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Endocrinal system  /certified fixed orthodontic courses by Indian dental academy
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Endocrinal system /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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  • 1. Endocrinal System Thyroid and Parathyroid www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. Thyroid • Endocrine gland situated in the neck. • Two lobes joined by an isthmus. • Secretes two hormones Thyroxine(T3) and Triiodothtroxine(T4) www.indiandentalacademy.com
  • 4. Regulation of thyroid gland activity • Thyroid gland is an effector component of classic hypothalamic-anterior pitutaryperipheral gland axis. • Major stimulator- TSH or thyrotropin from anterior pitutary. • Direct stimulator for TSH is TRH or thyrotropin-releasing harmone from hypothalamus. • Negative feedback mechanism. www.indiandentalacademy.com
  • 5. Actions of thyroid hormone • • • • Whole body actions : Increase the whole body consumption of Oxygen and heat production. Increase the cardiac output. Accelerates the response to starvation. Metabolic disposal of other hormones and many drugs are increased. www.indiandentalacademy.com
  • 6. Effects on growth and development • Stimulates linear growth, development and maturation of the bone. • Accelerates secretion of growth hormone. • Normal skeletal muscle function also requires thyroid. • Has critical effects on the development of CNS. • Contributes to the reproductive function of both genders. www.indiandentalacademy.com
  • 7. Disorders of thyroid function • Hyperthyroidism : • More common in women in the age range of 20-40 years. • Three conditions account for most cases Grave’s disease Toxic multinodular goitre Solitary toxic nodule www.indiandentalacademy.com
  • 8. • Clinical features : • Characteristic eye changes- Exoptholmous, limitation of ocular movement and optholmoplegia. • Increase in BMR • Heightened level of anxiety and restlessness • Intolerance to heat. • Pretibial myxoedema www.indiandentalacademy.com
  • 9. • • • • • • • • • Management : Antithyroid drugs – Carbimazole Beta blockers Radioactive iodine Total or subtotal thyroidectomy. Dental aspects : GA is risky – chances of dangerous dysrythmias Sedation may be necessary – N20 is safer Risk of giving adrenaline containing LA is more of theoretical risk. • Thyroid crisis !!! www.indiandentalacademy.com
  • 10. Hypothyroidism • Commonest cause is chronic autoimmune hypothyroidism- two clinical forms Goitrous form (Hashimoto’s disease) & Atrophic form • Other causes – surgical removal, radiation, iodine deficiency and some drugs. • Common in women in the age group 60 yrs www.indiandentalacademy.com
  • 11. • Clinical features : • Often unrecognized • Weight gain, lassitude, dry skin and loss of hair. • Bradycardia and heart failure. • Neurological and psychological changes like sleeplessness, irritability and mental dullness. • Hoarseness,hypothermia and cold intolerance. • Associated autoimmune disease like Sjogren’s syndrome. www.indiandentalacademy.com
  • 12. • Dental aspects : • Main danger is of precipitating myxoedema coma by sedatives(diazepam), opioids, tranquillizers and general anaesthetics. • Local anaesthesia is safe and preferrable. • Stunted growth is most marked feature of cretinism.Also eruption and shedding of primary teeth are delayed. • Additional problems may be posed by associated hypopitutarism and Sjogren’s syndrome. www.indiandentalacademy.com
  • 13. Parathyroids • Four pea-sized glands located on the back of thyroid gland. • Secrete parathyroid hormone(PTH). • Secretion is controlled by negative feed back mechanism. Stimulated by fall in the plasma ionized calcium. www.indiandentalacademy.com
  • 14. • Actions of PTH : • Acts on kidneys, GIT and bone. • PTH and vit D both act to control plasma Ca levels. • Increases renal re absorption of calcium and impairs phosphate re absorption. • Enhances GI absorption of calcium. • Promotes osteoclastic bone resorption which is reflected in a rise in plasma level of calcium and alkaline phosphatase enzyme. www.indiandentalacademy.com
  • 15. Hypoparathyroidism • Most common cause is thyroidectomy. • Muscle irritability and tetany is the classical feature with Facial twitching(Chvostek’s sign) Carpopedal spasms(Trousseau’s sign) Numbness and tingling of arms and legs • Other uncommon features like Psychiatric disorders Dental defects www.indiandentalacademy.com Constipation Etc.
  • 16. • Diagnosis and management : • Blood biochemistry Low plasma calcium and often raised phosphate. • Therapy : Replacement therapy includes Vit D and calcium supplements. Vit D 500-3000 micrograms/day, Calcium 2-3 gms/day. www.indiandentalacademy.com
  • 17. • Dental aspects : • LA is safe • Dental management may be complicated by tetany, Seizures, psychiatric problems and learning disabilities. • Congenital forms may feature enamel hypoplasia, shortened roots and sometimes delayed eruption. www.indiandentalacademy.com
  • 18. Hyperparathyroidism • Three types – Primary hyperparathyroidism : usually caused by a parathyroid adenoma seen in post menopausal women. Secondary hyperparathyroidism : is a response to plasma low calcium levels secondary to chronic renal failure or prolonged dialysis. Tertiary hyperparathyroidism : follows prolonged secondary hyperparathyroidism that has become autonomous. www.indiandentalacademy.com
  • 19. • Clinical features : • “Stones, bones and abdominal groans” • Hypercalcaemia leading to Renal disease – renal calcifications (stones) Skeletal disease – bone pain, pathological fractures and giant cell tumors. GI - Peptic ulcers and pancreatitis. Others – hypertension and sometimes dysrhythmias. • Hyperparathyroidism may sometimes be associated with tumors of other endocrine glands (MEN I, II and III). www.indiandentalacademy.com
  • 20. • Diagnosis : • Confirmed by raised parathyroid hormone levels – raised serum calcium. Plasma phosphate levels may be low. • Enzyme alkaline phosphatase level will be normal unless there is significant bony involvement. • Management : • Surgical : Parathyroidectomy. • Medical : active Vit D hormone(1,25dihydroxycholecalciferol). Also hydration, increased salt intake and mild forced diuresis. www.indiandentalacademy.com
  • 21. Dental aspects • LA is preferred over GA. • Dental treatment may be complicated by Renal disease – may impair drug excretion. Peptic ulceration – may limit the choice of analgesics. Bone fragility – pathological fractures. • Dental changes : • Loss of lamina dura and generalized bone rarefaction. • Giant - cell lesions of hyperparathyroidism (Browns tumor). www.indiandentalacademy.com
  • 22. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com