Eur .1 Oral Sci 1997: 105: S3I 556Printed in UK .Alt rigta.': re.^crvaci

Copyrigtil C Eur J Oral Sci 1997

EUROPEAN JOURNAL OFOR.H.L SCIENCES

ISSN imi9-iS36

Dental maturity in children ofshort stature, with or withoutgrowth hormone deficiency

Larisa Krekmanova,Jan Carlstedt-Duke,Mikael Bronnegard,Claude Marcus, Eva Grondahl andThomas Modeer, Goran DahllofDepartments of Pediatric Dentistry, Schoolof Dentistry, Pediatrics and DiagnosticRadiology, Huddinge University Hospital,Karoiinsika Institutet, Stookhoim, Sweden

Krekmanova L, Carlstedt-Duke J, Brimnegdrd M, Marcus C. Grimdahl E,Modeer T, Dahllof G: Dental matutity in chikken of short stature, with orwithout growth hormone deficiency. Eur J Oral Sei J997: 105: 551-556.e Eur J Oral Sci, i997

The aim of this investigation was to study dental maturity in healthyprepubertal children of short stature {heighK - 2 SD), with or without growthhormone jGH) deficiency, compared to healthy controls. The GH-deficientgroup (GH level< 10,0 ng/\) included 29 children (11 female, 18 male) with amean age of 10,2 + 2,2 years. The GH non-deficient group consisted of 17children (5 female, 12 male) with a mean age of 8,5 + 2.1 years. All the childrenwere evaluated for serum concentrations of IGF-l, alkaline phosphatase(ALP), triiodthyronin (T3), thyroxine (T4), thyroid-stimulating hormone(TSH), and fasting plasma insulin: height and bone age were also recorded.Dental maturity was determined from panoramic radiographs. The meandifference between the dental and chronological ages was —0.67+: 0,89 years inthe GH-deficient group compared to 0,23' +1.07 years in their controls: in theGH non-deficient group the difference was —0.95 + 0,82 years compared tocontrols 0,16+1.06 years in their controls. Compared to chronological age.both bone and dental age were lower in the GH-deficient and GH non-deficientgroups. It is concluded that children of short stature, both GH-deficient andGH non-deficient, exhibit a delayed dental age compared to their chronologicalage- and sex-matched controls. A multiple stepwise regression analysis showedthat the sittmg height and GH level were the only significant factors associatedwith dental rnaturity.

Larisa Krekmanova, Department ofPediatric Dentistry, School of Dentistry,Karoiinska Institutet, POB 4064, S-141 04Huddinge, Sweden

Telefax: +46-8 7743395E-mail: Larisa,Krekmanovaeofa.ki,se

Key words: chiidren; dental maturity:growth hormone deficiency

Aocepted for pyb!jcation August 1997

The growth hormone (GH) is the primary hormonethat stimulates longitudinal bone growth (1), The.amount of secreted GH is determined by 2 antagon-ists released from the hypothalamtis, growth hor-mone-inhibiting hormone and growth hormonereleasing hormone (2, 3), The release of GH isepisodical, with night and day variations and secre-tion peaks predominantly at night-time. The highestproduction of GH appears during puberty. In thepost-pubertal period, an age-correlated decrease ofGH production is found (4, 5).

Growth is regulated by many hormones actingin concert. During infancy and childhood, GH,insulin and thyroid hormone are of majorimportance for growth and development, bothdirectly and via insulin-like growth factor 1(IGF-l) (2), During puberty, the sex hormones

also play a primary role in normal development(6),

The insufficient production of growth-promolinghormones, or the lack of response by the targettissues can result in growth failure and disturbancesin bone metabolism (7, 8), Subnormal GH secre-tion is classified as either GH-deficiency orGH-insufficiency (2, 9),

Children with GH deficiency exhibit signs suchas short stature, changes in orofacial development,and retarded dental maturity (10-13). Most of thestudies on dental maturity in children withGH-deficiency have been performed with smallgroups of post-pubertal children with different med-ical diagnoses. The aim of this investigation wastherefore to study dental maturity in healthy prepu-bertal children of short stature with or withoutGH-deficiency,

552 Kreknianova et al.

Patients and methods

This is the baseline investigation of a 2-year longit-udinal study of dental maturity and craniofacialgrowth in children of short stature (height

Dental maturity and growth hormone deficiency 5 5 3

Table I

Chronological age atid dental maturity scores (dental age) in children of slwri stature with or u~ithoiit GH-defideney and respectiveage- atid sex-matched controls: x= mean values, .sd = statidard deviations

Methods for estimationof denta! maturity

chronological age (years)KATAJA et al. (15)LtUEQVIST & LUNDBERG ( 1 6 )

GusTAVssoN & K O C H (17)

HA.WIKKO (18)

Short GH-deficient(n =

Si

10.29.49.08.98.9

29)

sd.

2.32.41.52.22.2

Controls{n--

x.

10.010.29.69.89.8

= 87)

sd.

2.2 n.s.2.4 n.s.2.0 n.s.2.3 n.s.2.3 n.s.

Short GH non-deficient(n =

8.57.88.67.47.3

• 1 7 )

sd j

2.12 71.52.62.6

Controls(n-

X,

8.88.99.48.48.4

= 51)

sd^

2.5 n.s.2.7 n.s.1.9 n.s.2.6 n.s.2.5 n.s.

Student MesL level of significance: n.s.^non significant.

Table 2

Comparison between dental malwiiy scores (denial age} and chronological age in children of short stature nith or wiihout GH-deJiciencyand respective age- and sex-matched eontrols; d=mean difference between dental ages, and chronologiea! ages, sd= standard deviations

Methods for estimationof denial maturity

KATAJA et al. (15)

LiLJEQVIST & L U N D B E R G ( 1 6 )

G u s T A V S S Q N .& K O C H ( 1 7 )

HA.AVIKKO 118)

ShorlGH-deficient

{/i = 29)

di sd.

-0.67 0.89-1.80 0.63-1.22 l.,08-1.40 0.92

Controls

di

0.23-0.87-O.,22-0.51

= 87)

sd.

1.07***1.20***1.14***0.95***

Short GHnon-deficient

(n=17)

d, sd.

-0 .95 0.82-1 .45 0.82-1.43 1.16-1.48 0.70

Controls(n =

d.

0.16-0 .70-0 .36-0.41

^51)

sd.,

1.06***0.98*1.07***1.06***

Contrast

/-value

0.6690.6160.1800.608

P

n.s.n.s.n.s.n.s.

Stodent /-test, level of significance: * = / '

5 5 4 Krekmanova et al.

The independent variables considered in the modelwere chronological age, tooth length and width,weight, sitting height, predicted adult height, max-imum peak GH during Arg-Ins test, IGF-1, ALP.T3, T4, TSH, and RUS, i.e., bone age. Statisticallysignificant correlations between dental age andsitting height (P

Dental maturity and growth hormone deficiency 5 5 5

maturity according to K.\TAJA et al. (15) as thedependent variable showed that the sitting heightand GH level were significant variables enteringthe model. This finding indicates a correlationbetween GH and dental maturity, which is inaccordance with the concept that GH is the mainregulator of childhood and adolescent growth (6).The fact that there were no significant differencesin dental maturity between children of short staturewith or without GH-deficiency and the suggestionthat GH level is associated to dental maturity mayseem to be a paradox. However, the definition ofGH deficiency at L E . WESTPHAL O. Growth hormone treatmentof short stature. Ada Paediatr Scand (Suppli i989; 362;9-13.

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