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Endocrine Diseases and its Dental Management

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Endocrine Diseases and its Dental Management

  1. 1. + SPECIAL NEEDS:! Endocrine Diseases Tan Li Ting, Melissa Lee Lay See, Nurul ‘Adilah Jumati, Syahirah Malek
  2. 2. OVERVIEW • Endocrine System • Common Endocrine Diseases • Risk factors • Signs and symptoms • Dental Management & Considerations
  3. 3. ENDOCRINE SYSTEM - Responsible for hormonal secretion - Diversify it's function through hypothalamus and pituitary - Controls physiological process and homeostasis
  4. 4. MAJOR ENDOCRINE GLANDS 1. Pineal gland 2. Pituitary gland 3. Thyroid gland 4. Thymus 5. Adrenal gland 6. Pancreas 7. Ovaries 8. Testes
  5. 5. TOP 4 COMMON ENDOCRINE DISEASES (NOT IN ORDER) 䐟 Osteoporosis 䐠 Diabetes mellitus 䐡 Hyper/Hypothyroidism 䐢 Hyper/Hypoparathyroidism
  6. 6. +
  7. 7. ENDOCRINE DISEASES: OSTEOPOROSIS • Define Osteoporosis (U.S. National Library of Medicine): o A disease in which bones become fragile and more likely to fracture. o Usually the bone loses density, which measures the amount of calcium and minerals in the bone ENDOCRINE DISEASE: Osteoporosis
  8. 8. ENDOCRINE DISEASES: OSTEOPOROSIS • Commonly found amongst women • Causes: o Lack of intake of Calcium/Vit. D o Menopause: decreased estrogen level ENDOCRINE DISEASE: Osteoporosis
  9. 9. RISK FACTORS: OSTEOPOROSIS Low Body Weight Family History Smoking & High Alcohol Consumption RISK FACTORS ENDOCRINE DISEASE: Osteoporosis
  10. 10. SYMPTOMS: OSTEOPOROSIS Early Stages: • Almost no symptoms More than often, many will have experienced a fracture before finding out. Later Stages: • Pain (Due to compression fractures) • Loss of height ENDOCRINE DISEASE: Osteoporosis
  11. 11. • Assoc. with alveolar bone loss & increased risk of periodontal disease o Weakened bone structure o Increased risk of alveolar bone resorption, attachment loss, tooth loss and edentulism • Bisphosphonate therapy o Increased risk of Osteonecrosis after dental extraction ENDOCRINE DISEASE: Osteoporosis DENTAL CONSIDERATIONS: OSTEOPOROSIS
  12. 12. DENTAL CONSIDERATIONS: OSTEOPOROSIS • Frequent dental visits o Scaling and Root Planing to prevent progression of periodontal disease resulting in bone loss • Denture fit o Ill-fitting dentures • Susceptible to periodontal bacteria o Increase risk for periodontal diseases and tooth loss ENDOCRINE DISEASE: Osteoporosis
  13. 13. +
  14. 14. • High blood sugar, because pancreas does not produce enough insulin or cells do not respond to the insulin. • Most common endocrine disease in Singapore • Prevalence: 11.3% in 2010 • M>F • Indian 17.2%, Malay 16.6% and Chinese 9.7% ENDOCRINE DISEASE: Diabetes Mellitus ENDOCRINE DISEASES: DIABETES MELLITUS
  15. 15. TYPES: • Type I Diabetes Mellitus o Juvenile diabetes o Insulin dependent • Type II Diabetes Mellitus o Adult onset o Non-insulin dependent • Third type o Gestational diabetes o pregnant women ENDOCRINE DISEASE: Diabetes Mellitus TYPES: DIABETES MELLITUS
  16. 16. SYMPTOMS • Excessive thirst, urination and hunger • Sudden weight loss • Increased fatigue • Increased susceptibility to infections due to lowered immunity ENDOCRINE DISEASE: Diabetes Mellitus SYMPTOMS: DIABETES MELLITUS
  17. 17. ! Hemoglobin joins with glucose " HbA1C ! Glycosylated hemoglobin ! Measured 3-6 monthly to check if DM is under control ! Blood sample from vein or finder prick is needed to measure ! 6.5% is good for DM patient ! > 7% is not well controlled ENDOCRINE DISEASE: Diabetes Mellitus HB1AC: DIABETES MELLITUS
