{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:26:17Z","timestamp":1789694777867,"version":"4.0.1"},"reference-count":53,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T00:00:00Z","timestamp":1645142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acromegaly is a chronic disease caused by an abnormal secretion of growth hormone (GH) by a pituitary adenoma, resulting in an increased circulating concentration of insulin-like growth factor 1 (IGF-1). The main characteristics are a slow progression of signs and symptoms, with multisystemic involvement, leading to acral overgrowth, progressive somatic changes, and a complex range of comorbidities. Most of these comorbidities can be controlled with treatment. The literature reveals that the most evident and early signs are those related to soft tissue thickening and skeletal growth, especially in the head and neck region. Methods: The authors reviewed the available literature on the clinical oro-dental features of acromegaly, selecting articles from PubMed and Google Scholar.\u00a0The aim of this review was to summarize all the reported clinical oro-dental features of acromegalic patients. Results: The most common facial dimorphisms involved the maxillo-facial district, with hypertrophy of the paranasal sinuses, thickening of the frontal bones, and protruding glabella, which may be associated with joint pain and clicks. Regarding the oro-dental signs, the most frequent are dental diastema (40\u201343%), mandibular overgrowth (22\u201324%), mandibular prognathism (20\u201322%), and macroglossia (54\u201358%). These signs of acromegaly can be significantly reduced with adequate treatment, which is more effective when initiated early. Conclusions: Increased awareness of acromegaly among dentists and maxillo-facial surgeons, along with the early identification of oro-facial changes, could lead to an earlier diagnosis and treatment, thereby improving patients\u2019 quality of life and prognosis.<\/jats:p>","DOI":"10.3390\/jcm11041092","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:22:19Z","timestamp":1645431739000},"page":"1092","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9087-3953","authenticated-orcid":false,"given":"Alberto","family":"De Stefani","sequence":"first","affiliation":[{"name":"Faculty of Dentistry, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Dassie","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Preo","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Muneratto","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Fabris","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Maffei","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gracco","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2900-7196","authenticated-orcid":false,"given":"Giovanni","family":"Bruno","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1750-1172-3-17","article-title":"Acromegaly","volume":"3","author":"Chanson","year":"2008","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1556\/OH.2011.29109","article-title":"Az acromegalia korai felismer\u00e9s\u00e9nek jelentos\u00e9ge","volume":"152","author":"Valkusz","year":"2011","journal-title":"Orv. Hetil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s41572-019-0071-6","article-title":"Acromegaly","volume":"5","author":"Colao","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S0300-595X(86)80014-7","article-title":"10 Pathology of excessive production of growth hormone","volume":"15","author":"Scheithauer","year":"1986","journal-title":"Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000371808","article-title":"The History of Acromegaly","volume":"103","year":"2016","journal-title":"Neuroendocrinology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s11102-016-0772-8","article-title":"Acromegaly: Clinical features at diagnosis","volume":"20","author":"Vilar","year":"2017","journal-title":"Pituitary"},{"key":"ref_7","first-page":"411","article-title":"Acromegaly","volume":"110","author":"Dineen","year":"2017","journal-title":"QJM"},{"key":"ref_8","first-page":"57","article-title":"Updates in Diagnosis and Treatment of Acromegaly","volume":"14","author":"Zahr","year":"2018","journal-title":"Eur. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.beem.2009.05.010","article-title":"Acromegaly","volume":"23","author":"Chanson","year":"2009","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"932","DOI":"10.3389\/fendo.2020.610519","article-title":"Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study","volume":"11","author":"Guo","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Akirov, A., Asa, S.L., Amer, L., Shimon, I., and Ezzat, S. (2019). The Clinicopathological Spectrum of Acromegaly. