C/O:A male dwarf patient of age 18 years Complains of multiple teeth in the lower front region of the jaw. Patient is the third child in the family with two elder sisters one young brother and a younger sister. P/H:STUDYING in fourth grade with poor performance in school. Patient had reduced appetite. Prolonged history of constipation.
Gingival hyperplasia in the lower anterior region of the jaw Multiple teeth show carious involvement
Since clinically patient appeared dwarf, a d/d of HTM and HPM were considered. Hormonal and metabolic disorders show proportional dwarfism while skeletal disorders show disproportionate short stature. Mongols have congenital heart diseases. X-rays to determine the bone age which is retarded in the cretin and not in the mongol. Harmonal :Laron syndrome Hall Palistor syndrome Rickets, osteomalacia, osetogenesis imperfecta Skeletal :Dysplasia epiphysealis multiplex
To asses pitutary function, indirect tests are performed In hypopitiutary there is decrease in ACTH – CORTISOL Decrease.Thus there is hyponatrimia, hypoglycimia. The measurement of serum TSH is the best test to determine thyroid function
Crown completion of 3rd molar is at 13 years of age.thus his dental age is 13 years.
COXA VARA :Alteration of the angle made by the axis of the femoral neck to the axis of the femoral shaft so that the angle is less than 135°; the neck becomes more horizontal. Normally, at birth the angle of inclination of the femoral neck is 1500. This angle decreases to 120 - 1300 in the adult(Idiopathic coxa vara, this angle is decreased below the normal 1200)
Oral prophylaxis along with restoration of decayed teeth was done.
school children from iodine deficient areas when compared to non-iodine deficient areas, 20 % prevalence of nerve deafness and 3-5 % prevalence of cretinism
Because the foetus inherits enough thyroid hormone to supply its needs for about 3-4 months There may also be some hormone supplied by the secretion of a rudimentary gland, Difficulty in identifying congenital hypothyroidism leads to cases being left untreated for a length of time.
1.The untreated cases of congenital hypothyroidism may persist till adolescence and adulthood and evolve into adolescent or adult cretin. 2.Despite of the chronic history.
ASSESSMENT OF THYROID FUNCTION 2.Susceptible to cardiovascular disease from arteriosclerosis and elevated LDL. 4.Thyroxine increases the action of warfarin sodium.
1.lethargy- indicate an uncontrolled state. Risk of aspiration of dental materials. 3.Sedation might lead to myxoedema coma-manifested as hypothermia, bradycardia and severe hypotension
so these medications should be used sparingly. Narcotics also cause depression
Patients who have thyroid disease present a treatment challenge to dentists.
Adult cretinism /dental courses
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
Arm span-97 cm
Pulse -76 beats/min
Voice not mature
Fish scale appearance - skin
Indian Dental academy
• Leader continuing dental education
• Offer both online and offline dental courses
Deep tendon reflexes difficult to elicit
Secondary sexual characters not
Tongue size is proportional
to jaw size
Carious involvement of
• Parent counseling was done. Parents were
made aware of the deficiency disorder.
• Extraction of the over-retained teeth was
• Patient was put on thyroid hormone
supplement, Thyronorm od dose. Initially 25
gm was used which was increased up to 50
gm per day.
• Significant improvement was observed,
– appetite increased,
– Bowel movements improved,
– phonation and physical activity improved,
– Mental alertness increased.
• Cretinism is a condition of severely stunted
physical and mental growth due to untreated
congenital deficiency of thyroid hormone
• 1 in 4000 newborn infants
• Twice as common in girls as in boys
Harrison’s Principles of Internal Medicine - 17th edition
Endemic Areas with deficiency of iodine
M. I. PAPILSKY, S.A. MEDICAL JOURNAL 1957, 9 June 1956,547-549
Partial or complete agenesis
of the thyroid gland.
Deficiency of anterior
pituitary thyrotrophic hormone.
• Sporadic cretinism is not hereditary.
• Endemic cretinism can affect one or more
members in the family.
• Hypothyroidism does not become apparent in
the first few months of life.
M. I. PAPILSKY, S.A. MEDICAL JOURNAL 1957, 9 June 1956,547-549
• The untreated cases of congenital
hypothyroidism may persist and evolve into
adolescent or adult cretin.
• Relief or decrease in the symptoms can be
achieved by adequate thyroid replacement
Seth A Borg, Roentological aspects of adult cretinism, review of literature,
• Salivary gland enlargement
• Delayed dental eruption
• Compromised periodontal health
• Delayed wound healing
ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July 2002,849-858)
Diagnose the type of thyroid condition.
Assess cardiovascular status.
Obtain baseline TSH. Control is indicated by
hormone levels, length of therapy and medical
Assess drug interactions with thyroxine.
Focus on lethargy
Monitor vital signs
If the patient is on treatment for thyroid disease
and has achieved euthyroid state, there is no
contraindication to treatment.
Patients who have hypothyroidism are sensitive to
central nervous system depressants and barbiturates.
Postoperative pain control with narcotic drugs
should be limited .
Continue hormone replacement therapy as
ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July
• It is important to diagnose congenital
hypothyroidism in early infancy .
• It is also important even in later years to diagnose
the adult sporadic cretin or the adult hypothyroid
• Awareness of the condition and current stage of
treatment is important in understanding the possible
modifications needed for dental treatment.
• I take this opportunity to express my great sense of gratitude to
Dr. Venkatesh G. Naikmasur (HOD)for his constant motivation
• Its my pleasure to acknowledge Dr. S.K. Joshi (MD, Radio-
diagnosis) and Dr. Shyam Amur (MD, Gen Medicine) for their
whole hearted admiration and inspiration…
• Special thanks to Dr. Krishna, Dr. Atul Sattur, Dr. Sunil and
Dr. Krutika for their support throughout…
• My heartfelt regards to my parents for their blessings , to our
senior PGs and friends for their patience and cooperation
• Last but not the least, my special thanks to the conference
committee for giving this wonderful opportunity.