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

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


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.


  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.

  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.

    Gerald Vonberger |

  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.

    Jenn |

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  6. I am in dental school right now and I am looking into thyroid dysfunction. I appreciate all the information on this because I have a test coming up that I am worried about. This information helped me to understand what will be on the test. Thank you so much.

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  8. I think that there are a lot of things that could qualify as a dental emergency. It's important to stay on top of that kind of stuff. It can really make a lot of difference to have a dentist available in case of an emergency.

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  20. I've never thought about how to deal with dental issues when you have thyroid issues as well. I'm sure this is tricky. It would be hard to deal with both of these at the same time. I wonder what type of special care there is for people with health issues that affect teeth.

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  22. It sounds like if you have any disorders or problems with your thyroid or parathyroid glands that you would want to visit the dentist to get your mouth checked out. Can the dentist give you any medicine to help you with the oral problems you face? I sounds like going in is going to answer the majority of questions that I would have.

  23. Reading this helped me realize how important it is to address whether an oral problem is caused by thyroid disease. I didn't realize that thyroid problems can cause periodontal disease, macroglossia, glossitis, accelerated dental eruption, and burning mouth syndrome. My mother has been experiencing these oral conditions, so I should find out if she's having thyroid issues so that a dentist will know how to address these dental problems.

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