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111962"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1038\/s41574-018-0114-1","article-title":"The causes and consequences of pituitary gigantism","volume":"14","author":"Beckers","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s11102-006-0409-4","article-title":"Acromegaly","volume":"9","author":"Scacchi","year":"2006","journal-title":"Pituitary"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4769","DOI":"10.1210\/jc.2006-1668","article-title":"High prevalence of pituitary adenomas: A cross-sectional study in the province of Li\u00e8ge, Belgium","volume":"91","author":"Daly","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez, C., Hern\u00e1ndez-Ramirez, L.C., Espinosa-De-Los-Monteros, A.L., Franco, J.M., Guinto, G., and Mercado, M. (2013). Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: A case report and review of the literature. BMC Res. Notes, 6.","DOI":"10.1186\/1756-0500-6-411"},{"key":"ref_16","unstructured":"(2022, January 30). Gigantism and Acromegaly-StatPearls-NCBI Bookshelf, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538261."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12022-017-9498-z","article-title":"Overview of the 2017 WHO Classification of Pituitary Tumors","volume":"28","author":"Mete","year":"2017","journal-title":"Endocr. Pathol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s11102-017-0789-7","article-title":"The genetic background of acromegaly","volume":"20","author":"Gadelha","year":"2017","journal-title":"Pituitary"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s12020-018-1571-y","article-title":"Oro-dental pathologies in acromegaly","volume":"60","author":"Kohlmann","year":"2018","journal-title":"Endocrine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"bcr2013200266","DOI":"10.1136\/bcr-2013-200266","article-title":"Seeing the unseen: Diagnosing acromegaly in a dental setup","volume":"2013","author":"Agrawal","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/cen.12959","article-title":"ACROSCORE: A new and simple tool for the diagnosis of acromegaly, a rare and underdiagnosed disease","volume":"84","author":"Prencipe","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1530\/EC-20-0176","article-title":"Assessment of oro-dental manifestations in a series of acromegalic patients, the acrodent study","volume":"9","author":"Roumeau","year":"2020","journal-title":"Endocr. Connect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2334\/josnusd.53.133","article-title":"Dental patient with acromegaly: A case report","volume":"53","author":"Kashyap","year":"2011","journal-title":"J. Oral Sci."},{"key":"ref_24","first-page":"8","article-title":"Acromegaly: Oral Diagnostician\u2019s Role in Diagnosis: A Case Report","volume":"2","author":"John","year":"2016","journal-title":"IJSS Case Rep. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1007\/s11102-016-0725-2","article-title":"Challenges in the diagnosis and management of acromegaly: A focus on comorbidities","volume":"19","author":"Abreu","year":"2016","journal-title":"Pituitary"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/S1010-5182(02)00182-8","article-title":"Cephalometric assessment of cranial abnormalities in patients with acromegaly","volume":"31","author":"Weiss","year":"2003","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"381","DOI":"10.4103\/2230-8210.95678","article-title":"Oral manifestations in growth hormone disorders","volume":"16","author":"Atreja","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S159","DOI":"10.1002\/JPER.18-0006","article-title":"Staging and grading of periodontitis: Framework and proposal of a new classification and case definition","volume":"89","author":"Tonetti","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/0030-4220(54)90255-8","article-title":"The clinical significance of hypercementosis","volume":"7","author":"Weinberger","year":"1954","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4317\/medoral.18984","article-title":"The bite force and craniofacial morphology in patients with acromegaly: A pilot study","volume":"19","author":"Karakis","year":"2014","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1046\/j.1365-2265.2002.01576.x","article-title":"Submandibular salivary gland volume is increased in patients with acromegaly","volume":"57","author":"Manetti","year":"2002","journal-title":"Clin. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2265.1974.tb03290.x","article-title":"Salivary Gland Enlargement In Acromegaly","volume":"3","author":"Thomson","year":"1974","journal-title":"Clin. Endocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/archinte.1974.00320210025002","article-title":"Visceromegaly in Acromegaly: Evidence that Clinical Hepatomegaly or Splenomegaly (but not Sialomegaly) Are Manifestations of a Second Disease","volume":"134","author":"Sober","year":"1974","journal-title":"Arch. