Dentists and orthodontists play a key role in recognizing the facial manifestations of acromegaly



October 11, 2021

1 minute read

Disclosures: The authors do not report any relevant financial disclosures.

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Dentists and orthodontists are uniquely positioned to identify the earliest facial manifestations of acromegaly, although new survey data suggests that more awareness of the disease is needed to improve early diagnoses.

The facial features of people with acromegaly include mandibular prognathism, development of supraorbital ridges and cheekbones, altered nose and ear size, thickening of soft tissue and lips, and facial asymmetry, Francesca Dassie, MD, from the faculty of dentistry at the University of Padua, Italy, and colleagues wrote in the context of the study. Up to 80% of patients present with oral features including mandibular growth, occlusion disturbances, dental malocclusion, dental diastema, and macroglossia, all of which can contribute to the development of obstructive sleep disorders.

Acromegaly 2019
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“Facial dysmorphia and oral changes are among the most common and early manifestations of acromegaly,” the researchers wrote. “The onset of facial dysmorphism may precede the diagnosis of acromegaly for up to 10 years.”

Dassie and his colleagues administered a questionnaire to assess the ability of 220 dentists and 206 orthodontists to recognize early recognition of orofacial manifestations of acromegaly. The questionnaire included photos with facial and oral details and a lateral teleradiography of patients with acromegaly.

On examination of the photos, dentists have most often observed mandibular prognathism and projection of the lips; orthodontists have also reported the alteration of the relative soft tissues. “Orthodontists, who typically use photos to document patients’ oral features, have paid more attention to oral impairment than dentists,” the researchers wrote.

During the dental assessment, 90% of participants generally assessed the size and appearance of the tongue, the presence of diastemas, and signs of sleep disturbance. Orthodontists were also better able to identify sella turcica enlargement on teleradiography. Of the participants, 10.8% had patients with a diagnosis of acromegaly and 11.3% referred at least one patient with suspected acromegaly.

“Dentists could play a strategic role in identifying patients with acromegaly and their co-morbidities; however, the fact that only a very small percentage of them claimed to have intercepted suspects suggests that there is not yet enough knowledge and sensitivity regarding the pathology, ”the researchers wrote. “Raising awareness among dentists of the clinical issues of patients with acromegaly, the availability of tools such as ACROSCORE for non-endocrinologists, and the use of photos with the facial and oral details of patients can improve the early diagnosis of the disease.” acromegaly. “



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