This document outlines the dental management of patients with thyroid disease. It discusses taking a thorough medical history and examination. Treatment plans should consider the patient's thyroid condition and medications. Hyperthyroidism can increase risks of infection, bleeding, and cardiac issues while hypothyroidism increases infection risk. Dental procedures should minimize stress and avoid epinephrine for uncontrolled hyperthyroid patients. Vital signs must be monitored and treatment stopped if issues arise.

1. Dental management
of patient
with thyroid disease

2. . .
. .
. .

3. Outlines
• History taking
• Clinical examination
• Treatment plans
• Hyperthyroid disease review
• Hypothyroid disease review
• Dental management

4. • 36

5. History taking
Chief complaint :
Present illness :
1
Past medical history
- Hyperthyroid treatment
partial thyroidectomy
completed thyroidectomy
-
Current medicine : Thyroxine 50 mg

6. Extraoral examination
• General appraisal : normal
• Skull : normal
• Facial form and profile : normal
• Skin : normal
• Eyes : normal
• Neurologic deficit : normal
• Lymph nodes of head and neck :
normal
• TMJ : normal
• Masticatory muscle: normal

7. Extraoral examination
(Cont.)
• Lymph nodes of head and neck :
normal
• TMJ : normal
• Masticatory muscle: normal
• Opening pattern : straight
• Salivary glands : normal
• Muscles of head and neck : normal

8. Intraoral
examination

9. Intraoral
examination
• Lip
Vermillion border : normal
Lip commissure : normal
Inner surface of lip : normal
• Buccal mucosa : linear alba
• Salivary flow rate : normal
• Oropharynx : normal
• Soft palate : normal

10. Intraoral examination
(Cont.)
• Hard palate : torus palatinus size
10x10x3 mm3
• Tongue : Hyperpigmentation
• Floor of mouth : normal
• Gingiva : Physiologic
hyperpigmentation
at the anterior area of upper arch
from tooth 32 and 33

11. Intraoral radiographic examination

12. Treatment plan
Visit Tooth Procedure
number
1 00 - History taking
- Extra-oral
examination
- Intra-oral
examination
- Radiographic
examination
2 00 Treatment
planning
16 discussion
34
Extraction
Fluoride varnish.
3 25,26,27 Extraction

13. Treatment plan (Cont.)
Visit Tooth number Procedure
6 12 D, Pa – resin
22 composite
Pa – resin composite
filling.
7 48 Extraction
8 15,16,25,26,27 Impression
RPD design
9 15,16,25,26,27 Try – in framework
10 15,16,25,26,27 Try – in artificial teeth
11 15,16,25,26,27 Insert RPD
12 00 - Reinforce oral
hygiene and
preventive program

14. Hyperthyroidism

15. CHARACTERISTICS OF
HYPERTHYROID DISEASE

16. caries
Maxillary,
mandible Periodonta
osteoporo Oral l disease
sis manifest
ation
Accelerate Burning
d dental mouth
eruption syndrome

17. Diagnos
is
• History taking
• Clinical examination
• Laboratory: TSH decrease
free T3,T4 increase

18. Treatment
Thyroidectomy Surgery

19. Hypothyroidism

20. Pathophysiology and Etiology

21. Macrogloss
ia
Impaction
of the
mandibular Thick lips
second Oral
molars
manifest
ations
Delayed
Malocclusi
eruption of
on
teeth

22. Diagnosis
• History taking
• Clinical examination
• Laboratory: TSH increase
free T3,T4 decrease
• :
Thyroid autoantibody, Thyroglobulin
antibodies : positive

23. Treatment
Synthetic thyroid hormone
Sodium levothyroxine (LT4)
Sodium liothyronine (LT3)

24. Role of Dentist
• Suspect a serious thyroid disorder ,
aid in early diagnosis
• Avoid possible dental complications
resulting from treating patients with
thyroid disorder

25. Dental management

26. Dental management
infect
ion
Myxed Psycholo
ema gical
coma problems
Hypothyro
idism Narcoti
c
Bleed Barbitu
ing rate
Tranqui
lizer
CVD

27. Bleeding potency
subcutaneous
mucopolysacch
arides
excess
subcutaneous
mucopolysacchari
des
Ability of small
blodd vessel
constriction
Bleeding potency

28. Susceptibility to
infection
Metabolic
activity of
fibroblast
Delayed wound
healing
Prolong
unhealed wound
Risk of infection

29. Hypothyroid
coma(myxedema
coma)
Trau myxe
ma
Co Stress dema
ld
Dental coma
treatment




30. Drug interactions of L-
thyroxine
• increases the effects of warfarin
sodium :
coagulation tests in the patient that
taking an oral anticoagulant
• Tricyclic antidepressants :
elevates L-thyroxine levels

31. Dental anti-thyroid drugs
PTU has
managemen Hemostasis
anti-vitamin K
Stres
t s and Infect
anxie ion
Reduction ty anti-thyroid
protocol drugs
Hyperthyroidism
Thioamind
Drug )
interfere Fliori interac
ASA
thyroid de tions interfere
gland s protein
function
Thyrotoxic
binding
crisis
epinephrin
of T4
e is
and T3

32. Symptoms of
Thyroid crisis
Extreme restlessness, nausea,
vomiting, abdominal pain, fever,
profuse sweating, tachycardia, cardiac
arrhythmias,
pulmonary edema, congestive heart
failure
Stupor,
coma
Severe
hypotension
and death

33. How thyrotoxicosis contributes
to heart failure

34. Cardiovascular signs and
symptoms of hyperthyroidism
Conge Palpa Exercis
stive tion e
heart intoler
failure ance
Exertio
Periph
nal
eral
dyspne
edema CVD a
Cardiac Systolic
hypertr hyperte
ophy Angi nsion
Atrial
na
fibrillati
chest
on
pain

35. Dental management of cardiac
arrhythmia in thyroid patient
•
• epinepihrine
•
•
• AF

36. Dental management of cardiac
arrhythmia in thyroid patient (Cont.)
• AF
anticoagulant
drug prothrombin time(PT)
international normalized ratio(INR)
INR ≤ 3.5
•
-
-
-
•
(sedation)
• epinephrine 1:100,000

37. Before treatment
dental treatment
• presence of cardiovascular disease, assess
cardiovascular status.
• symptoms of thyroid disease, defer
elective treatment and consult a physician.
• Give attention to drug-induced leukopenia
and anemia.
• Make proper treatment modifications if the
patient is receiving anticoagulation
therapy.

38. During dental
treatment
• Monitor vital sign during procedure
– Euthyroid no contraindication to local
anesthesia with epinephrine
– Use caution with epinephrine if patient
take nonselective beta blocker
– Hyperthyrodism not controlled should
avoid epinephrine
• Minimize stress
• Discontinue treatment if there are

39. After dental
treatment
• hypothyroidism sensitive to central
nervous system depressants and
barbiturates.
• Control pain
• precaution NSAID for hyperthyroidism,
avoid aspirin.
• Continue hormone replacement therapy or
antithyroid drugs as prescribed

40. Dental management of
thyrotoxic crisis
• Large doses of antithyroid drugs 200 mg
of propylthiouracil
• Potassium iodide
• Propranolol
• Hydrocortisone 100-300 mg
• Dexamethasone
• Intravenous IV glucose solution

41. Management of
myxedema coma
Hydrocortisone 300 mg,

42. • - x-ray
• Mechanism 