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Hormones and oral health.ppt final


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Hormones and oral health.ppt final

  1. 1. Presented by : Dr. Venisha Pandita PG Ist Year Department of Public Health Dentistry
  2. 2. CONTENTS:     Introduction Anatomy and physiology. Hormones of pituitar y gland and associated diseases Hormones of thyroid gland and associated diseases Hormones of parathyroid gland and associated diseases
  3. 3.       Hormones of adrenal gland and associated diseases Hormones of gonads and associated diseases Pregnancy Menopause Conclusion References
  4. 4. The word hormone is derived from the Greek “hormao” meaning “I excite or arouse”, was given by Starling in 1905. Hormones are secretory products of ductless(endocrine) glands released directly into the circulation in small amounts in response to a specific stimulus and on delivery in circulation produces response on the target cells or organs.
  5. 5. CHEMISTRY OF HORMONES    Steroids Proteins and polypeptides Amino-acid derivatives. MECHANISM OF ACTION: Hormone receptors found on target cell membrane are termed as external receptors and those within cytoplasm and nucleus are termed internal receptors.
  6. 6.    The endocrine system is specifically designed to integrate and control the human body’s innumerable metabolic activities. Its functioning components are endocrine glands. In most instances, the agent stimulating or inhibiting their activity is the hormone produced by the corresponding target gland
  7. 7.  1. 2. 3. 4. 5. 6.   1. 2. Hormones secreted by anterior lobeGrowth hormone, Adrenocorticotropic hormone, Thyroid stimulating hormone, Follicle stimulating hormone, Leutinizing hormone Prolactin Hormone secreted by intermediate – melanocytes stimulating hormone Hormone secreted by posterior lobeVasopressin oxytocin.
  8. 8. DISEASES OF PITUITARY GLAND HYPERPITUITARISM   a) b) It results from hyper function of anterior lobe of pituitary gland, most significantly with increased production of growth hormone. TYPES:Gigantism Acromegaly
  9. 9. Clinical features of gigantism:    Stature of individual- generalized overgrowth of most tissue in childhood Symptoms Skull
  10. 10. ORAL MANIFESTATIONS Symptoms  Teeth  Jaw bone  Palate  Macroglossia  Lips Radiological features  Skull changes  Air sinuses  Teeth  Jaw bone
  11. 11.    Surgery- trans sphenoidal surgery may result in cure of growth hormone excess especially in patients with macroadenoma. Medical therapy- octreotide, a long acting analogue of somatostatin, lowers growth hormone. Radiotherapy
  12. 12. HYPOPITUITARISM   It results due to reduced secretion of pituitary hormone which may occur due to pituitary adenoma that compresses the pituitary gland. It results in pituitary dwarfism. Total absence of all pituitary secretions is known as panhypopituitarism. Etiology:    Disease of pituitary gland Space occupying lesion Sheehan’s syndrome
  13. 13. Clinical features: Short stature of individual  Hypocalcemia  Diabetic insipidus  Symptoms  Sexual characteristics  Skull ORAL MANIFESTATIONS   Jaw bone Teeth
  14. 14.   Radiographic features:Teeth-Complete absence of third molar bud. Roots of teeth are short and apices are wide open. Alveolar bone- there is loss of alveolar bone. Management:  Removal of cause Growth hormone replacement therapy
  15. 15.  1. 2. 3. Thyroid hormones are: Thyroxine (T4) Tri-iodo-thyronine (T3) calcitonin
  16. 16. Hyper thyroidism     It is a syndrome in which there is excessive production of thyroxin in thyroid gland. Etiology Exophthalmic goiter Toxic adenoma Pituitar y disease
  17. 17. Clinical features      Age and sex- higher predilection for females between 20 and 40 years. Thyroid features- thyroid is diffusely enlarged, smooth, possible asymmetrical and nodular, a thrill may be present, may be tender. Neuromuscular Gastrointestinal Cardiorespiratory
  18. 18.     Ocular Reproductive Dermatological Others- heat intolerance, sweaty and warm extremities, thin shiny skin, increased pulse rate and fatigue, thirst and osteoporosis.
