The patient is a 25-year-old Somali female who presented with irreversible pulpitis in tooth #11. She has a history of controlled hyperthyroidism for which she takes medication daily. On examination, her thyroid was enlarged and her pulse and blood pressure were elevated. The proposed treatment is oral prophylaxis and root canal treatment for tooth #11, while closely monitoring her blood pressure during visits due to her increased risk for a thyrotoxic crisis from dental procedures or stress.

1. EAU DENTAL DEPARTMENT
PROFESSOR DR SAABIR
COURSE PRINCIPLE OF MEDICINE

2. Case presentation of hyperthyroidism

3. patients personal information
 Age:25
 Gender :female
 Nationality:somali
chief complaint
Presence of irreversible pulputis with tooth #11
Since 2years ago and want to make root canal treatment(RCT) and oral prophylaxis .

4. History
Dental history
 Teeth filling(restoration)3years ago.
Medical History
Controlled hyperthyroidism since 4-5 years and was on regular medication
(carbimazole 5mg and propylthiouracil 50mg once daily).

5. General physical examination
 Pulse rate 76 beatsmin
 Respiratory rate 16 breathmin
 Blood pressure as recorded was 12080

6. Intraoral examination
 Multiple tooth was made in restoration in relation to #36,37,46,47.no missing
teeth.
 The upper and lower lips ,buccal , labial mucosa and plate were normal on
inspection and palpation .
 Gingiva was mildly inflamed
 Her tongue was scalloped
 Salivary flow was normal.

7. Extra oral examination
 Graves disease: is an autoimmune disorder that can cause hyperthyroidism
 The thyroid may be enlarged or noticeably palpable
 The enlarged gland may be more visually noticeable when the patient is in supine
position in dental chair

8. Discussion
 Is a condition that occurs when the thyroid gland makes more thyroid hormones
than the body needs ,thydoid hormones control the way the body uses energy
and affect the body”s metabolism
 It has other name (thyrotoxicosis)

9. Treatment
 Patient was asked to get her recent report for thyroid function test
 The level of thyroid stimulating hormone was low while T4 and T3 levels are high
 This consisted of oral prophylaxis and endodontic treatment ,treatment plan was
formulated

10. Con…….
 Oral prophylaxis is planned to remove all calculus and plaque in her teeth
 Endodontic treatment (RCT) is the best treatment to survive the tooth focusing on
to solve the pain as early as possible
 Blood pressure was monitored on every visit

11. Potential medical problem related to dental care
 Thyrotoxic crisis may be precipitated in patients with untreated or incompletely
treated by:
a) Infection
b) Trauma
c) Surgical procedure
d) stress
 It increases the risk for hypertention ,angina and MI
 Radioactive iodine complications

12. Oral menifestations
 Osteoporosis my occur
 Periodontal disease may be more progressive
 Dental caries may be more extensive
 Premature loss of decidious teeth and early eruption of permanent teeth may
occur

13. prevention of problem
 Detection of patients with thyrotoxicosis by history and examination findings
 Referral for medical evaluation and treatment
 Avoidance of any dental treatment
 Avoidance of epinephrine and other pressor amines

14. Treatment planning
 Once under good medical management the patient receive any indicated dental
treatment.
 If acute infection occurs the physician should be consulted regarding
management.

15.  THANKS