A case of generalized osteitis fibrosa demonstrating the effect of hyperparathyroidism on tooth development

Abstract

The effect of hyperparathyroidism on the developing teeth of a young patient (aged fifteen) suffering from generalized osteitis fibrosa has been studied. Although the mandible, as well as the maxilla, was extensively affected by the disease and the teeth were surrounded by bone showing marked resorption, there was no evidence of resorption inside of the teeth. Contrarily, the unusually good teeth with no cavities and only one filling, as well as the formation of pulp stones, point to the fact that due to the hypercalcemia the calcification of the dental structures is increased rather than depleted. The most striking effects of hyperparathyroidism are as follows: (1) interruption of the tooth development, producing marked defects in dentin formation, seen as deeply stained contour lines, which are probably records of very severe or active phases of the disease; (2) formation of osteodentin, produced when odontoblasts are destroyed ; and (3) formation of osteocementum deposited at the root surfaces in excessive amounts. A completed tooth in a person who has contracted the disease in later life would probably show none of these changes in the dentin. It may be concluded that teeth present a very stable deposit of calcium, which is not readily resorbed, because it was not affected in this severe case of hyperparathyroidism. This is in line with the findings of Bauer, Aub and Albright1 who state that the bone trabeculae serve as the most available source of calcium. It also concurs with the statement of Jaffe, Bodansky, and Blair8 that labile calcium is found in the regions of most active bone growth. There is no continuous resorption and apposition in the adult tooth as there normally is in bone; therefore calcium salts are not readily available from this source. Since calcium is not resorbed from dentin in hyperparathyroidism, the further conclusion may be drawn that resorption does not occur in other systemic diseases such as pregnancy, osteomalacia, or diseases due to avitaminosis.