Hyperparathyroidism (HPT) results from excessive parathyroid hormone production by the parathyroid glands, causing systemic and orofacial problems that medical and dental professionals must understand [1]. This brief communication will concentrate on the orofacial manifestations of HPT and the significance of recognizing these signs in panoramic radiography.

This report was approved by the Institutional Review Board of Dankook University Dental Hospital (DKUDH IRB 2024-04-006), and the committee waived the need for written informed consent.

HPT is one of the most important metabolic bone diseases affecting dentofacial structures [1,2]. HPT is categorized into three types [3]: primary HPT (parathyroid adenomas, hyperplasia, or carcinoma), secondary HPT in response to either lower serum calcium levels or high serum phosphate levels (e.g., low vitamin D and chronic kidney disease [CKD]), and tertiary HPT resulting from parathyroid hyperplasia related to prolonged secondary HPT. Secondary HPT related to CKD is the most common, with a 75% prevalence among CKD patients, because of the high prevalence of diabetes and hypertension with increased life expectancy [4].

Systemically, patients with secondary HPT may exhibit hypercalcemia, bone demineralization (osteopenia and osteoporosis), renal problems (kidney stones), neuromuscular symptoms (muscle weakness and fatigue), and gastrointestinal symptoms (e.g., constipation, peptic ulcers, and pancreatitis). In particular, all the skeletal manifestations in patients with CKD are called renal osteodystrophy (RO) [3,5].

The dental perspective offers a unique vantage point for the early detection of secondary HPT based on specific orofacial signs [1,2,5-7]:

1) Brown tumors: These rare lesions are the result of osteoclastic activity and fibroblastic proliferation and present as painless jaw swelling and radiolucency on the radiograph.

2) Altered dental development: Delayed eruption of the teeth, hypoplastic enamel and/or dentin, cementum loss, and loss of the lamina dura may occur (Fig. 1).

3) Radiographic findings: Panoramic radiographs may show demineralization of the jaw bone, subperiosteal resorption along the jawline, or presence of cystic changes (Fig. 1).

4) Craniofacial bone changes: These include the loss of the cortical bone and the presence of a mixed, ground-glass lesion in severe cases (Fig. 2).

In addition to incidental radiologic findings, patients presented with a spectrum of symptoms, ranging from systemic symptoms, facial asymmetry, and swelling to orofacial pain, including neuropathy, toothache, and temporomandibular disorders, which are characterized by crepitus and

pain during mastication and mouth opening [2].

CKD is a prevalent condition that affects approximately 10% of the population [3]. The increase in life expectancy and consequent rise in the older population could potentially lead to a higher prevalence of this condition.

Therefore, dental professionals must recognize CKD-related orofacial complications. Specifically, when evaluating patients for dental implant placement, dentists should be vigilant regarding a range of metabolic bone disorders such as osteoporosis, osteomalacia, and Paget’s disease, along with RO [8].

The success of managing RO depends on early diagnosis, and dental panoramic radiographs are crucial in its early detection. Competency to assess signs, symptoms, and risk factors associated with HPT and other metabolic bone diseases is requisite for dental practitioners.

No potential conflict of interest relevant to this article was reported.

The datasets used during the current study are available from the corresponding author on reasonable request.

None.