ABSTRACT
Introdução: a prevalência de doenças endócrino-metabólicas tem aumentado nos últimos anos com a melhoria da expectativa de vida da população. Diabete Melittus, hipotireoidismo, hipertireoidismo, hipoparatireoidismo e hiperparatireoidismo podem levar as alterações no sistema estomatognático, contudo, a literatura ainda é limitada nesta área. Objetivo: Abordar as características e o processo fisiopatológico de doenças endócrino-metabólicas, com destaque para as alterações ósseas e do sistema estomatognático. Metodologia: Os dados foram coletados através da seleção de artigos sobre alterações ósseas e do sistema estomatognático associadas ao hipotireoidismo, hipertireoidismo, hipoparatireoidismo, hiperparatireoidismo e diabete mellitus, publicados nos bancos de dados, Bireme, MEDLINE e Scielo. Resultados: Foram coletados 73 artigos publicados na literatura entre os anos 1995 e 2012, dos quais 40 foram selecionados por se enquadrar no tema proposto. A literatura consultada demonstrou que alterações dos níveis séricos dos hormônios tireoidianos e do paratormônio, assim como diabete mellitus, influenciam no metabolismo ósseo. Atrasos na esfoliação e erupção dentária, no crescimento e desenvolvimento ósseo são observados no hipotireoidismo, enquanto o hipertireoidismo apresenta densidade óssea mineral diminuída, osteoporose dos ossos maxilares, esfoliação acelerada dos dentes decíduos e erupção prematura dos permanentes. No hipoparatireoidismo, observa-se osteoesclerose, dentição hipoplásica e reduzida remodelação óssea. Intensa atividade osteoclástica, ausência de lâmina dura e tumor marrom podem estar presentes no hiperparatireoidismo. Diabete mellitus pode ocasionar oesteoporose, doença periodontal e hipoplasia de esmalte. Embora conhecidas, a magnitude e as causas destas alterações no sistema estomatognático ainda são pouco elucidadas. Conclusões: É imprescindível que o cirurgião dentista tenha conhecimento sobre as manifestações locais ou sistêmicas associadas a estas desordens endócrino-metabólicas que podem acometer os pacientes, para que possa reconhecê-las e contribuir com o seu diagnóstico e tratamento precoces(AU)
Introducción: La prevalencia de las enfermedades endocrino-metabólicas se ha incrementado en los últimos años por el incremento de la esperanza de vida de la población. La diabetes mellitus, hipotiroidismo, hipertiroidismo, hipoparatiroidismo e hiperparatiroidismo pueden presentar alteraciones en el sistema estomatognático, sin embargo, los estudios encontrados en la literatura son todavía limitados en esta área. Objetivo: abordar las características y procesos fisiopatológicos de estas enfermedades y los cambios especialmente en los huesos y del sistema estomatognático. Métodos: los datos fueron recolectados a través de la selección de artículos sobre las alteraciones óseas del sistema estomatognático en pacientes afectados con el hipotiroidismo, el hipertiroidismo, el hipoparatiroidismo, el hiperparatiroidismo y la diabetes mellitus, publicada en las bases de datos, BIREME, SciELO y MEDLINE. Resultados: se recolectaron 73 artículos publicados entre los años 1995 y 2012, de los cuales 40 fueron seleccionados por la relación con el tema de interés para nuestro propósito. La literatura ha demostrado que los cambios en los niveles séricos de la hormona tiroidea y paratiroidea, y la diabetes mellitus afectan el metabolismo óseo. En el hipotiroidismo se observan retrasos en la exfoliación y erupción de los dientes, en el crecimiento y desarrollo óseo. El hipertiroidismo, hay disminución de la densidad mineral ósea, osteoporosis de los huesos de la mandíbula, exfoliación acelerada de los dientes temporales y erupción prematura de los permanentes. En el hipoparatiroidismo, se observan osteosclerosis, dientes hipoplásicos, y remodelación ósea reducida. Puede estar presente intensa actividad de los osteoclastos, ausencia de la lámina dura y tumor pardo en el hiperparatiroidismo. La diabete mellitus puede causar oesteoporosis, enfermedad periodontal e hipoplasia del esmalte. Aunque conocidas, la magnitud y las causas de estos cambios en el sistema estomatognático aún no están claros.Conclusiones: es esencial que el dentista tenga conocimiento de las manifestaciones locales o sistémicas asociadas con estos trastornos endocrinos y metabólicos para que pueda reconocerlos y ayudar en el diagnóstico precoz y el tratamiento(AU)
Introduction: the prevalence of endocrine-metabolic diseases has increased in recent years due to improvement of the life expectancy of the population. Diabetes mellitus, hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may present alterations in the stomatognathic system; however, some studies found in literature are still limited in this area. Objective: to address the characteristics and pathophysiological process of these diseases, especially bone changes and in the stomatognathic system. Methods: data were collected through the selection of articles about bone alterations of the stomatognathic system associated with hypothyroidism, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, and diabetes, published in databases, BIREME, MEDLINE and SciELO. Results: seventy three articles published between 1995 y 2012 were revised, and 40 were selected on the basis of their association with the topic of interest. It has shown that changes in serum levels of thyroid and parathyroid hormones, and diabetes mellitus have an impact on bone metabolism. Delays in tooth eruption and exfoliation, bone growth and development are observed in hypothyroidism, whereas decreased bone mineral density, jawbones osteoporosis, accelerated exfoliation of deciduous teeth and premature eruption of permanent teeth were observed in hyperthyroidism. In hypoparathyroidism, there were osteosclerosis, hypoplastic teeth, and reduced bone remodeling. Intense osteoclastic activity, brown tumors and the absence of lamina dura in hyperparathyroidism may be observed. Diabetes mellitus can cause osteoporosis, periodontal disease and enamel hypoplasia. Although they are known, the magnitude and causes of these changes in the stomatognathic system are still unclear. Conclusions: it is essential that dentist can recognize the local or systemic manifestations associated with these endocrine and metabolic disorders and help to early diagnosis and treatment(AU)
