Factors affecting growth and development /certified fixed orthodontic courses by Indian dental academy


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Factors affecting growth and development /certified fixed orthodontic courses by Indian dental academy

  1. 1. FACTORS AFFECTING GROWTH AND DEVELOPMENT www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  4. 4. Contents 1. 2. 3. 4. 5. Definition Classification Prenatal factors Natal factors Postnatal factors www.indiandentalacademy.com
  5. 5. GROWTH    It is the quantitative aspect of biologic development and is measured in units of increase per units of time.--- MOYERS Change in any morphological parameter which is measurable– MOSS Increase in size, change in proportion and progressive complexity-- KROGMAN www.indiandentalacademy.com
  6. 6. DEVELOPMENT     Progress towards maturity– TODD All naturally occurring unidirectional changes in the life of an individual from its existence as a single cell to its elaboration as a multifunctional unit terminating in death– MOYERS Characterized by changes in complexity, a shift to fixation of function, and more independence, all of which is under genetic control, yet modified by the environment. DEVELOPMENT=GROWTH+DIFFERENTIATIO N+TRANSLOCATION www.indiandentalacademy.com
  7. 7. Why to assess growth of an individual? 1. 2. 3. 4. Identification of grossly abnormal pathologic growth. Recognition and diagnosis of significant deviations from normal growth. Planning of therapy. Determination of the efficacy of therapy. www.indiandentalacademy.com
  9. 9. VAN LIMBORGH’S CLASSIFICATION 1. 2. 3. INTRINSIC FACTORS EPIGENITIC FACTORS a) Local b) General ENVIRONMENTAL FACTORS a) Local b) General www.indiandentalacademy.com
  10. 10.    Pre natal Natal Post natal www.indiandentalacademy.com
  11. 11. Pre-natal factors 1. 2. 3. 4. 5. 6. 7. Developmental anomalies. Teratogens. Congenital infections. Maternal health. Socioeconomic status of parents. Multiple births. Congenital defects. www.indiandentalacademy.com
  12. 12. Natal causes 1. 2. Trauma during birth. e.g. forceps delivery Intrauterine moulding. www.indiandentalacademy.com
  13. 13. Post natal factors 1. 2. 3. Hereditary Epigenitic Environmental www.indiandentalacademy.com
  14. 14. PRENATAL FACTORS www.indiandentalacademy.com
  16. 16. Pierrie robin syndrome      Retrognathia or micrognathia Glossoptosis Airway obstruction Crying child Management- prone position, relief of airway, mandibular lengthening process www.indiandentalacademy.com
  17. 17. Treacher collins syndrome      Autosomal dominantmutation in tracheal gene Diminished neural crest cell migration Avian like faces with colobamata of lower eyelids, slanting palpebral fissures, malar defficiencies, microstomia, auricular defects. Severe conditions show malformed ears, cleft palate. Enlarged antigonial notch. www.indiandentalacademy.com
  18. 18. Crouzon syndrome     Maxilary hypoplasia with reduced dental arches and crowding Prenatal fusion of superior and posterior sutures of maxilla Short upper lip, widely spaced eyes, protruding eyeballs Unilateral or bilateral crossbite www.indiandentalacademy.com
  19. 19. Apert syndrome    Premature fusion of skull bonesmalformed head shape protruding eyes, fused fingers and toes, cleft palate, airway problems, ear infections and hearing loss, etc Management- multidisciplinary approach.. Orthodontist play a role in correction of facial form. www.indiandentalacademy.com
  20. 20. Hereditary ectodermal dysplasia      X linked recessive disorder… Hypohydrosis , hypotrichosis and hypodontia Decreased vertical dimension of face, protruding lips, thin sparse hair over the head. Very few teeth, malshaped or peg shaped teeth, caries Severe cases may be associated with cleft of lip or palate www.indiandentalacademy.com
  21. 21. Hemifacial hypertrophy     One half of face enlarged F>M Unilateral teeth size, tongue increased Eruption of teeth on affected side is hastened www.indiandentalacademy.com