  19. 19. Management     Anti thyroid drugs Subtotal thyroidectomy Radioactive iodine Beta-blockers.
  20. 20. ORAL MANIFESTATIONS     Teeth- advanced rate of dental development and early eruption with premature loss of primary teeth. Alveolar bone- generalized decrease in bone density or loss of some areas of edentulous alveolar bone. Radiographic features Generalized osteoporosis Alveolar resorption
  21. 21. HYPOTHYROIDISM   It is caused by insufficient secretion of thyroxin by the thyroid gland. Failure of thyrotropic function on the part of the pituitary gland or any atrophy or destruction of the thyroid gland or an atrophy or destruction of thyroid gland leads to an inability of the gland to produce sufficient hormone to meet the requirement of the body.
  22. 22. Types:  Cretinism  Juvenile myxedema  Myxedema  Primary hypothyroidism  Secondary hypothyroidism Clinical Features: Cretinism and juvenile myxedema  Age  Symptoms  Bones  Signs
  23. 23. Myxedema Symptoms   Early symptoms- weakness, fatigue, cold intolerance, lethargy, dryness of skin, headache, menorrhagia and anorexia Late symptoms- slowing of intellectual and motor activity, absence of sweating, weight gain, constipation, pallor, decreased sense of taste and smell, aches and pains.
  24. 24. Signs      Face Eyes Skin Tendon reflexes Other features- bradycardia , disorientation, thickened nose.
  25. 25. Myxedema
  26. 26. Oral manifestations Cretinism and juvenile myxedema  Teeth  Jaw bone  Tongue  Skull  Face  Lips Myxedema  Tongue and lip  Face  Teeth
  27. 27. Management    Levothyroxine, which is available as 25, 50,100ug tablets. It is customary to start slowly and a dose of 50ug/day is given for 3 weeks to finally 150ug/day. In elders and patients with ischemic heart disease, the initial dose should be 25ug/day.
  28. 28.    Lowering the body temperature Other therapies like supporting respiration, narcotic antagonist and oxygen if necessary Hospitalization if severe.
  29. 29.   Precaution- the use of sedative and analgesic are dangerous as these agents tend to precipitate coma in patients with hypothyroidism. Inpatients with severe hyperthyroidism the emergencies likely to occur thyroid crisis, emotional disturbances, cardiac difficulties.
  30. 30.  Parathyroid hormone- PTH is a single chain polypeptide of 84- amino acid which are synthesized by the chief cells and released in response to a fall in serum ionized calcium concentration.
  31. 31. Hyperparathyroidism  It is an endocrine disorder in which there is an excess of circulating parathyroid hormone.  Excess PTH stimulates osteoclast to mobilize calcium from skeleton leading to hypercalcemia in addition to PTH increased renal tubular reabsorption of calcium. Types: Primary  Secondary  Tertiary
  32. 32. Clinical features         Age and sex- female :male ratio is 3:1. mainly 30-60 years of age. Classic triad- bones, grones and stones Renal calculi Gastrointestinal problems Hypercalcemia Bone pane and fractures. Cartilage Eyes
  33. 33.   Oral manifestations Brown tumor Teeth- drifting and loss of teeth, malocclusion
  34. 34. MANAGEMENT     Surgery- hyperplastic tissue should be removed surgically Vitamin D supplement Parathyroidectomy Precaution-restriction of dietary phosphate, phosphate binding agent and aluminum salts should be done.
  35. 35. Hypoparathyroidism  It is an uncommon condition in which there is insufficient secretion of parathyroid hormone. Etiology a) b) c) Surgical damage to parathyroid gland Damage from radiotherapy Autoimmune Clinical features    Hypocalcaemia Symptoms Trousseaus sign
  36. 36. ORAL MANIFESTATIONS    Teeth- hypoplasia of enamel. Delayed eruption, external root resorption and root dilacerations Chvostek sign Candidiasis
  37. 37.   Calcium and Vit D supplement. Intravenous calcium gluconate
  38. 38. Pseudohypoparathyroidism   It is also called Albright hereditary osteodystrophy. In this normal parathyroid hormone is present in the body but biochemical pathway responsible for activating target cells are defective in function. Types Type I: Type I a- molecular defect of intracellular binding protein prevents formation of cyclic adenosine monophosphate. This will hamper cell metabolism.
