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Systematic review of oral manifestations related to hyperparathyroidism

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Abstract

Objectives

We sought to identify oral symptoms found in hyperparathyroidism and compare their rate of occurrence, as well as potential variations in sequelae between primary, secondary, and tertiary hyperparathyroidism.

Materials and methods

Database searches were performed through EMBASE and PubMed, with a continual handsearch for relevant articles. PRISMA guidelines were followed.

Results

Two hundred five articles including 245 patients were analyzed with data extraction. The average age was 34.02 years old (age range 1–83), with 91 male and 154 female patients (1:1.7 M/F ratio). Patients presented with symptoms including facial asymmetry or swelling (167/214 cases; 78.0%), oral pain (30/214; 14.0%), systemic symptoms (25/214; 11.7%), referrals or incidental findings (16/214; 7.5%), and neuropathy (6/214; 2.8%) independently and in combination together. Bony pathology occurred most often in the mandible (100/245 cases; 40.8%), while 72 cases were in the maxilla (29.4%) and 73 cases in both jaw bones (29.8%).

Conclusions

Our data collection identifies a wide variation in the presentation of hyperparathyroidism. In order to be more certain of oral maladies from hyperparathyroidism, studies with large patient populations need to be conducted at healthcare centers to clarify the oral outcomes of hyperparathyroidism.

Clinical relevance

What was thought to be a characteristic finding of HPT, mandibular radiolucency occurred in only a minor portion of cases. Furthermore, the pathognomonic sign of HPT on radiograph, loss of lamina dura, was only the third most common presentation. Bone pathology was most commonly reported in literature, but should not be assumed the only oral sequelae of hyperparathyroidism.

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Acknowledgements

The authors would like to once again give their sincere thanks to Dr. Paul Bain from Harvard’s Countway Library for his immense help formulating these searches. Furthermore, the authors would like to thank Dr. Nalton Ferraro for supporting this manuscript with a clinical case.

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Authors and Affiliations

  1. Harvard School of Dental Medicine, Boston, MA, USA

    Benjamin Palla

  2. Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Munich, Germany

    Egon Burian, Riham Fliefel & Sven Otto

  3. Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstraße 2a, 80337, Munich, Germany

    Egon Burian & Sven Otto

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  1. Benjamin Palla
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  2. Egon Burian
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  3. Riham Fliefel
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  4. Sven Otto
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Contributions

Data collection: BP and EB. Data interpretation: BP, EB, and SO. Figures and tables: BP. Drafting manuscript: BP and EB. Revising manuscript: BP, EB, RF, and SO. SO supervised the review.

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Correspondence to Egon Burian.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Palla, B., Burian, E., Fliefel, R. et al. Systematic review of oral manifestations related to hyperparathyroidism. Clin Oral Invest 22, 1–27 (2018). https://doi.org/10.1007/s00784-017-2124-0

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