Sex differences in dental development in children with precocious puberty related to central nervous system lesions.

Forty-three children with precocious puberty related to central nervous system (CNS) lesions were examined. Plasma concentrations of estradiol in the females and testosterone in the males were obtained. Panoramic radiographs were used to assess dental root and crown development. All mandibular canines, premolars, and molars were included which could be visualized without apparent distortion. Dental development was retarded significantly relative to chronological age in female patients with CNS lesion-related precocious puberty. However, no significant abnormal dental development was detected in the males of the same group. The data suggest hat elevated levels of estrogen associated with precocious puberty may retard odonto~enesis. Hormonal effects on developing teeth have been postulated but not demonstrated clearly. 1-4 Oral evaluations of patients with precocious puberty and with Turner’s syndrome have suggested that hormones associated with the hypothalamic-pituitarygonadal (HPG) axis may have subtle influences dental and craniofacial development. 3,s,6 In a previous study of 101 children with precocious puberty, we observed that dental development was normal in all diagnostic categories except idiopathic precocious puberty (IPP). 6 The children with IPP had significantly delayed dental development despite advanced skeletal age. Seeking to explain their delayed dental development, we postulated that the effect of precocious puberty in dental development and in the relationship between dental and skeletal development might differ according to sex, since 98% of our patients with IPP were girls. To evaluate this hypothesis, we examined the effect of sex on dental development in male and female children with precocious puberty due to central nervous system (CNS) lesions. This diagnostic group was chosen because it was the only one in which there were sufficient numbers of children from each sex to perform statistical analysis. Central precocious puberty (CPP) is the result premature activation of the HPG axis and can be either idiopathic or the result of CNS system tumors or abnormalities. 7 CPP in boys causes increased plasma testosterone, whereas CPP in girls causes increased plasma estradiol. Methods and Materials The authors examined 43 white patients who were referred to the National Institute of Child Health and Human Development with a diagnosis of CNS-related precocious puberty. Data from some of these patients, without analysis of possible sex differences, were included in an earlier report. 6 The diagnoses of the 29 females included hypothalamic hamartoma (14), congenital hydrocephalus (4), astrocytoma (3), neurofibromatosis (2), dermoid teratoma (1), arachnoid cyst (1), optic glioma (1) ependymoblastoma (1), Dandy-Walker syndrome (1), and nold-Chiari syndrome (1). The diagnoses of the males included hypothalamic hamartoma (6), astrocytoma (5), neurofibromatosis (1), glioma (1), arachnoid cyst (1). Plasma estradiol levels were obtained in the female patients and plasma testosterone levels were determined in the males. The skeletal age was assessed for each patient using radiographs of the wrist and hand. 8 A panoramic radiograph was used to evaluate odontogenic crown and root development2 ,9 Included were all molars, premolars, and canines which showed no apparent radiographic distortion. Teeth with closed root 276 DENTAL DEVELOPMENT AND CNS LESION-RELATED PRECOCIOUS PUBERTY:ROBERTS et al. TABLE 1. Dental Age by Sex in Children With Precocious Puberty Related to Central Nervous System Lesions Sex Mean Dental Age (Standard Deviation Units Number Number Number Relative with with Adwith to Number Age Range and Normal vanced Delayed Normal Signifiof Mean Age Dental Dental Dental Concance Patients (Years~Months) Age Age Age trois) Level*