This document discusses various endocrine disturbances and their oral manifestations. It covers conditions such as pregnancy, adrenocortical diseases like Cushing's disease and Addison's disease, thyroid diseases including hyperthyroidism and hypothyroidism, diabetes mellitus, and renal diseases. For each condition, it describes the underlying causes, systemic signs and symptoms, and relevant oral changes such as dry mouth, gingival hyperplasia, and increased risk of oral infections. Management considerations for dental treatment of patients with endocrine and renal disorders are also outlined.

1. ENDOCRINE DISTURBANCES
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
• Pregnancy
• Adrenocortical Diseases
• Thyroid Diseases
• Diabetes Mellitus
• Renal Diseases
• References

4. INTRODUCTION
• It is often difficult to determine the exact effect of a single endocrine abnormality on any structure.
• Endocrine disorders affecting bone and teeth (gigantism, acromegaly, and hyperparathyroidism).
• Hypoparathyroidism resulting from parathyroid or thyroid surgery; Low serum Calcium
• Tetany is the clinical manifestation of reduced serum calcium.
• Tetany may also be encountered in anxious dental patients who hyperventilate; alkalosis and a reduced
plasma ionized calcium.

5. PREGNANCY
• Hormonal changes that occur may have the effect of exacerbating a previously existing chronic
gingivitis.
• Hyperplastic Gingivitis, purple coloration of the gingival papillae, fragile and bleed easily and
Halitosis may be evident.
• Pregnancy Tumor; extremely vascular and profuse bleeding is to be expected.
• Regresses considerably, if not completely, after pregnancy.
• Strict oral hygiene measures.

6. MENOPAUSE
• There is no substantive evidence that the hormonal changes occurring during and after
the menopause directly affect the oral mucosa.
• The oral problems may include xerostomia, burning mouth syndrome, increase in
incidence of dental caries, dysesthesia, taste alterations, atrophic gingivitis,
periodontitis, and osteoporotic jaws

7. ADDISON’S DISEASE
• Result of lack of function of the adrenal cortex.
• Autoimmune disorder.
• Melanotic pigmentation of the oral mucosa; BM, Gingiva, Palate
• Oral Candidosis.
• Investigations include:
1. Impaired adrenal response to synthetic analogue of ACTH
2. Na --. K ++
3. Measurement of plasma cortisol and ACTH
4. Blood pressure measurement

8. ADDISONIAN CRISIS
• Vomiting
• Drowsiness
• Hypotension
• Hyponatremia
• Hyperkaliemia
• Hypoglycemia and eventually collapse and coma

10. CUSHING’S DISEASE
• Hyperfunction of the adrenal cortex.
• ACTH secretory pituitary adenoma.
• Corticosteroid therapy.

11. CORTISOL EFFECTS
• Increases basal metabolism.
• Increases glucose production by liver (by increasing delivery of amino acids from peripheral
tissues, increase gluconeogenesis by increasing amount of enzymes, and permitting other key
metabolic reactions to operate at maximal rate)
• Inhibit glucose uptake (except brain & heart)
• Increases hepatic glycogen deposition
• Promotes lipolysis in extremities & lipogenesis in other sites (face & trunk) – clinical feature of
Cushing’s
• Promotes protein & RNA metabolism (anabolic, subsequently catabolic b/d protein)
• Suppresses the immune response
• Lysis of lymphocytes
• Decreases no. of circulating leukocytes, migration of tissue leukocytes

12. CORTISOL EFFECTS
• Inhibits fibroblast proliferation
• Induces lipocortins –> inhibit phospholipase A –> inhibit production of
inflammatory molecules
• Increases blood pressure (during stressful periods) Effects

14. PHAEOCHROMOCYTOMA
• Tumor of the adrenal medulla, which secretes epinephrine and norepinephrine
• Neurofibromatosis and the multiple endocrine adenoma syndrome (type III).
• Neurofibroma of the oral mucosa or lips.
• High blood pressure
• Heavy sweating
• Headache
• Tachycardia
• Tremors
• Pallor
• Dyspnea

15. HYPERTHYROIDISM
• Excessive production of thyroid hormones does not appear to have any
direct effect on the oral mucosa.
• Dental practitioners may be the first to observe patients with
exophthalmos.
• May also appear hyper-excitable and report weight loss.
• May also have a tremor and tachycardia.

16. HYPOTHYROIDISM
• Impaired immune mechanism and oral Candidosis.
• Pernicious Anemia.
• Congenital hypothyroidism (cretinism) is characterized by
dwarfism and mental retardation.
• Orofacial signs include:
• Enlargement of the tongue.
• Defective facial development.
• Delayed eruption of the teeth.

19. SIGNS AND SYMPTOMS OF A THYROTOXIC
CRISIS
• • Tachycardia
• Irregular pulse
• Sweating
• Hypertension
• Tremor
• Nausea, vomiting, abdominal pain and coma

20. DIABETES MELLITUS
• Deficiency of insulin or resistance to insulin.
• Oral Features:
• Dry mouth
• Compromised periodontal health
• Oral Candidosis
• Glossodynia—BMS
• Lichenoid drug reactions (oral hypoglycemic drugs)

21. MEDICAL PROBLEMS IN DENTISTRY – SCULLY 6TH EDITION

22. RENAL DISEASES
• Oral changes occur not only as a result of chronic renal failure but also as a consequence of the
medical management of renal disease.

23. CHRONIC RENAL FAILURE
• Irreversible deterioration in renal function.
• Plasma Creatinine’s normal range is 80–120 µmol/l.
• Plasma Creatinine1000 µmol/l = dialysis will be required.
• GFR =120 ml/min measures renal function.
• Progressive impairment in kidneys’ function leads to the development of the
clinical syndrome of uraemia.

24. OROFACIAL MANIFESTATIONS OF CHRONIC RENAL FAILURE
• Dry mouth
• Mucosal ulceration
• Bacterial and fungal plaques
• Pallor of the mucosa (anaemia)
• Oral purpura
• White plaques (uraemic stomatitis)
• Giant cell lesions—osteolytic lesions in jaws

25. RENAL PATIENTS UNDERGOING DIALYSIS
• Kidney function is inadequate.
• Patient's blood is detoxified by passing it through a machine.
• AV Shunt
• Heparin
• The optimum time for dental procedures is 12–24 hours post-
haemodialysis.
• Extractions?
• Antibiotic Prophylaxis

26. CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
• Does not require hospitalization.
• Treated as heamodyalised patients but do not have the problem of
heparinization or AV shunts.
• CAPD patients are at risk from peritonitis.

27. ORAL MANAGEMENT OF HEMODYALISED PATIENTS
• Impaired excretion of drugs by kidney Bleeding tendency
• Heparinization prior to dialysis
• Arteriovenous shunts susceptible to infection
• Anaemia
• Increased carriage of hepatitis B and C Hypertension

30. RENAL TRANSPLANT PATIENTS
• Immunosuppressive medications
• Oral Complications:
• Drug-induced gingival overgrowth (hyperplasia)
• Bacterial and fungal plaques
• Increased incidence of oral malignancy (reported)
• Oral Candidosis
• Herpes simplex infections (secondary)

32. REFERENCES
• Menopause and Oral Health -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195183/
• Chapter 13: Blood and nutrition, endocrine disturbances, and renal disease

33. THANK YOU