MANAGEMENT OF ENDOCRINE DISORDERS
MANAGING A DIABETIC PATIENT .
A/ INTRODUCTION:
Diabetes is a chronic disease (one that cannot be cured), but it can be treated and controlled. It is caused by a lack or failure of the pancreas to use a hormone called insulin. The pancreas is the gland responsible for producing hormones, including insulin and glucagon, and substances needed for digestion (enzymes).
Insulin allows glucose (sugar) to enter the body’s cells so that it can be used as an energy source. In a person without diabetes, insulin does its job well and the cells have the energy they need to function. When insulin is lacking or does not perform its function effectively, as is the case in a person with diabetes, glucose cannot be used as fuel for the cells. It then accumulates in the blood and causes an increase in sugar levels (hyperglycemia). Over time, high blood sugar levels lead to certain complications, particularly in the eyes, kidneys, nerves, heart and blood vessels. There are different types of diabetes: type 1 diabetes, type 2 diabetes (pregnancy diabetes will not be covered in this course).
B/ DEFINITION :
- Type 1 diabetes: This type of diabetes most often appears during childhood, adolescence, or early adulthood, rarely in older people. Type 1 diabetes was formerly known as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes. It is characterized by a complete lack of insulin production. A person with type 1 diabetes therefore depends on daily injections to ensure their survival.
- Type 2 diabetes: It usually manifests itself in adulthood, in individuals aged 40 and over. In this type 2 diabetes (IDDM), either insulin production is insufficient, or the insulin produced does not do its job well; this is called insulin resistance.
C/ DIABETIC BALANCE: A patient is considered diabetic;
- if he has a fasting blood sugar level greater than 1.26g/l on two consecutive blood tests.
- if glycated hemoglobin ( HbA1c) is greater than 7%. HbA1c reflects the glycemic balance over the last 3 months and therefore the balance of diabetes.
D/ DIABETES BALANCE AND RISK OF INFECTION:
- The unbalanced diabetic patient presents an infectious risk.
- Oral effects :
- Increased incidence of periodontal diseases
- Xerostomia and the appearance of caries
- Increased risk of bacterial, viral and fungal infections.
- Altered taste (medications)
E/ CARE: GENERAL INSTRUCTIONS
- Prior contact with the attending physician
- Know the latest HbA1c level
- Limit stress through psychological preparation and/or sedative premedication
- In case of DID, plan an extraction/care after a meal
- A source of glucose must be present in the office (sugar)
- Vasoconstrictors are not contraindicated in balanced type 1 and 2 patients.
- NSAIDs and corticosteroids are not recommended.
- Antifungals: miconazole (DAKTARIN) is contraindicated in patients taking hypoglycemic sulfonamides (Diamicron and Amarel)
- cases of HbA 1c > 7%.
For non-invasive procedures
- conservative care
- Bloodless prosthetic care
- Removing stitches
- Fitting of removable prosthesis
- Fitting and adjustment of orthodontic appliances
- Taking an intraoral x-ray
CAT: Respect general precautions
- cases of HbA 1c > 7%.
For invasive procedures
- All acts involving manipulation:
From the gum
Tooth peri apical region
- cases of breach of the oral mucosa (outside local and loco-regional anesthesia
b-1. Are these acts involving mucosal and/or bone healing???
- No: CAT
1 hour before the act:
*Orally: 2 g amoxicillin / adult and 50 mg / kg in children. If allergic to penicillins: 600 mg clindamycin and 20 mg / kg child / 06 YEARS
*Mouthwash (BDB) /07 J (chlorhexidine 0.12%)
- Yes :
*SAME PROTOCOL But continue antibiotic prophylaxis for 7 to 10 days
MANAGEMENT OF A PATIENT WITH ENDOCRINE PATHOLOGIES
I / INTRODUCTION : The thyroid is an unpaired endocrine gland located in the lower median cervical region, formed of two lobes connected by an isthmus. This gland secretes thyroid hormones (TH).
A/ EFFECTS OF THYROID HORMONES Thyroid hormones have multiple metabolic and tissue effects. They regulate the development and differentiation of the organism. All tissues respond in one way or another to their action. They stimulate or inhibit the activity of a large number of enzymes.
- Effect on development: This effect is observed on growth and differentiation. Growth is defined as an increase in the total mass of the organism and differentiation corresponds to the set of complex modifications that lead to the diversification of the cellular structure and functions and to the morphogenesis of the organism.
- Effect on the central nervous system: HTs promote myelination of nerve fibers and stimulate the development and growth of axons, cell bodies and dendrites. A HT deficiency during uterine life.
