Dental manifestations in adult hypophosphatasia and their correlation with biomarkers

Hypophosphatasia (HPP) is a genetic condition with broad clinical manifestations caused by alkaline phosphatase (ALP) deficiency. Adults with HPP exhibit a wide spectrum of signs and symptoms. Dental manifestations including premature tooth loss are common. Much of the published literature reporting dental manifestations consists of case reports and series of symptomatic patients, likely biased towards more severe dental manifestations. The objective of this study was to systematically explore the dental manifestations among adults with HPP by conducting a comprehensive dental evaluation. To minimize bias, the study explored dental manifestations in an unselected cohort of adults with HPP. Participants were identified searching electronic health record (EHR) data from a rural health system to discover adults with persistent ALP deficiency. Heterozygotes with pathogenic (P), likely pathogenic (LP), or uncertain variants (VUS) in ALPL and at least one elevated ALP substrate were defined as adults with HPP and underwent genetic, dental, oral radiographic, and biomarker evaluation. Twenty‐seven participants completed the study. Premature tooth loss was present in 63% (17/27); 19% (5/27) were missing eight or more teeth. Statistically significant associations were found between premature permanent tooth loss and HPP biomarkers ALP (p = 0.049) and bone‐specific ALP (p = 0.006). Serum ALP (ρ = −0.43, p = 0.037) and bone‐specific ALP (ρ = −0.57, p = 0.004) were negatively correlated with number of teeth lost prematurely. As noted with tooth loss, periodontal breakdown was associated with bone‐specific ALP. An inverse association between periodontal breakdown and bone‐specific ALP was observed (p = 0.014). These findings suggest a role for ALP in maintenance of dentition.

Induced motion of a fixated target: influence of voluntary eye deviation

Induced motion (IM) was observed in a fixated target in the direction opposite to the real motion of a moving background. Relative to a fixation target located straight ahead, IM decreased when fixation was deviated 10 degrees in the same direction as background motion and increased when fixation was deviated 10 degrees opposite background motion. These results are consistent with a "nystagmus-suppression" hypothesis for subjective motion of fixated targets: the magnitude of illusory motion is correlated with the amount of voluntary efference required to oppose involuntary eye movements that would occur in the absence of fixation. In addition to the form of IM studied, this explanation applies to autokinesis, apparent concomitant motion, and the oculogyral illusion. Accounts of IM that stress visual capture of vection, afferent mechanisms, egocenter deviations, or phenomenological principles, although they may explain some forms of IM, do not account for the present results.