  39. 39.   Type I b- defective receptor for the PTH on the surface of target cells. It Is an autosomal dominant trait. Type I c- there is defective adenylate cyclase Type II- There is induction of camp by PTH in target cells, but function response by cell is not invoked
  40. 40. Clinical features    Stature Shortened finger Osteoma cutis ORAL MANIFESTATIONS   Facial features-mid facial hypoplasia, the face is rounded in appearance Teeth- generalized enamel hypoplasia, oligodontia, delayed eruption of teeth. Management vitamin D and calcium
  41. 41.    1. 2. Parts of glands each gland is divided into adrenal medulla and a cortex. ADRENAL MEDULLA- it arises from ectodermal tissues and function as a part of the sympathetic nervous system. It manufactures and secretes two catecholamine: epinephrine nor-epinephrine
  42. 42.  a) b) c) ADRENAL CORTEX – it secretes three major classes of hormone:Glucocor ticoids or cor tisols Mineralocor ticoids/ aldosterone Sex hormones( testosterone, estrogen, progestrone)
  43. 43. Addison’s disease  It is also called as chronic adrenal insufficiency of the adrenal cortex. Etiology:   Autoimmune Infection Drugs
  44. 44. Clinical features  Age and sex- more common in males and frequently seen in 3rd and 4th decade.  Symptoms- feeble heart action, general debility, vomiting, diarrhea, postural hypotension, reduced resistance to infection, trauma and stress.  Sign- bronzing of skin and pigmentation of oral mucosa.
  45. 45.  Metabolic function- decreased cortisol level interferes with the manufacture of carbohydrates from proteins, causing hypoglycemia and diminished glycogen storage in liver.  Neuromuscular function- it is inhibited producing muscle weakness.
  46. 46. ORAL MANIFESTATION  bronze pigmentation Management   Glucocorticoids replacement Supplement mineralocorticoids
  47. 47. Cushing Syndrome It arises from excess secretion of glucocorticoids by the adrenal glands. Etiology    Adrenal tumor Administration of corticosteroids Ectopic Clinical features     Age and sex Symptoms Moon face Buffalo hump
  48. 48. ORAL MANIFESTATION  Dental age- in children growth and development including skeletal and dental age may be retarded. Management     Surgery Radiotherapy Drugs- Metyrapone 2-6 gm/day in divided doses by mouth, Aminoglutethimide, ketoconazole are also given which act by blocking steroid synthesis.
  49. 49. Adrenal insuf ficiency  It is relatively rare and usually occurs in connection with an acute septicemia and is called as waterhouse-friderichsen syndrome. Types: Primar y- It occurs due to disorders of pituitary or adrenal glands.  Secondar y- it occurs due to chronic administration of corticosteroid resulting in the suppression of endogenous steroid.
  50. 50. Etiopathogenesis      Sudden withdrawal of steroid Following stress Bilateral adrenalectomy Destruction of pituitary gland Trauma Clinical features    Age- occurs primarily in children Onset- rapidly fulminating septic course Symptoms- patient is not able to tolerate stress. There is anxiety, vomiting, cold clammy skin, lethargy and partial or complete loss of consciousness.
  51. 51.  Sign- oral, conjunctival, and vaginal mucosa often show patches of pigmentation. ORAL MANIFESTATION  Early eruption- teeth may erupt early, compared with the normal, but the eruption is in harmony with the skeletal age.
  52. 52. Management  Replacement therapy-it is given in combination of glucocorticoids, mineralocorticoids and anabolic steroids. Dental considerations:  Defer the treatment  Position the patient  Airway maintenance  Saline-i.v 5% dextrose saline  Hydrocortisone-100-200mg of hydrocortisone
  53. 53.   1. 2. Exocrine secretion of pancreas: Pancreatic juices( promote digestion of carbohydrates,fats and proteins) Endocrine secretion: Insulin glucagon
  54. 54. Diabetes mellitus    It may be caused by autoimmune response. Principal laboratory sign are hyperglycemia. It is caused by disorders of carbohydrate mechanism resulting from insulin deficiency or ineffectiveness, producing hyperglycemia and glycosuria.