  22. 22. Cleft lip and palate     1 in 700 Most common congenital anomaly Due to nonfusion of medial nasal, lateral nasal and maxillary process Oronasal communication, facial deformity, malposition of teeth, speech problems, breathing problems, frequent infections www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. TERATOGENS  Agents which are capable of producing embryological defects in critical doses.  Can be physical , chemical or biological agents. www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. Other prenatal factors 1. 2. 3. 4. 5. 6. Poor maternal health Mother’s nutritional status Placental insufficiency Multiple births Socioeconomic conditions Congenital infections www.indiandentalacademy.com
  27. 27. Poor maternal health    E.g systemic diseases like renal failure, cardiac failure, diabetes, hypertension Affects fetus due to altered blood flow, altered diet of mother, drugs Also complications during delivery www.indiandentalacademy.com
  28. 28. Mother nutritional status     Balance diet Alcohol and cicarettes Depends on financial condition, culture, society, emotional status of mother Fetal alcohol syndrome- due to defficiency of midline tissue of neural plate www.indiandentalacademy.com
  29. 29.  Placental insufficiency- may occur due to poor nutrition of mother, maternal health, etc  Multiple births- 1st child is less in weight and more in I.Q when compared to subsequent children. Too many children- difficult to concentrate www.indiandentalacademy.com
  30. 30.  Socioeconomic conditions- children with unfavorable conditions lag in growth and development when compared to children with favorable conditions  Congenital infections- CMV, Rubella, toxoplasmosis, syphilis, HSV, HIV www.indiandentalacademy.com
  31. 31. NATAL FACTORS www.indiandentalacademy.com
  32. 32. Intrauterine moulding 1. 2. 3. Pressure of arm against face– maxillary defficiency. Flexion of head against chest– mandibular deffiency. Forceps delivery www.indiandentalacademy.com
  33. 33. 4. Sometimes head distortion during passage through the birth canal www.indiandentalacademy.com
  34. 34. Childhood fractures     # of condyle is most common Reduced development on the affected side Jaw deviated to affected side. Management- early mobilisation and symptomatic treatment www.indiandentalacademy.com
  35. 35. GENETIC FACTORS     Actual outcome of growth= genetic potential+ environmental influences. Mutations- inherited by offspring Genetic studies make use of twin and family data. N.b:- difference between growth before and during adolescence. www.indiandentalacademy.com
  36. 36.  a) b) c) Genes control:Size of body parts Rate of growth Onset of growth events e.g menarche, calcification of teeth, eruption of teeth, ossification of bones and start of adolescent growth spurt. www.indiandentalacademy.com
  37. 37. Genetic influences on malocclusion    Malocclusion runs in families– e.g Hapsburg jaw Primitive humans– genetic isolation– uniform malocclusion Urban population– e.g U.S.A c/a Genetic melting point have highest rate of malocclusion. www.indiandentalacademy.com
  38. 38. Stockard study    Crossbreeding of boston terrier with collie Results showed malocclusions due to jaw discrepancies than from tooth size- jaw imbalances. Results were misleading as malocclusions were due to the extent to which achondroplasia was expressed. www.indiandentalacademy.com
  39. 39. Twin study by Lundstorm(1963)       100 pair of twins 50 monozygotic & 50 dizygotic Skeletal and dental overjets measured More variations in dizygotic Skeletal problems were more variable Disadv– environmental and climatic conditions may not be the same for both the twins www.indiandentalacademy.com
  40. 40. Epigenetic factors   Genetically determined but manifest influence on associated structures– GRABER Sum total of all biochemical, biomechanical and biophysical events produced by the functioning of cells, tissues and the organs– RAKOSI AND PETROVIC www.indiandentalacademy.com
  41. 41.    Primary genetic control determines certain initial features like tooth buds calcify in jaws,etc. But there are inductive local feedback and inner communication mechanisms between cells and tissues- e.g teeth talk to bone. If face is under genetic control then it should be possible to predict 100% features of children from cephalometric data of parents. www.indiandentalacademy.com
