The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study

Abstract

Purpose Oro-facial manifestations of acromegaly are among the earliest signs of the disease and are reported by a significant number of patients at diagnosis. Despite this high prevalence of acromegaly oral manifestation, dentists do not play a pivotal role in acromegaly identification and diagnosis. The aim of our study was to evaluate the ability of dentists and orthodontists in the early recognition of the oro-facial manifestations of acromegaly. Methods A telematic questionnaire was administered to dentists and orthodontists. The questionnaire included photos with facial and oral-dental details and lateral teleradiography of acromegaly patients (ACRO). Results The study included 426 participants: 220 dentists and 206 orthodontists. Upon reviewing the photos, dentists most often observed mandibular prognathism and lips projection, while orthodontists also reported the impairment of relative soft tissue. Orthodontists, who usually use photos to document patients’ oral-facial characteristics, paid more attention to oral-facial impairment than dentists. During dental assessment, 90% of the participants usually evaluated tongue size and appearance, diastemas presence, and signs of sleep impairment (mainly orthodontists). Orthodontists were also more able to identify sella turcica enlargement at teleradiography. A total of 10.8% of the participants had ACRO as patients and 11.3% referred at least one patient for acromegaly suspicion. Conclusion The study highlighted dentists’ strategic role in identifying ACRO. Increasing dentists’ awareness about acromegaly clinical issues may improve early diagnosis, potentially resulting in an increased quality of life and decreased mortality among ACRO.

Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review

“…Nevertheless, clinicians should pay attention to these aspects when reading the results of radiographic examinations. Dentists and orthodontists [53] are advised not to focus their attention only on the teeth but to carefully examine every aspect of the oral cavity of each patient. On the other hand, these radiological examinations may be crucial also to nondentist professionals to rule out or confirm the possibility of a pathological involvement of the pituitary sellar area.…”

Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management

“…Acromegaly is a rare chronic disease characterized by systemic comorbidity and reduced quality of life. Acromegaly can be difficult to detect and is rarely recognized by non-specialist clinicians, resulting in a significant diagnostic delay, which inevitably causes a worsening of the patient's symptoms and general condition [ 1 ]. Despite the remarkable improvements recently achieved in acromegaly treatment, patient symptoms and quality of life are typically not completely under control, especially in case of active disease, and even in the case of good biochemical control [ 2 ].…”