  18. 18. TYPE 1 TYPE 2 Genes Age > 45 years old Environment Pre-diabetes (DM during prev. pregnancy) Diet Given birth to a baby > 9 pounds Chemicals and Drugs Impaired glucose tolerance Distribution of fats: Excess body weight(esp. around waist) Family history of DM Inactivity: Low activity level (exercising < 3 times a week) ENDOCRINE DISEASE: Diabetes Mellitus RISK FACTORS: DIABETES MELLITUS
  19. 19. • Gestational diabetes o Greater than 25 years old o Family or personal health history o Excess weight o Nonwhite race ENDOCRINE DISEASE: Diabetes Mellitus RISK FACTORS: DIABETES MELLITUS
  20. 20. • Oral manifestations o compromised periodontal health/worsen due to DM o candidosis (denture wearers) o dry mouth and sialosis-> increased caries o glossitis o burning mouth syndrome o oral, facial dysasthesia • Poor response/healing to periodontal therapy • Priority given to dental infections ENDOCRINE DISEASE: Diabetes Mellitus DENTAL CONSIDERATIONS: DIABETES MELLITUS
  21. 21. • Enlarged salivary glands and xerostomia • Increase susceptibility to periodontal disease • More severe case of periodontal disease • Poorer wound healing ENDOCRINE DISEASE: Diabetes Mellitus DENTAL CONSIDERATIONS: DIABETES MELLITUS
  22. 22. Diabetes Mellitus: Patient Management ENDOCRINE DISEASE: Diabetes Mellitus PATIENT MANAGEMENT: DIABETES MELLITUS
  23. 23. • Scheduling dental visits: o Early morning, since their blood sugar level is higher at this time. o Regular dental visits • Infection and wound healing: o Post-op antimicrobial or antibiotic therapy o Avoidance of smoking ENDOCRINE DISEASE: Diabetes Mellitus PATIENT MANAGEMENT: DIABETES MELLITUS
  24. 24. Diabetes Mellitus: Patient Management • Diet: o Ensure patient has eaten normally and taken medicines as usual. • Advice: o Eat healthily o Exercise regularly o Take medication on time o Frequent medical check up (HbA1c) ENDOCRINE DISEASE: Diabetes Mellitus PATIENT MANAGEMENT: DIABETES MELLITUS
  25. 25. +
  26. 26. Metabolic processes Oxygen use ENDOCRINE DISEASE: Thyroid gland disorders ABOUT THE THYROID Secretes 3 hormones: 䐟 Thyroxine (T4) 䐠 Triiodothyronine (T3) 䐡 Calcitonin- Regulate Ca and phosporus levels, skeletal remodeling Thyroid hormones influence the growth and maturation of tissues, energy metabolism and turnover of both cells and nutrients.
  27. 27. ENDOCRINE DISEASE: Thyroid gland disorders Hypothyroidism and hyperthyroidism are the two most common thyroid disorders in women between the age of 20 and 50, who are also five times more likely than men to develop thyroid disorders. # -singhealth Hyperthyroidism is the condition caused by unregulated production of thyroid hormones. (decrease TSH, increase T3 and T4) Hypothyroidism is defined by a decrease in thyroid hormone production and thyroid gland function. (increase TSH, decrease T3 and T4)
  28. 28. CAUSES: HYPERTHYROIDISM Other risk factors: Gender History Age Smoking Trauma to the thyroid Major stress ENDOCRINE DISEASE: Thyroid gland disorders Thyroid nodules CAUSES Thyroiditis Excessive iodine intake Medications Graves’ disease
  29. 29. TYPES AND CAUSES: HYPOTHYROIDISM 1) CRETINISM (CONGENITAL) • Iodine deficiency • Defective or absent thyroid gland 2) MYXEDEMA (ACQUIRED) • Hashimoto’s thyroiditis • Treatment of overactive thyroid • Severe iodine deficiency • Pituitary gland disorder • Long -term lithium intake ENDOCRINE DISEASE: Thyroid gland disorders
  30. 30. Thyroid Gland Disorders: SYMPTOMS HYPERTHYROIDISM HYPOTHYROIDISM 1. Nervousness 2. Anxiety 3. Hand tremors 4. Goiter 5. Weight loss, despite increased appetite 6. Heart palpitations 7. Heat intolerance 8. Increased perspiration 1. Fatigue 2. Cold intolerance 3. Thin brittle hair or fingernails 4. Weight gain, easily with normal diet 5. Weakness 6. Goiter
