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Adult cretinism /dental courses


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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.

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Adult cretinism /dental courses

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing Dental Education
  2. 2. Height-100 cm Weight-17.5 kg Arm span-97 cm Pulse -76 beats/min
  3. 3. Lethargic Voice not mature Fish scale appearance - skin Hypertelorism Sparse hair
  4. 4. Indian Dental academy • • Leader continuing dental education • Offer both online and offline dental courses
  5. 5. Cold extremities Deep tendon reflexes difficult to elicit Protuberant abdomen Secondary sexual characters not developed
  6. 6. Gingival hyperplasia Over-retained deciduous teeth Tongue size is proportional to jaw size Carious involvement of teeth
  7. 7. Differential diagnosis • Hypothyroidism • Hypopituitarism
  8. 8. Investigations Blood investigations: • T3 - <0.01 ng/L (0.52 – 1.85 ng/ml) • T4 - <0.04mcg % (f= 4.8 – 11.6 mcg%, m= 4.4 – 10.8mcg%) • TSH - >40.0IU/ml (0.53 – 5.6IU/ml, by ELISA) • Serum Na+ -138.0 mmol/L (136-145 mmol/L) • Serum K + - 4.1 mmol/L (3.5 – 5.1 mmol/L) • Serum Cl+ - 106 mmol/L (97- 111mmol/L) • Blood glucose – 65 mg% (70-140 mg%)
  9. 9. Radiographic Investigations Orthopantomograph:
  10. 10. PNS view:
  11. 11. Lateral skull Lateral cervical spine
  12. 12. PelvicHand and wrist
  13. 13. Final Diagnosis
  14. 14. Treatment • Parent counseling was done. Parents were made aware of the deficiency disorder. • Extraction of the over-retained teeth was done. • Patient was put on thyroid hormone supplement, Thyronorm od dose. Initially 25 gm was used which was increased up to 50 gm per day.
  15. 15. Follow up • Significant improvement was observed, – appetite increased, – Bowel movements improved, – phonation and physical activity improved, – Mental alertness increased.
  16. 16. Discussion • Cretinism is a condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormone (hypothyroidism). • 1 in 4000 newborn infants • Twice as common in girls as in boys Harrison’s Principles of Internal Medicine - 17th edition
  17. 17. Etiology Cretinism: Sporadic 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.
  18. 18. • 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
  19. 19. • 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 therapy. Seth A Borg, Roentological aspects of adult cretinism, review of literature, April 1975
  20. 20.
  21. 21. • Salivary gland enlargement • Macroglossia • Glossitis • Delayed dental eruption • Compromised periodontal health • Dysgeusia • Delayed wound healing ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July 2002,849-858) Oral manifestations:
  22. 22. Diagnose the type of thyroid condition. Assess cardiovascular status. Obtain baseline TSH. Control is indicated by hormone levels, length of therapy and medical monitoring. Assess drug interactions with thyroxine. Before Treatment
  23. 23. Focus on lethargy Monitor vital signs Avoid sedation If the patient is on treatment for thyroid disease and has achieved euthyroid state, there is no contraindication to treatment. During Treatment
  24. 24. After 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 prescribed. ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July 2002,849-858)
  25. 25. Conclusion • 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 endemic cretin. • Awareness of the condition and current stage of treatment is important in understanding the possible modifications needed for dental treatment.
  26. 26. Acknowledgement • I take this opportunity to express my great sense of gratitude to Dr. Venkatesh G. Naikmasur (HOD)for his constant motivation and encouragement… • 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 throughout… • Last but not the least, my special thanks to the conference committee for giving this wonderful opportunity.
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  28. 28.
  29. 29. Provisional Diagnosis
  30. 30. Skeletal disorders: • Achondroplasia • Spondyloepiphyseal dysplasia