  55. 55. T YPES  Type I or insulin dependent- it occurs due to deficiency. There is lack of insulin production resulting in severe hyperglycemia and ketoacidosis.  Type II or non-insulin dependent- it occurs due to insulin resistance.
  56. 56. Pathogenesis  a) b) c) d) Type I diabetes mellitus Autoimmune disorder. Increase blood glucose level- as there is deficiency of insulin glucose will remain in blood as absorption of it hampered. So blood glucose level is increased. Glucose as main energy source Polyuria and polydipsia Type II diabetes mellitus a) Decrease in number of insulin receptor- This results in non absorption of glucose in the body. 
  57. 57. Etiology Type I diabetes mellitus  Viruses  Diet  Stress  Immunological factors Type II diabetes mellitus  Genetic  Environmental factors- lifestyle, malnutrition, eg, pregnancy.
  58. 58. Clinical features           Polydipsia Polyuria Polyphagia Breath Visual activity Atherosclerosis Diabetic neuropathy Infection Other symptoms- nocturia, weight loss, fatigue, obesity, temperature and hypertension Symptoms of type II diabetes mellitus- mild in nature with this disease discovered on routine hematological examination.
  59. 59. ORAL MANIFESTATIONS           Effect on periodontium Periodontitis Median rhomboid glossitis Oral candidiasis Localized osteitis Burning mouth Trigeminal nerve involvement Xerostomia and increase caries activity Delayed healing Radiographic features loss of lamina Dura with blurring of alveolar crest,
  60. 60. ADA criteria 1997 endorsed by WHO 1998 for diagnosis of diabetes mellitus 2hours after giving 75gm glucose load: Fasting Normal DM Impaired fasting glycemia IGT < 110 > 126 > 110 & <126 < 126 Post- Prandial < 140 > 200 < 140 >140 & <200
  61. 61. Complications     Microangiopathy Coronary artery disease Blindness Ketoacidosis, diabetic coma, premature mortality.
  62. 62. Management    Diet control Oral hypoglycemic drugs- sulfonylureas, biguanides, alfa-glucosidase inhibitors Insulin therapy
  63. 63. Diabetes Insipidus    Causes- It occurs due to insufficiency of the posterior pituitary hormone. In these patients there is damage to the neurohypophyseal mechanism for the production of vasopressin. Symptoms- There is increased thirst and passage of large quantities of urine. There is also dehydration, headache, irritability, and fatigue due to restriction of fluid. Management- Administration of vasoprssin is the treatment of choice. Desmopressin can be given intranasal in a dose of 5-10mg once or twice daily.
  64. 64.   a) b) c) d) e) f) g) DENTAL CONSIDERATIONS Emergency Dental managementAppointment should be of short duration and in the morning Glucose drink should be available. Local anesthesia without epinephrine Suturing Physician referral Antibiotic prophylaxis Avoid complicated oral procedure.
  65. 65. Hypergonadism   It occurs in children, results in precocious puberty. The long bone develops quickly and child may initially turn toward tallness, but this is offset by the early fusion of epiphyses so that adult’s person may be short.
  66. 66. Hypogonadism    It occurs in equal frequency in males and females. The bones are long and slender and epiphyses are late in fusion. The supracilliary ridges, malar bone, and mandible show greater development.
  67. 67.    The chin is pointed, the palate is high and markedly arched and irregularities of the teeth occur. The mandible tends to become enlarged. The skull is small and there is marked or even excessive enlargement of the frontal and sphenoid sinuses and especially mastoid air sinus.
  68. 68. PREGNANCY •condition of having a developing embryo or fetus in the body •In Human duration of pregnancy is about 266 days after conception. •Roughly divided in three trimesters of about three calendar months each-into the embryonic period lasting from fertilization through the first eight weeks of pregnancy and the fetal period during the remainder of pregnancy
  69. 69. ORAL MANIFESTATION •The Popular notion that pregnancy cause tooth loss “a tooth for every pregnancy” and that calcium is withdrawn in significant amounts from the maternal dentition to supply fetal requirements has no histological, chemical, evident to support it. •In other hand, calcium is readily mobilized from bone to supply these demands and demineralization of alveolar processes can result.