  31. 31. DENTAL CONSIDERATIONS: HYPERTHYROIDISM Oral manifestations: • Enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue) • Accelerated dental eruption • Burning mouth syndrome • Increased susceptibility to caries • Periodontal disease • Maxillary or mandibular osteoporosis • Sjogren's syndrome • Thyroid may be enlarged or noticeably palpable (Graves’ disease) Medications: o anti-thyroid drugs- methimazole, propylthiouracil o radioactive iodine o beta-blocker and iodides ENDOCRINE DISEASE: Thyroid gland disorders
  32. 32. Our role: Look out for signs and symptoms to aid in early diagnosis. If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment to put on hold until full medical evaluation. 1. Brief and stress-free appointments 2. NO local anaesthetic with epinephrine and epinephrine ENDOCRINE DISEASE: impregnated cord for uncontrolled hyperthyroidism 3. Side effects: Propylthiouracil ! agranulocytosis ! Sialolith ! prolonged bleeding due to warfarin 4. Susceptible to infections due to drug side effects 5. Dietary advice: Avoid iodized salt, seafood Thyroid gland disorders PATIENT MANAGEMENT: HYPERTHYROIDISM
  33. 33. DENTAL CONSIDERATIONS: HYPOTHYROIDISM Oral manifestations: • Delayed dental eruption • Salivary gland enlargement • Macroglossia • Glossitis (swollen tongue) • Compromised periodontal health- delayed bone formation • Dysgeusia (distortion of taste) • Delayed wound healing Medications: Synthroid. levothyroxine, armour thyroid ENDOCRINE DISEASE: Thyroid gland disorders
  34. 34. PATIENT MANAGEMENT: HYPOTHYROIDISM 1. Susceptible to cardiovascular disease (e.g atrial fibrillation) ! Consult primary care provider to seek whether antibiotics prophylaxis is required 2. Focus on lethargy, may indicate uncontrolled state and a risk for patients and respiratory rate ! possibility of an iatrogenic hyperthyroid state caused by hormone replacement therapy used to treat hypothyroidism 3. Avoid giving depressants, sedatives or narcotic analgesics ! may cause exaggerated response in patients with mild to severe hypothyroidism ENDOCRINE DISEASE: Thyroid gland disorders
  35. 35. +
  36. 36. ENDOCRINE DISEASE: Parathyroid gland disorders Parathyroid glands • small endocrine glands that produce parathyroid hormone (PTH) • there are four parathyroid glands usually located behind the thyroid gland • controls the amount of calcium in the blood and within the bones so that nervous & muscular systems can function properly • PTH increases blood calcium levels by stimulationg osteoclasts to break down bone, increasing resorption • PTH increases gastrointestinal calcium absorption by activating Vitamin D • PTH increases renal absorption of calcium by the kidneys ENDOCRINE DISEASE: Parathyroid Disorders
  37. 37. Hyperparathyroidism • Overactivity of the parathroid glands • Excess production of PTH • Raised PTH levels are harmful to bone • Primary hyperparathyroidism / Secondary hyperparathyroidism ENDOCRINE DISEASE: Parathyroid Disorders ENDOCRINE DISEASES: DIS: DIABETES MELLITUS HYPERPARATHYROIDISM
  38. 38. Symptoms • Fragile bones that easily fracture • Kidney stones • Excessive urination • Abdominal pain • Tiring easily or weakness • Depression or forgetfulness • Bone and joint pain • Frequent complain of illness with no apparent cause • Nausea, vomiting or loss of appetite ENDOCRINE DISEASE: Parathyroid Disorders SYMPTOMS: HYPERPARATHYROIDISM
  39. 39. Complications of Hyperparathyroidism 1. Dental abnormalities • widened pulp chambers • development defects • alterations in dental eruption • weak teeth • malocclusions • loss of lamina dura on radiographs • giant cell lesions ENDOCRINE DISEASE: Parathyroid Disorders ENDOCRINE DENTAL CONSIDERATIONS: DISEASES: HYPERPARATHYROIDISM OSTEOPOROSIS
