Diabetes, adrenal insufficiency, thyroid disease (2)

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Oral Diagnosis I …

Oral Diagnosis I
Third Year

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  • 1. Diabetes Adrenal Insufficiency Thyroid Diseases November 19, 2006 Dr. Suresh. C.S. BDS; MDS; MDSc (UK) Oral Diagnosis I
  • 2. Diabetes ”Overview” Diabetes mellitus is of great importance to dentists  Detect new case of diabetes  Render dental care to diabetic patients without endangering their well being  Recognize the level of severity and glycemic control and the presence of complications from diabetes to consequently manage the patient accordingly.
  • 3. Current Classification of Diabetes  Type l: Beta-cell destruction or defect in beta-cell function which lead to absolute insulin deficiency.  Immune mediated: Presence of insulin or islet cells antibodies.  Idiopathic: No evidence of antibodies.  Type 2: Insulin resistance with relative insulin deficiency.
  • 4. Current Classification of Diabetes (Cont.)  Other specific type: Genetic defects of beta-cell function or insulin action, pancreatic diseases, endocrinopathies, malnutrition, or drug or chemical-induced diabetes.  Impaired fasting glucose.  Gestational diabetes: Any degree of abnormal glucose tolerance during pregnancy.
  • 5. Diabetes Incidence & Prevalence A dental practice serving an adult population of 2000 can expect to encounter about 120 persons with diabetes. 50% of these patients are unaware of their condition.
  • 6. Diabetes Etiology  The genetic role in type 2 diabetes is much greater than type 1.  Obesity plays an important part in the cause of type 2.  Type 1 has a sudden onset mainly found under age 40.  Type 2 generally occurs after age 40 in obese individuals.
  • 7. Diabetes Signs & Symptoms *Polydypsia *Marked irritability *Polyuria *Recurrence of bed wetting *Polyphagia *Drowsiness *Loss of weight *Malaise *Loss of strength Type 1: the onset of symptoms is sudden Type 2: The onset of symptoms is slow & the cardinal signs are less commonly seen.
  • 8. Diabetes Medical Management  Type 1  Diet & physical activity  Insulin (Conventional Multiple injections, Continuous infusion, Pancreatic transplantation).  Type 2  Diet & physical activities  Oral hypoglycemic agents  Insulin plus hypoglycemic agents  Insulin
  • 9. Diabetes Dental Management  Any dental patient who has the cardinal symptoms of diabetes should be referred to a physician for diagnosis & treatment.  Pts with findings that may suggest diabetes:  Headache, dry mouth, marked irritability, repeated skin infection, blurred vision, paraesthesia, periodontal abscesses, loss of sensation.
  • 10. Diabetes Oral Complications & Manifestations Poorly controlled diabetes:  Xerostomia  Bacterial, viral & fungal infection (Candidiasis)  Poor wound healing  Increase incidence of caries, gingivitis, & periodontal disease, periapical abscesses & burning mouth syndrome
  • 11. Adrenal Insufficiency Definition  Disorders affecting the adrenal glands result in excess or insufficient production of adrenal products.
  • 12. Secretory Products of the Adrenal Glands  Adrenal Cortex: Adrenal Medulla  Glucocorticoids *Epinephrine  Cortisol *Norepinephrine  Corticosterone *Dopamine  Mineralocorticoids  Aldosterone  Deoxycorticosterone  Sex hormones  Dehydroepiandrosterone  Androstenedione
  • 13. Adrenal Insufficiency Incidence & Prevalence  A dental practice serving 2000 adults can expect to encounter 50 patients who use steroids or have potential adrenal abnormalities (Chronically use corticosteroids and thus are at risk for secondary adrenocortical insufficiency).
  • 14. Adrenal Insufficiency Signs & Symptoms Hypoadrenalism  Primary adrenal insufficiency: (Addison’s disease): Weakness, fatigue, abnormal pigmentation of the skin & mucous membrane. In addition, hypotension & weight less.  Secondary adrenal insufficiency: (chronic corticosteroid administration). Usually does not produce symptoms unless the patient is significantly stressed.
  • 15. Addison’s Disease
  • 16. Adrenal Insufficiency Signs & Symptoms Hyperadrenalism:  Pts. Who have been receiving long term high- dose corticosteroid therapy can develop signs & symptoms of Cushing’s syndrome:  Weight gain, round or moon shaped facies, a buffalo hump on the back, abdominal striae and acne.  Other symptoms can include hypotension, heart failure, osteoporosis and bone fractures, diabetes mellitus, impaired healing, mental depression & psychosis.
  • 17. Adrenal Insufficiency Medical Management Management of the adrenal disease  Elimination of infection  Malignant disease Hormonal replacement Correcting ACTH Balancing the beneficial effects of steroids with unwanted side effects.
  • 18. Adrenal Insufficiency Dental Management Dental treatment of a patient with undiagnosed adrenal insufficiency should be delayed until the patient is medically stabilized No treatment modifications are required for medically stable adrenal disorders
  • 19. Thyroid Disease A patient of thyroid disease is of concern to the dentist  The dentist may detect early signs and symptoms (disease or tumor).  Pt. with untreated thyrotoxicosis may be in danger if the dentist performs surgical or operative procedures.
  • 20. Thyroid Disease Incidence & Prevalence The most common thyroid disorder is iodine deficiency (diet related) goiter. In US the prevalence of goiter ranges from 0.5 to 7%.
  • 21. Thyroid Disease Signs & Symptoms Hyperthyroidism  Nervousness  Fatigue  A rapid heart beat & palpitations  Heat intolerance  Weight loss  Soft & friable hair and soften nails  Graves’ ophthalmopathy (edema & inflammation).
  • 22. Thyroid Disease Oral Manifestations  Hyperthyroidism  Osteoporosis that may involve the alveolar bone  dental caries  Periodontal disease  Teeth that may develop rapidly  Premature loss of deciduous teeth.
  • 23. Thyroid Disease Signs & Symptoms Hypothyroidism  Dwarfism  Overweight  Thick lips  Large protruded tongue  Delayed eruption teeth  Malocclusion  Mental retardation, etc.
  • 24. Thyroid Disease Medical Management Hyperthyroidism  It may involve anti-thyroid agents to block hormone synthesis. Hypothyroidism  Administration of synthetic preparation containing LT4 or LT3.
  • 25. Thyroid Disease Dental Management If the patient is under good medical management, the dental treatment plan is unaffected.