  70. 70. •Caries activity is attributed to an increase in local cariogenic factors •Condition that may influence the pregnant patient’s teeth is acid erosion, which may caused by repeated regurgitation of gastric contents associated with morning sickness or esophageal reflux. •Periodontal disease occurs in 50% to 100%of all pregnant women •Gingival changes occur most frequently in association with poor oral hygiene and local irritants, esp bacterial plaque.
  71. 71. •Clinically, the appearance of inflamed gingiva during pregnancy is characterized by a fiery red color of marginal gingiva and interdental papillae •Tissue is edematous, with a smooth, shiny surface texture, loss of resiliency, and tendency to bleed easily. •Interdental papillae may hypertrophy and form pseudopocket.
  72. 72.  Tumor like growths, usually on the interdental papillae or other areas of the frequent is referred to as a “pregnancy tumor”, epulis gravidarum, or pregnancy granuloma .  Poor oral hygiene invariably is present, and often there are deposits of plaque or calculus on the teeth adjacent to the lesion.
  73. 73. •Full development granuloma is a sessile or pedunculated lesion that is usually painless. •Color varies from purplish red to deep blue. •Bone destruction is rarely observed around pregnancy granulomas. •Oral findings that may be seen in pregnant women is generalized tooth mobility. •probably related to the degree of the gingival disease and the disturbance of the attachment apparatus, as well as to mineralisation; changes in the lamina dura. •Condition usually reversed after delivery.
  74. 74. Dental Management •Pregnant patients begins with thorough medical history. •History should note any complications the patient has encountered in the pregnancy to date and record any previous miscarriages, recent cramping, •No elective dental care should be undertaken during the tri-semester. •Prolong chair time is avoided •Emergency dental care may be rendered at any time during pregnancy, after consultation to physician
  75. 75. MENOPAUSE     Menopause is not a disease, it is a natural transition period in ever woman's life. Menopause is a time of declining ovarian function However, during menopause, many women may experience uncomfortable symptoms such as hot flashes, vaginal dryness, depression, sleeplessness, etc. Traditionally women have sought hormone replacement
  76. 76.          Some Possible Symptoms Associated with various Stages Hot flashes, flushes, night sweats and/or cold of Menopause flashes, clammy feeling Bouts of rapid heart beat Irritability, Mood swings, sudden tears Trouble sleeping through the night (with or without night sweats)  Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles Loss of libido Crashing fatigue Anxiety, feeling ill at ease Feelings of dread, apprehension, doom
  77. 77. Dental Management •Postmenopausal osteoporosis can be prevented and treated by sound dietary control adequate levels of dietary calcium. •The condition may be prevalent because of dietary adequacies of young women and could become an important issue in dental care for postmenopausal women •Counseling may be indicated for some patients, and it is most appropriate for the dentist to refer the menopausal patient for medical evaluation and treatment to optimize the befits of dental treatment.
  78. 78.  Hormones form an integrate regulatory system of human body. They regulate various human systems like growth,digestion,reproduction ,etc. Any dearrangement in hormonal function immense effects on human body. Hence a deeper understanding of hormones ,their chemistry, mechanism and side effects are important.
  79. 79.        Ghom Govindrao Anil.Textbook of oral medicine and radiology.2nd ed;Jaypee:New Delhi 2010pg 533-556 Chugh S.N.Textbook of medicine 3rd ed;jaypee:new delhipg 549-590 Hall E john, Gyton C Arthur.Textbook of medical physiology.11th ed;elseviers:dehradun pg1100-1111 Davidson sir stanley,Boon A Nicholus Principles and practice of medicine.20th ed ; Churchill Livingstone:massachussets2012pg960-977 Shafer,Levy,Hine.Textbook of Oral Pathology.5th ed;Elsevier:New Delhi 2005 pg35-44 McMinn,R.T Hutchings,J.Pegington, P.Abrahams.Color Atlas Of Human Anatomy.3rd ed;osby-Wolfe:Hongkong 1995pg 23,46,50,57-58 T.W Saddler.Medical Embryology 4th ed;Wolters Kluwer:New Delhi 2010 pg 27-278