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.joms.2019.12.001","article-title":"Parotid Gland Enlargement in Acromegaly: A Case Report of This Rare Finding","volume":"78","author":"Mandel","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1023\/A:1022145116901","article-title":"Self image and quality of life in acromegaly","volume":"5","author":"Pantanetti","year":"2002","journal-title":"Pituitary"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"630","DOI":"10.20945\/2359-3997000000193","article-title":"Determinants of morbidities and mortality in acromegaly","volume":"63","author":"Kasuki","year":"2019","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1365-2265.2011.04019.x","article-title":"The effects of long-term growth hormone and insulin-like growth factor-1 exposure on the development of cardiovascular, cerebrovascular and metabolic co-morbidities in treated patients with acromegaly","volume":"75","author":"Jayasena","year":"2011","journal-title":"Clin. Endocrinol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s11102-017-0797-7","article-title":"Complications of acromegaly: Cardiovascular, respiratory and metabolic comorbidities","volume":"20","author":"Pivonello","year":"2017","journal-title":"Pituitary"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1210\/er.2002-0022","article-title":"Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management","volume":"25","author":"Colao","year":"2004","journal-title":"Endocr. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1210\/er.2018-00115","article-title":"Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update","volume":"40","author":"Gadelha","year":"2018","journal-title":"Endocr. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.2174\/1871530320666200127103320","article-title":"Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly-Part 1: Diagnostic and Clinical Issues","volume":"20","author":"Cozzi","year":"2020","journal-title":"Endocr. Metab. Immune Disord.-Drug Targets"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0030-1255020","article-title":"Acromegaly: A Cross-Sectional Analysis of the Oral and Maxillofacial Pathologies","volume":"119","author":"Herrmann","year":"2011","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3109\/00016357.2014.979868","article-title":"Craniofacial and pharyngeal airway morphology in patients with acromegaly","volume":"73","author":"Tuncer","year":"2015","journal-title":"Acta Odontol. Scand."},{"key":"ref_44","first-page":"277","article-title":"Morphologic analysis of dentofacial structure in patients with acromegaly","volume":"13","author":"Takakura","year":"1998","journal-title":"Int. J. Adult Orthodon. Orthognath. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3","DOI":"10.15713\/ins.jmrps.14","article-title":"The size and morphology of sella turcica: A lateral cephalometric study","volume":"1","author":"Nagaraj","year":"2015","journal-title":"Radiol. Pathol. Surg."},{"key":"ref_46","first-page":"3","article-title":"Unusual Skeletal Growth of an Adult Patient with Acromegaly: A 12 Year Follow-up After Orthognathic Surgery","volume":"31","author":"Lee","year":"2020","journal-title":"Taiwan J. Orthod."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/2229411220120203","article-title":"Acromegaly-A Case Report with Dentist\u2019s Perspectives and Review of Literature","volume":"3","author":"Kaur","year":"2012","journal-title":"J. Adv. Oral Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S1010-5182(05)80274-4","article-title":"Typical changes in the viscerocranium in acromegaly","volume":"19","author":"Farmand","year":"1991","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1071\/HC15033","article-title":"Symptoms and signs of acromegaly: An ongoing need to raise awareness among healthcare practitioners","volume":"8","author":"Conaglen","year":"2016","journal-title":"J. Prim. Health Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1016\/j.ejim.2013.09.014","article-title":"Diagnosis of acromegaly: Role of the internist and the other medical professionals","volume":"25","author":"Aydin","year":"2014","journal-title":"Eur. J. Intern. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s40618-015-0245-3","article-title":"The problem of unrecognized acromegaly: Surgeries patients undergo prior to diagnosis of acromegaly","volume":"38","author":"Keskin","year":"2015","journal-title":"J. Endocrinol. Investig."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"P10","DOI":"10.1055\/s-0033-1359445","article-title":"Oral and dental symptoms in patients with acromegaly","volume":"121","author":"Kohlmann","year":"2013","journal-title":"Exp. Clin. Endocrinol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s11102-021-01183-y","article-title":"The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: A questionnaire-based study","volume":"25","author":"Preo","year":"2022","journal-title":"Pituitary"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1092\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:22:40Z","timestamp":1760134960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,18]]},"references-count":53,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11041092"],"URL":"https:\/\/doi.org\/10.3390\/jcm11041092","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,18]]}}}