  42. 42.  1. 2. Hence from investigations so far, two conclusions are inescapable:Inheritance of facial dimensions is polygenic Not more than 25% of any variability of any dimension in children can be explained by consideration of that dimension in parents. www.indiandentalacademy.com
  43. 43.  1. 2. 3.  1. 2. Local epigenetic factors– Muscles “ what is environment to bone is genetic to muscles and teeth” Neurotropism Function General epigenetic factors– Hormonal General body growth www.indiandentalacademy.com
  44. 44. Muscles  Influences both initiation and formation of bone  Decreased contraction– underdevelopment of that part of face  Excessive contraction– restricts the growth e.g torticollis or wry neck. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. Neurotropism  It is the nervous control of skeletal growth by transmission of a substance through the axons  TypesNeuromuscular Neuroepithelial Neurovisceral 1. 2. 3. www.indiandentalacademy.com
  47. 47. Axoplasmic transport Efferent- muscle www.indiandentalacademy.com Afferent-epithelial cell
  48. 48. Neuromuscular trophic relationships 1. 2. 3. 4. 5. Muscle development Muscle denervation- reinnervation Cross- innervation Hyperneuralization Control of genetic activity www.indiandentalacademy.com
  49. 49. Muscle development  Myoblast stage of differentiation- neural innervation is established  If muscle is not efferently innervated- motor end plates will never develop.  Also muscle spindles, receptors and tendon organs require afferent innervation. www.indiandentalacademy.com
  50. 50. Muscle denervation and reinnervation  Ventral root section- muscle degeneration  Denervation atrophy or disuse atrophy of innervated but inactive muscles?  Studitsky et al(’62)— Autotransplanted mince muscle fragments– if supplied by motor nerve– reform to functioning muscle www.indiandentalacademy.com
  51. 51. Cross innervation  Demonstrates neurotrophic relationship between neuron and uninnervated tissue.  Motor nerve to fast and slow muscles cut- fast nerve + slow muscle and vice versa  Results- fast muscle becomes slow and vice versa. www.indiandentalacademy.com
  52. 52. Hyperneuralisation  It is seen when neurotrophic substance were released in quantal amounts.  Nerve crushed and 2nd nerve implanted- will form new end plate but if implanted www.indiandentalacademy.com
  53. 53. Neurotrophic control of genetic activity  Protein synthesis in oral epithelial cells  Specific enzymes synthesis in epithelium  Mechanism- direct control on the synthesis of DNA, RNA and Protein synthesis www.indiandentalacademy.com
  54. 54. General body growth  Rate, pattern, timing of peak growth is different for different individual  Affected by many factors like genetic, hormonal, climate, racial, nutritional  Height– 2 spurts 6-7 yrs- small but inconsistent Pubertal spurt- 12 yrs in girls and 14 in boys www.indiandentalacademy.com 1. 2. www.indiandentalacademy.com
  55. 55. Hormones  I excite or arouse  Specific stimulus– endocrine glands release hormones into circulation in small amounts--acts on target cells  2nd great controlling system of our body after nervous system  Most mysterious and elegant of all systems of the body. www.indiandentalacademy.com
  56. 56. Hormones responsible for growth 1. 2. 3. Group I- responsible for influencing skeletal growth .e.g GH, Insulin, Thyrotrophic hormones Group II- responsible for ossification of long bones. E.g Parathormone Group III- responsible for pubertal growth spurts .e.g Androgens, Progesterone, Estrogen www.indiandentalacademy.com
  57. 57. 4. Group IV- prolactin www.indiandentalacademy.com
  58. 58. Growth hormone  Infancy- growth due to thyroid hormone and GH.  Permissive action  Excess GH- Gigantism and Acromegaly  Decrease GH- Dwarfism www.indiandentalacademy.com
  59. 59. Summary of effects of growth hormones Ant pitutary GH Negative feedback mechanism Indirect growth promoting action Direct anti insulin action cortisol Liver and other organs somatomedians Skeletal chondrogenesis Skeletal growth extraskeletal Protein synthesis fat lipolysis www.indiandentalacademy.com Cell proliferation carbohydrate Blood sugar
