the generalities of these so-called ductless glands.

The glands to be considered have been chosen because of their direct bearing upon calcium metabolism of the body. These include the thyroid, parathyroid, thymus and pituitary glands. The exact process of their secretions is as yet unknown but the results of both hyper (over) and hypo (under) activity can be fairly well demonstrated.

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*Visiting Dental Staff, Rhode Island Hospital, Providence, Rhode Island.

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THYROID

  1. Description.

Located anterior to trachea—consists of two lobes of spherical, vesicular tissue connected by an isthmus. Secretes about 1 mg. of thyroxine per day.

  1. Action of Secretion.

Has marked effect upon growth and development—especially protein metabolism.

  1. Overfunction.

Before puberty.

Excessive growth.

Oral Manifestations.

Teeth erupt early but are strong and usually free from caries

 

Case of exophthalmic goitre.

(From Schafer’s “The Endocrine Organs.”)

Adult.

Exophthalmic Goitre. Fig. 1.

Symptoms.

High basal metabolic rate.

Excessive irritability.

Excessive appetite.

Loss of weight.

Oral Manifestations.

Little if any change in mouth.

Teeth usually caries free and periodontal tissues fairly normal—Fig. 2.

 

                Patient, female. Age 28. Diagnosis—Early stages of hyperthyroidism. Basal metabolic rate variable but below normal. Note good quality of alveolar bone and well formed dental arch.

  1. Underfunction (Hypothyrodism).

Child.

Cretinism (Dwarfism).

Symptoms.

Bone and mental growth retarded.

Ossification very slow—chronic rickets.

Oral Manifestations.

Deciduous teeth erupt late.

Permanent teeth irregular and of perform.

Many teeth impacted and congenitally missing.

                Case of myxedema. Left, before treatment. Right, after treatment.

Adult.

Myxedema—Fig. 3.

Many grades of development.

Progressive disease.

General failure in health.

Mental and sexual activity recede.

Sluggishness, lack of appetite.

Characteristic changes.

Skin thick and pasty—does not pit and pressure.

Lips thick and everted.

Mouth and tongue enlarged.

Lowered heart beat and respiration.

Patient obese.

Oral Manifestations.

Patient may be prone to extensive caries or severe periodontal disease.

Teeth may loosen and be lost.

There is a decided break down of alveolar bone.

(See Fig. 4)

PARA-THYROIDS

  1. DESCRIPTON.

Two pairs—each located on the side of lobes of the thyroid.

Patient, female. Age 42. A definite case of myxedema. Complete report of this case appeared in Dental Cosmos, January, 1935. Note destruction of alveolar bone.

Radiograms showing extensive loss of periodontal tissue. Patients presented without the cardinal symptoms of periodontoclasia but a systemic examination disclosed a possible incipient glandular disorder.

  1. Action of Secretion.

Control and regulation of calcium metabolism. It is essential for the assimilation of calcium and it maintains the equilibrium between serum calcium and phosphorous when calcium and Vitamin D intake is interfered with.

Undersecretion (lack of para hormone).

Tetany—spasmodic contraction of muscles especially affecting the extremities.

Oral Manifestations.

Hypoplastic teeth.

Teeth fracture easily due to poor calcification.

Oversecretion.

Bone rarefication due to drawing calcium from bones.

Bone cysts (Osteitis firbosa cystica).

 

PITUITARY

  1. Description.

Located in sella turcica (skull).

Grossly consists of two lobes—anterior and posterior.

  1. Action of secretions.
    1. Anterior lobe—Growth and sexual development.
    2. Posterior lobe—Oxytocin stimulates uterine contraction.

Vaso-pressin—Causes increased kidney excretions.

 

 

Four photographs of the same person showing the gradual development of acromegaly. A—at twenty-four years of age (normal); B—at twenty-nine (onset of disease); C—at thirty-seven; D—at forty-two.

Underfunction.

Pars anterior.

Adiposity (Froelich’s Syndrome).

Stunted growth.

Low basal metabolic rate.

Decreased sexual activity.

Male—fat—effeminate and misunderstood

Overfunction.

Pars anterior.

Child—Gigantism.

Adult—Acromegaly—Fig. 7.

Enlargements of bones of face—and—hands.

Increased sexual activity.

Thickening of skin.

Glycosmia.

Oral Manifestations.

Chief changes are in the relationship of deep arches, the teeth remaining same, patient becomes a decided prognathous.

 

THYMUS

  1. Description.

Located in front of trachea. Is fully developed at about the age two and then it undergoes degeneration until action of the giant ceases at puberty.

  1. Action of secretion.

Regulates calcium metabolism from birth and age of puberty.

Underfunction.

Generally little known.

Patient probably rachitic and matures much earlier than normal.

Oral Manifestations.

Teeth blue and translucent.

Permanent teeth may erupt early and are irregular.

Overfunction.

Maturation delayed.

The oral manifestations are very large center with laterals very small or congenial missing.

The glands reviewed above of course are not the only ones having some bearing on the conditions of general metabolism, the gonads, Pancreas (Islands of Langerhans). Pineal body and suprarenal must be taken into consideration but there is still so little known about these glands that only a discussion concerning them could be offered.

 

Conclusions.

The very nature of the function of endocrine glands, plus the known conditions which arise when their normal action is interfered with, definitely call for some consideration of these organs in deep science. Animal experimentation must be coupled with clinical observation and enough evidence must be gathered before the case of endocrine dysfunction vs. oral health can be carried on with some certainty.

—A. Budner Lewis, A.B., D.M.D., 1015 Union Trust Bldg., Providence, Rhode Island.