(34) Acromegaly: Craniofacial Features and Oral Manifestations – The Role of the Oral Healthcare Provider

Abstract: Acromegaly was first discovered in the late 19th century in Europe. Initially a neuroendocrine entity, its management quickly became a disease requiring the interface of multiple medical specialties primarily involving endocrinology and neurosurgery. The worldwide prevalence estimate is around 50 cases per million with an annual incidence of about 3.5 cases per million. Nevertheless, this diagnosis comes with a wide variety of comorbidities that develop into a progressing chronic disease. Delayed diagnosis is finally achieved typically in the fourth decade of life, usually 10 years after initial symptoms arise. Morbidity and mortality are both high in this insidious disease encompassing multi-system pathophysiology. Mortality rates are easily double that of the general population.
Today the oral healthcare provider has become key in the diagnosis and management of this condition. In fact, a dental diastema is one of the signs required for early disease detection. Pituitary Tumor Centers of Excellence (PTCOE) should include dental providers of all subspecialties, namely Oral and Maxillofacial Surgeons, in the care of these patients (1).
A paucity of literature exists in this realm. We have conducted a literature review to this effect with the goal of raising awareness amongst our peers. Our experience with patient out-reach programs at New York University (NYU) College of Dentistry and affiliate medical center quickly shed light on this gap in care.
Our profession can contribute immensely to the screening of craniofacial and oral features within this group of patients. Furthermore, early screening of acromegalic patients is already being promoted by periodic visits at the level of pediatric dentistry (2). Typical manifestations are apparent in both soft and hard tissues involving a spectrum of periodontal disease, dental anatomy variations, occlusal scheme discrepancies and finally craniofacial anomalies. Oral and maxillofacial surgical care should play an active role in this process. Conversely, surgical treatment ranges from simple dento-alveolar procedures addressing basic pre-prosthetic correction all the way to complex craniofacial surgeries such as alleviation of obstructive sleep apnea.
We encourage early intervention: this not only optimizes reversibility of associated features but can also avoid subsequent invasive treatment, potentially recurrent and debilitating in late adulthood. To this effect, assessment tools should be introduced in dental schools and implemented in routine care to screen for this patient population. A multi-disciplinary team approach between the medical and dental healthcare providers is essential. At NYU, we are developing a collaboration between colleagues from both the dental and medical spheres. Our goals include an international multi-center partnership, especially seeing how rare this entity is.

References:

1. Frara, Stefano, et al. "Pituitary tumors centers of excellence." Endocrinology and Metabolism Clinics 49.3 (2020): 553-564.

2. Preo, Giorgia, et al. "The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study." Pituitary (2022): 1-8.