  60. 60. GIGANTISM  Increased production of GH before the closure of the epiphyseal plate- grows at rapid pace .  Clinical features Extreme height (7 ft tall)  Oral changes Enlargement of facial soft tissues Enlargement of the mandible True generalized macrodontia www.indiandentalacademy.com
  61. 61. ACROMEGALY •Excess GH after the closure of the epiphyseal plate. •Clinical features Increased size of hands and feet coarse facial features •Oral changes cause or accentuate sleep apnea Mandibular prognathism -- Apertognathia www.indiandentalacademy.com (anterior open bite), spacing, macroglossia
  62. 62. Acromegaly www.indiandentalacademy.com
  63. 63. PITUITARY DWARFISM • Decreased production of GH Clinical features 1. Short stature 2. Face is small 3. skull size is usually normal www.indiandentalacademy.com
  64. 64. Oral changes  Smaller jaws  Size of teeth is reduced with delayed eruption  Shedding of deciduous teeth is delayed by several years  Third molars absent www.indiandentalacademy.com
  65. 65. Thyroid hormones  T3 and T4(follicular cells)  Calcitonin (parafollicular cells)  Inc O2 consumption by cells  Key role in development of brain and nervous system in children. www.indiandentalacademy.com
  66. 66. Hyperthyroidism      Graves disease Enlarged thyroid CNS signs Cardiac signs Wasting of muscles, heat intolerance, osteoporosis (bone resorption) www.indiandentalacademy.com
  67. 67. Hypothyroidism      Myxoedema , Cretinism Inc sleep, dec memory, slow reflexes Yellowish discolouration of skin, cold sensitivity, nonpitting oedema Mental retardation Decreased sexual development www.indiandentalacademy.com
  68. 68. Parathormone Chief cells  Increases serum Ca levels.  Hypoparathyroidism- Tetany Tingling and numbness  Hyperparathyroidism- osteitis fibrosa cystica Bone fractures, decreased muscle tone, mental confusion  www.indiandentalacademy.com
  69. 69. Adrenal glands Adrenal medulla Adrenaline Noradrenaline Adrenal cortex Zona glomerulasasalt Zona fasciculatasugar Zona reticularissex www.indiandentalacademy.com
  70. 70. Glucocorticoids  Cortisol, corticosterone  Must in medical kit  Stimulates gluconeogenesis, protein catabolism, anti allergic and anti inflammatory www.indiandentalacademy.com
  71. 71. Insufficiency of adrenal cortex Chronic form Acute form Waterhouse friderichen syndrome Addison's disease -Primarily occurs in children -Auto immune destruction of adrenal glands -Fulminating septic course and death in 48-72 hrs - leathergy, fatigue, muscular weakness www.indiandentalacademy.com
  72. 72. Hyperfunctioning of adrenal cortex     Cushing syndrome Moon face, buffalo hump, muscular weakness Children- premature cessation of epiphyseal growth Adults- severe osteoporosis www.indiandentalacademy.com www.indiandentalacademy.com
  73. 73. Sex hormones  Males- testosterone  Females- estrogen and progesterone  Growth spurts www.indiandentalacademy.com
  74. 74. Girls- I- onset of spurt II- peak height velocity III- onset of menstruation Boys- I-fat spurt (feminine fat distribution) II- height spurt III- peak height velocity www.indiandentalacademy.com IV- end of growth spurt
  75. 75. Environmental factors  Local environmental factors- Habits  General environmental factorsNutrition Illness Race 1. 2. 3. www.indiandentalacademy.com
  76. 76. 4. 5. 6. 7. 8. 9. Climate and seasonal effects Exercise Family size and birth order Psychological disturbances Socioeconomic conditions Secular trends www.indiandentalacademy.com
  77. 77. Habits  Eg. Tongue thrusting, mouthbreathing, thumbsucking  Alter functional equilibrium  Normal growth- abnormal growth www.indiandentalacademy.com
  78. 78. Thumb sucking  Mainly to obtain- nutrients, feelings of euphoria, sense of security and feeling of warmth.  Till 3-4 years normal  Management- psychological Remainder therapies www.indiandentalacademy.com
  79. 79. Tongue thrusting  Tongue between ant teeth and against lower lip during swallowing  Skeletal open bite  Management- tongue crib www.indiandentalacademy.com
  80. 80. Mouth breathing  Lowering of mandible and tongue with extension of head  Adenoid faces  Management- Removal of etiology www.indiandentalacademy.com
