Hyperthyroidism-hypothyroidism
- General:
The dentist will frequently be called upon to treat patients suffering from endocrine pathologies.
Endocrine glands, such as the thyroid, represent a large internal communication network, with their target organs being located nearby or far away in the human body.
Thyroid disorders are relatively common (the second most common endocrine disease in the world after diabetes) and diagnosis is easy.
Through the anamnesis and the clinical examination, the dental surgeon will also be able to easily establish the link between a thyroid disorder and an oral pathology.
Hyperthyroidism-hypothyroidism
- Abnormalities of HT secretion:
1- Hypothyroidism
Hypothyroidism corresponds to an insufficiency of secretion of HT by the thyroid gland.
This causes an increase in the secretion of TSH by the pituitary gland which leads to the formation of a goiter.
The general clinical signs of hypothyroidism are numerous:
- puffy face (myxedema) due to infiltration of mucoprotein substances into the skin;
- weight gain;
- asthenia;
- depressive state;
- constipation ;
- hair loss;
- paleness of the skin;
- stocky hands;
- bradycardia and high blood pressure;
- osteoporosis;
- decreased mental and visual acuity.
- Oral signs are: thickened lips and large protruding tongue; poor bone age; delayed eruption of teeth; malocclusions.
The biological signs are:
- hypercholesterolemia;
- anemia;
- hypoglycemia
- Drug treatment aims to replace the failing system with replacement hormones: (Levothyrox®).
2 – Hyperthyroidism
Hyperthyroidism corresponds to an excess secretion of HT by the thyroid gland.
It is responsible for clinical manifestations grouped under the name of thyrotoxicosis.
The general clinical signs of hyperthyroidism are:
- weight loss;
- thermophobia;
- agitation and irritability;
- palpitations; tachycardia and increased pulse pressure;
- sweating;
- muscle wasting;
- tremors;
- diarrhea and weight loss.
- Objective manifestations by the dental surgeon, such as ophthalmia in hyperthyroidism,
- The biological signs are: hypercalcemia; hypercholesterolemia; iron deficiency; increased sedimentation rate and increased cortisol level.
- Treatment:
- antithyroid drugs, which aim to prevent excess production of thyroid hormones.
- Patients with this type of pathology are monitored and balanced, the vast majority of the time. There is therefore no particular precaution to take for them, they present neither a risk of hemorrhage nor a risk of infection.
- For hyperthyroid patients at moderate risk, it is best to avoid the use of vasoconstrictors.
- Furthermore, in these patients, the persistence of infectious foci can cause a thyrotoxic crisis.
- It is best not to give them barbiturates or narcotics.
- On the other hand, high-risk patients must be treated in a hospital setting.
- ORAL AND DENTAL CLINICAL PICTURE AND REPERCUSSIONS OF THYROID DISORDERS
- The thyroid intervenes in many anatomical areas and in different ways on the orofacial sphere. We will detail these different impacts according to the place of action.
1- Salivary impact:
- Saliva plays many roles in the mouth; not only does it protect teeth from caries and protect mucous membranes from pathological damage such as mycoses, but it also facilitates digestion, phonation, chewing, swallowing and tasting.
- 2- Volume of salivary cells:
Hypothyroidism causes a decrease in the volume of cells in the submandibular glands as well as a decrease in the volume of the striated and intercalated ducts.
3- carious incidence
Hypothyroidism is therefore clearly involved in the appearance of caries through its endocrine role on the histology of the salivary glands.
The thyroid therefore has a significant impact on the salivary glands and their secretions (T3 and T4 increase salivary secretion) and therefore acts on saliva but also on the roles of saliva and on salivary disorders.
4- the bones of the jaw
The jaw bones are composed of the maxilla and mandibular bones.
They are both composed of cortical bone on the periphery and spongy bone, also called trabecular bone, in their center.
They support the teeth with the help of alveolar bone which is a spongy bone surrounded by a cortex denser than the basal bone.
The basal bone supports the alveolar bone, it is more calcified and much denser.
- hyperthyroidism, it will be necessary to watch out for the risk of osteoporosis.
- In case of hypothyroidism, we will generally move towards osteosclerosis
- 5- Caries incidence
As we have seen above, in hypothyroid patients, the incidence of caries is increased due to hyposialia. In hyperthyroid patients, the occurrence of caries will also be greater because the subject will be led to ingest sugars more easily for their metabolism, which will be accelerated.
6- Development and dental counting
- One of the main effects of the thyroid at the general level is the effect on growth and development, mainly of the bone and the central nervous system. In the face of congenital hypothyroidism, the fetus will be affected from the first months.
Extra teeth: born with two baby teeth that had already erupted.
Adrenal pathologies
- Adrenal pathologies
- The adrenal glands produce three types of hormones:
- • glucocorticoids responsible for hydroelectric balance and the immune response;
- • corticosteroid minerals;
- • androgens.
- A patient may present hyperadrenalism for genetic reasons (Cushing’s disease) or by chronic intake of exogenous corticosteroids.
- These patients are prone to gingival hypertrophy and bacterial infections.
- It is recommended to prescribe anti-infectious premedication before treatment and a flash increase in the dose of corticosteroids in order to help the patient cope with stress.
Hyperthyroidism-hypothyroidism
- CLINICAL SIGNS:
4 fundamental signs, present whatever the cause:
- Intense physical and psychological asthenia
- Weight loss: significant and rapid with muscle loss ++
- Hypotension responsible for lipothymia and syncope (hypoglycemia also plays an important role)
- Digestive disorders: anorexia, constipation, abdominal pain, diarrhea, nausea and vomiting should raise concerns about acute decompensation
+ melanoderma if Addison’s disease (due to increase in MSH, co-produced with ACTH) brown coloring of the skin, predominant in exposed areas, areas of friction, palmar folds, scars slate-colored spots on the oral mucosa
≠ if corticotropic insufficiency: rather depigmentation.
- HYPERCORTICISM:
CUSHING’S syndrome
Increased secretion of cortisol: disease with serious progression without treatment.
ORIGIN • Primitive adrenal by benign tumor (adenoma) or malignant tumor (adrenal cortex)
Pituitary by abnormal secretion of ACTH (Cushing’s disease) by pituitary adenoma • Ectopic by abnormal secretion of ACTH by endocrine or non-endocrine tumor (pulmonary).
1-CLINICAL SIGNS:
- Fat distribution abnormality Facio-truncal overload
- Buffalo Hump
- Amyotrophy and absence of fat in the thighs, buttocks, arms
- Skin atrophy: pink or red stretch marks at the root
- Bone pain, osteoporosis (vertebral compression)
- Hyperandrogenism (acne, hirsutism)
- Facial erythema
- HTA
- Psychiatric disorders
2- TREATMENT OF CUSHING SYNDROME:
- Adrenal adenoma: adrenalectomy
- Pituitary adenoma: adenomectomy (if failure: radiotherapy, adrenalectomy or medication)
- Ectopic tumor: surgical excision (if possible)
- If not possible: anticortisone drugs
- OP’DDD (Mitotane)
- Aminoglutethimide (Orimetene)
- IN CASE OF ADRENALECTOMY OR MEDICAL TRT/substitution therapy with HYDROCORTISONE.
Hyperthyroidism-hypothyroidism
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.