Sunday, 4 May 2014

Dental Management of patients with Thyroid Disease

Thyroid dysfunction is the second most common glandular disorder of the endocrine system which may rear its head in any system in the body including the mouth. The oral cavity is adversely affected by either an excess or deficiency of these hormones. Obtaining an understanding of thyroid dysfunction is of significant importance to the dentist for two reasons. First, the dentist may be the first to suspect a serious thyroid disorder and aid in early diagnosis. Thus, as part of a health care team, the dentist plays an important role in detecting thyroid abnormalities. The second reason is to avoid possible dental complications resulting from treating patients with the thyroid disorders. Modifications of dental care must be considered when treating patients who have thyroid disease.


Oral Manifestation of thyroid disease

Hyperthyroidism
Hypothyroidism
Increased susceptibility to
caries
Salivary gland enlargement
Periodontal disease
Macroglossia
Presence of extra glandular
thyroid tissue (struma
ovarii—mainly in lateral
posterior tongue)
Glossitis
Accelerated dental eruption
Delayed dental eruption
Burning mouth syndrome
Compromised periodontal
health—delayed bone
resorption

Dysgeusia

Considerations for dental treatments



Before treatment assessment of thyroid function

  • Establish type of thyroid condition.
  • Is there a presence of cardiovascular disease? If yes, assess cardiovascular status.
  • Are there symptoms of thyroid disease? If yes, defer elective treatment and consult a physician.
  • Obtain baseline thyroid-stimulating hormone, or TSH. Control is indicated by hormone levels, length of therapy and medical monitoring. If the patient has received no medical supervision for more than one year, consult a physician.
  • Make baseline complete blood count, giving attention on drug induced leukopenia or anemia.
  • Assess medication and interactions with thyroxine and TSH. Make proper treatment modifications if the patient is receiving anticoagulation therapy.
  • Take blood pressure and heart rate. If blood pressure is elevated in three different readings or there are signs of tachycardia/bradycardia, defer elective treatment and consult a physician.

During Treatment

  • Oral examination should include salivary glands. Give attention to oral manifestations.
  • Monitor vital signs during procedure:
  • Minimize stress–appointments should be brief.
  • Is the patient euthyroid? If yes, there is no contraindication to local anesthetic with epinephrine.
     ■ Use caution with epinephrine if the patient taking nonselective β-blockers.
     ■ If the patient’s hyperthyroidism is not controlled, avoid epinephrine; only emergent procedures should be performed 
  • Discontinue treatment if there are symptoms of thyroid disease.

After Treatment

  • Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates.
  • Control pain.
  • Use precaution with nonsteroidal anti-inflammatory drugs for patients who have hyperthyroidism, avoid aspirin.
  • Continue hormone replacement therapy or antithyroid drugs as prescribed.


26 comments:

  1. I never realized how common thyroid glad problems were in children. I actually never even realized that a dentist would take care of a thyroid problem. I'm sure that would be a good reason to run to an emergency dentist at 2 in the morning. http://www.dentalcarextra.com.au/

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  2. A lot of these problems can lead to emergency situations. My son had a sudden tooth break and gum inflammation that wouldn't stop bleeding. We definitely had an emergency on our hands. It's good to know what to do with a situation like that before it actually happens. Luckily, we were able to handle it.

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  3. This is so helpful, thank you. I don't want to overreact, but I'm also not afraid to see an emergency dentist. At least I'll be able to check these symptoms before I panic completely. And if I need to, there's always an emergency dentist.

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