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.