- Effect on skeletal muscles: HT deficiency leads to an increase in the volume and consistency of skeletal muscles so contraction is slowed down.
- Cardiovascular effect: HT increases vascular flow and especially heart rate.
- Effect on the digestive system: HT increases intestinal motility, intestinal blood flow, oxygen consumption and intestinal absorption.
- Effect on renal function: HT increases glomerular filtration rate and renal blood flow.
- Effect on metabolism: HT administration increases oxygen consumption, heat production and accelerates carbohydrate, protein and lipid metabolism.
- Effect on behavior: Finally, thyroid hormones act on a person’s psychological behavior. In case of excess thyroid hormones, we often notice a state of anxious agitation accompanied by irritability and insomnia; the mood is often sad; an acute episode can lead to manic-depressive psychosis. On the contrary, in case of lack of thyroid hormones, psychological disorders are characterized by intellectual slowdown, emotional indifference and sadness.
B/ THYROID ABNORMALITIES :
1. Hypothyroidism: Hypothyroidism corresponds to an insufficiency of secretion of HT by the thyroid gland. The drug treatment is levothyroxine
2. Hyperthyroidism: Hyperthyroidism is an excess secretion of HT by the thyroid gland. Treatment consists of giving anti-thyroid drugs (methimazole and propylthiouracil), radioactive iodine I-131 or surgery.
3. thyroiditis: will not be covered in this course
C/ Repercussions of thyroid disorders on the oral cavity:
- Hypothyroidism :
- causes a decrease in the volume of cells in the submandibular glands as well as a decrease in the amount of saliva. Saliva has many roles in the mouth; not only does it protect the teeth from carious damage and protect the mucous membranes from pathological damage such as mycoses, but it also facilitates digestion, phonation, chewing, swallowing and tasting.
- Has a bone impact:
- Thyroid hormones stimulate the expression of osteopontin (OPN) and thus promote the formation of osteoblasts and the attachment of osteoclasts, which accelerates bone remodeling.
- The thyroid also secretes calcitonin by the parafollicular cells, it is a hypocalcemic hormone, which causes a decrease in the release of calcium by the bone (as well as by the kidney). It is the only hormone that acts directly on osteoclasts by reducing their mobility and accelerating their apoptosis. The resorption activity of osteoclasts is therefore inhibited by calcitonin.
- Also manifested by:
– early exfoliation of temporary teeth
– early eruption of mature teeth
– spontaneous alveolysis
– xerostomia.
MANAGEMENT OF ENDOCRINE DISORDERS
- Hyperthyroidism :
- causes alveolar bone loss which may be accentuated in the case of periodontitis. Thyroid disorders therefore have an influence on the bone. However, during orthodontic treatment, dental movements are weighted by bone remodeling; if the speed of apposition or bone resorption is modified then dental movements will be slowed down or accelerated.
- Osteocalcin is found in serum overconcentration in hyperthyroid patients, so bone turnover is greater in these patients. Osteocalcin (OC) is a protein secreted by osteoblasts and is found in bone and dentin. It plays a role in bone mineralization and in the balance of calcemia (calcium levels in the blood).
- Hyperthyroidism would lead to greater urinary excretion of Ca and therefore a decrease in blood Ca. This result would tend to cause hypomineralization of the bone during thyroid disorders.
- Clinical manifestations: Their intensity depends on the degree of thyrotoxicosis, its duration and the terrain.
- Cardiovascular disorders
regular tachycardia
an increase in the intensity of heart sounds
an increase in systolic BP.
- Neuropsychiatric disorders
excessive nervousness
a fine, regular tremor of the extremities
general fatigue.
Insomnia.
- Other events:
Full lips
Mouth breathing
A macro or microglossia
Delayed tooth eruption
Dental abnormalities (enamel hypoplasia)
An alteration of taste.
MANAGEMENT OF ENDOCRINE DISORDERS
D/ Dental care:
- Chair stress: premedication for hypothyroidism . Hyperthyroid patients being monitored will generally already be treated with CNS depressants or anxiolytics. It will therefore be useless to premedicate them before treating them.
- Anesthesia and cardiovascular effects: In the case of manifest hyperthyroidism, the use of vasoconstrictors during local anesthesia should be limited because they are likely to cause hypertensive crises, tachycardia or even arrhythmias.
- Uses of the thyroid collar: for patients treated with radioactive iodine 131
MANAGEMENT OF ENDOCRINE DISORDERS
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.