  40. 40. Complications of Hyperparathyroidism 2. Brown tumor 3.Loss of bone density (bone resorption) 4.Soft tissue calcifications ENDOCRINE DISEASE: Parathyroid Disorders DENTAL CONSIDERATIONS: HYPERPARATHYROIDISM
  41. 41. Patient management • No special consideration • higher risk of bone fracture • Take precaution in surgical tx • Recognize presence of brown tumor • Perform correct differential diagnosis so as not to conduct an inadequate tx ENDOCRINE DISEASE: Parathyroid Disorders PATIENT MANAGEMENT: HYPERPARATHYROIDISM
  42. 42. Hypoparathyroidism • Decreased function of the parathyroid glands • Underproduction of PTH • Leads to low levels of calcium in the blood • Can be inherited but is also encountered after thyroid or parathyroid surgery ENDOCRINE DISEASE: Parathyroid Disorders ENDOCRINE DISEASES: HYPOPARATHYROIDISM
  43. 43. Symptoms • Tingling or burning (paresthesia) on fingertips, toes and lips • Muscle aches or cramps affecting legs, feet, abdomen or face • Twitching or spasms of muscles, particularly around mouth, hands, arms or throat • Fatigue or weakness • Dry, coarse skin • Brittle nails • Anxiety or nervousness • Headaches • Depression, mood swings • Memory problems ENDOCRINE DISEASE: Parathyroid Disorders SYMPTOMS: HYPOPARATHYROIDISM
  44. 44. Complications of Hypoparathyroidism 1. Dental abnormalities • Enamel hypoplasia in horizontal lines • poorly calcified dentine • widened pulp chambers • dental pulp calcifications • shortened roots • hypodontia • delay or cessation of dental development ENDOCRINE DISEASE: Parathyroid Disorders DENTAL CONSIDERATIONS: HYPOPARATHYROIDISM
  45. 45. Complications of Hyperparathyroidism 2. Mandibular tori 3. Chronic candidiasis 4.Parasthesia of the tongue or lips 5.Alteration in facial muscles ENDOCRINE DISEASE: Parathyroid Disorders DENTAL CONSIDERATIONS: HYPOPARATHYROIDISM
  46. 46. Patient management ! More susceptible to caries ! Due to dental anomalies ! Dental management: ! Prevention of caries with periodic reviews, advice regarding diet, OHI ! Before performing dental tx, find out serum calcium level (must be 8mg/100ml) ! Prevents cardiac arrythmias, seizures ENDOCRINE DISEASE: Parathyroid Disorders PATIENT MANAGEMENT: HYPOPARATHYROIDISM
  47. 47. + The end. Thank you for your attention.
  48. 48. References • http://jada.ada.org/content/137/suppl_2/26S.full • http://www.ugr.es/~jagil/lalla_diabetes.pdf • http://jada.ada.org/content/137/8/1144.full.pdf+html • http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Oral_Health/default.asp • http://www.medicinaoral.com/odo/volumenes/v2i4/jcedv2i4p196.pdf • http://www.fourthmolar.com/blogs/entry/The-Dental-Management-of-Patients-with-Endocrine-Disease • http://webcache.googleusercontent.com/search?q=cache:e-dTttBHpwQJ:web.squ.edu.om/med-Lib/ MED_CD/E_CDs/Essential%2520of%2520Oral%2520Medicine/docs/ch09.pdf+endocrine+and +dental&cd=9&hl=en&ct=clnk&client=safari • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Thyroid-Disorders- Hyperthyroidism.aspx • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Diabetes- Mellitus.aspx#section3 • http://www.cgh.com.sg/Medical_Specialities/Medical_Services/Pages/endocrinology.aspx • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Thyroid-Disorders.aspx • http://thyroid.about.com/od/hyperthyroidismgraves/a/risks-symptoms.htm • http://www.webmd.com/drugs/condition-584-Hypothyroidism.aspx?d.. • http://www.medicinenet.com/hyperthyroidism/index.htm

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