Subject(s)
Humans , Stomatognathic System/physiopathology , Endocrine System Diseases/epidemiology , Facial Bones/physiology , Metabolic Diseases/epidemiology , Review Literature as Topic , Data Collection/methods , Databases, Bibliographic , Bone Demineralization Technique/methodsABSTRACT
Context: The mandible is inevitably affected by radiation during radiotherapy of head and neck cancers. Surveys have shown that most of the emphasis has been on osteoradionecrosis (ORN), while the other bony changes occurring in this area have been largely ignored. Aims: In this study we examine the radiologic changes in the mandible of irradiated patients using panoramic radiography and compare it with the mandible in non-irradiated cases. Materials and Methods: Mandibular bone changes of 48 patients who had received therapeutic radiation for head and neck cancer were assessed. We measured the width of the cortex and the width of the mandibular canal on panoramic radiographs and assessed the changes by comparison with the mandibular bones of non-irradiated subjects. Clinical evaluations were performed for assessing maximum jaw opening, masticatory muscle tenderness, and presence of mucosal ulcers and/or exposed bone in the oral cavity. Statistical analysis: Paired t-test, Chi-square test, and Mann-Whitney test were used for statistical analysis. P < 0.05 was taken to indicate statistical significance. Results: There was no evidence of mucosal ulceration or exposed bone in irradiated patients. There was significant relationship between the number of years after radiotherapy and the degree of limitation of mouth opening (P = 0.000). Receipt of concurrent chemotherapy did not seem to have any additive effect on the width of mandibular canal or the thickness of the mandibular cortex. Conclusion: Reduction in the width of the mandibular cortex and dimensions of the inferior alveolar canal could be considered as one of the effects of head and neck radiotherapy.
ABSTRACT
Purpose: We investigate the relation of bone changes of the condylar surface to disc displacement and discuss the development of joint symptoms in osteoarthrosis of temporomandibular (TM) joints.Subjects and Methods: Seventy-seven patients with an image diagnosis of degenerative bone changes of the unilateral condylar surface accompanied with joint symptoms were studied. The bone changes were assessed by panoramic radiographs and classified into two groups: pathologic bone changes (PBC) including erosion, osteophyte and deformity, and adaptive bone changes (ABC) including flattening and concavity. Magnetic resonance imaging was performed on the subjective TM joints to examine the configuration and position of articular discs. A visual analogue scale was used for evaluation of joint pain.Results: Erosion and deformity showed significantly higher prevalence than the other three kinds of bone changes in the joints with anterior disc displacement without reduction (ADWoR) as compared to those with anterior disc displacement with reduction (ADWR). The cases with the vertical disc position to the condyle ranging from 60° to less than 150° were more frequent than those ranging from 0° to less than 60° in the PBC group, whereas the cases with the vertical disc position to the condyle ranging from 0° to less than 60° were more frequent than those ranging from 60° to less than 150° in the ABC group. The average degree of joint pain when chewing but not jaw opening was higher in the joints with ADWoR than in those with ADWR, and in the PBC group than in the ABC group.Conclusion: The bone changes of the condylar surface diagnosed as PBC tended to induce more advanced disc displacement and chewing pain than those diagnosed as ABC.
ABSTRACT
PURPOSE: The aim of this study was to analyze radiologically the location and course of the mandibular canal and to observe the alveolar and basal bone changes during the remodeling procedures of atrophic mandible. MATERIALS AND METHODS: CT scanning was performed on dry 30 edentulous or partially dentulous mandibles. In 48 edentulous lower halves, measuring areas were determined by three points in the length of the mandibular canal. The distance from the mandibular canal towards cranial and caudal edges, buccal and lingual external borders of the body of the mandible were measured. A statistical comparison between the mean values of different classes of mandibular body was carried out in the selected areas. RESULTS: The distance between the mandibular canal and caudal borders of the body of the mandible and lingual borders dose not change in the atrophic process of mandible. The mandibular canal within the mandible courses downwards from mandibular foramen towards mesial and subsequently it gets to the mental foramen. The distance between the mandibular canal and buccal external border of basal bone changes similar to the change of cranial borders of alveolar bone in the atrophic process of mandible. CONCLUSION: CT scanning was very effective and practicable to analyze the location and course of the mandibular canal and to observe the alveolar and basal bone changes of atrophic mandible. Also more detailed investigation of basal bone changes observed during the remodeling procedures of atrophic mandibles seems reasonable to rely on the massive anthropologic collections of atrophic mandibles combined with CT scanning.