Dental aspects of hyperparathyroidism

Abstract

This report is based upon the study of thirteen dentulous patients with histologically proved hyperparathyroidism. The patients are in addition to the forty-two consecutive dentulous patients with surgically proved hyperparathyroidism previously reported. Four of the total of fifty-five patients in both studies revealed dental-structure changes of loss of lamina dura, giant-cell tumors, and demineralization. Involvement of the jawbones appears to be a late change and the least sensitive indicator of parathyroid overactivity, as compared to hypercalcemia, renal phosphate leak, hypophosphatemia, elevated alkaline phosphatase levels, and other bony lesions. It is concluded that the loss of lamina dura and the apearance of giant-cell tumors are late signs of hyperparathyroid bone disease, which is itself a late complication of primary hyperparathyroidism. However, even though infrequently found, changes in the dental structures may be the first sign of primary hyperparathyroidism. Roentgenographic jawbone alterations must be differentiated from other diseases which may have the same roentgenographic manifestations. Giant-cell lesions may reflect local neoplasia, an inflammatory process, or a parathyroid adenoma. Therefore, correlation of microscopic, clinical, roentgenographic, and laboratory findings is necessary before one can arrive at a definitive diagnosis.