  81. 81. THE NUTRIENTS Essential nutrients Non essential nutrients Cellulose, Proteins, Fats, Hemicelulose, Carbohydrates, Pectins Vitamins, Minerals Water www.indiandentalacademy.com
  82. 82. Proteins   Body building food Important in infancy and childhood  protein def- reduction in jaw size- new bone sensitive to protein  Delayed eruption of teeth. www.indiandentalacademy.com
  83. 83. VITAMINS Water soluble Fat soluble Vit A Vit D Non B complex Vit E Vit K B-complex Vitamin C Energy releasing Hematopoietic Thaimin B1,Riboflavi B2 Folic acid Niacin B3,PyridoxineB6 Vit B12 Biotin B7,Pantothenic acid www.indiandentalacademy.com
  84. 84. Vit A in growth Malformed enamel Retardation of eruption Disturbances in calcification of teeth Disturbances of periodontal tissues www.indiandentalacademy.com
  85. 85. www.indiandentalacademy.com Vitamin D metabolism
  86. 86. Vitamin D  Rickets and Osteomalacia  Retarded eruption of the deciduous and the permanent teeth  Jaw bones are thickened and the teeth irregularly arranged  Narrow maxilla and high arched palate. The mandible is shortened www.indiandentalacademy.com
  87. 87. Vitamin C  Scurvy  Collagen synthesis  Swollen bleeding gums, periodontal breakdown- mobile teeth www.indiandentalacademy.com
  88. 88. Minerals 1. 2. 3. 4% human body weight Macro minerals (require in >100mg/day).Ca,P,Na,K,Mg Micro minerals (Trace elements) Fl,I,Cu,Co,Mn,Se,Cr,Zn.(.004-.00004% of body weight) www.indiandentalacademy.com
  89. 89. Calcium  Function:-  Rigidity to bone and teeth  Blood coagulation n muscle contraction…  Necessary for release of neurotransmitter www.indiandentalacademy.com
  90. 90. www.indiandentalacademy.com Calcium homeostasis
  91. 91. Phosphorous   FunctionsFormation of bone and tooth  Constituent of nucleotides and nucleic acid  Constituent of lipids  Regulation of acid-base balance www.indiandentalacademy.com
  92. 92. Illness  Minor illness- no effect  Major and prolong illness- marked effect  Catch up growth after recovery www.indiandentalacademy.com
  93. 93. Race  Due to climatic, nutritional or socioeconomic conditions  Gene pool differences www.indiandentalacademy.com
  94. 94. Climate and seasonal effects  Cold climates- more adipose tissue  Autum- inc height  Spring- inc weight  Growth inc during night www.indiandentalacademy.com
  95. 95. Exercise  Effect on linear growth not made in quantitative fashion-MOYERS  Exercise- increase in muscle mass www.indiandentalacademy.com
  96. 96. Psychological disturbances  Due to reduction in GH levels  Catch up growth www.indiandentalacademy.com
  97. 97. Socioeconomic factors  Favourable conditions- children are larger, display different types of growth, show variation in timing of growth when compared with disadvantaged children.  Standard of living more imp than income www.indiandentalacademy.com
  98. 98. Secular trends  15 yr boy 5” taller than boy 50 yrs ago  Onset of growth is earlier but growth also stops earlier  Menarche achieved earlier in girls when compared with 50 yrs ago  No satisfactory www.indiandentalacademy.com such trends explanation for
  99. 99. Summary Prenatal factors Developmental anomalies Teratogens Congenital infections Condition of mother During pregnancy Natal factors Intrauterine moulding Forceps delivery Childhood # www.indiandentalacademy.com Post natal factors Genetic factors Epigenetic factors Environmental factors
  100. 100. References 1. 2. 3. 4. 5. Hand book of orthodontics- MOYERS Contemporary orthodontics- PROFFIT Control mechanisms in craniofacial growthJAMES McNAMARA (monograph 3Craniofacial Growth Series) Orthodontic principles and practiceT.M.GRABER Essentials of physiology- A.K.JAIN www.indiandentalacademy.com
  101. 101. 6. 7. 8. 9. 10. Nature vs. nurture in dentofacial variationA. LUNDSTROM (Eu J Ortho, 1984) Textbook of orthodontics- BISHARA, I Ed Textbook of Oral Pathology-SHAFER’S Essentials of Biochemistry- T.N. PATABHIRAMAN Textbook of Pedodontics- SHOBHA TONDON www.indiandentalacademy.com
  102. 102. www.indiandentalacademy.com
  103. 103. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com