Can Having Chronic Tooth Infections Cause Graves Disease
Indian J Endocrinol Metab. 2011 Jul; 15(Suppl2): S113–S116.
Oral manifestations of thyroid disorders and its management
Shalu Chandna
Department of Periodontics, MM Higher of Dental Sciences and Research, Ambala, Haryana, Bharat
Manish Bathla
ane Section of Psychiatry, MM College of Dental Sciences and Enquiry, Ambala, Haryana, Republic of india
Abstract
The thyroid is the major regulator of metabolism and affects all of the bodily functions. Thyroid dysfunction is the second most mutual glandular disorder of the endocrine organization which may rear its head in whatever system in the body including the mouth. The oral fissure is adversely affected by either an excess or deficiency of these hormones. Before treating a patient who has thyroid disorder, the endocrinologist needs to be familiar with the oral manifestations of thyroid dysfunctions. The patient with a thyroid dysfunction, as well as the patient taking medications for information technology, requires proper risk management before considering dental handling by the dentist. Thus, communication of dentist with endocrinologist must be bidirectional, to maintain patient'south oral and thyroid health.
Keywords: Dental management, hyperthyroidism, hypothyroidism, oral manifestations
INTRODUCTION
The thyroid gland is a bilobular structure that lies on either side of the trachea. Thyroid dysfunction is the 2d most common glandular disorder of the endocrine system and is increasing, predominantly amidst women.[one] Up to 5% of the female population has alterations in thyroid office,[2,3] and up to six% may have clinically detectable thyroid nodules on palpation.[four] An estimated xv% of the full general population has abnormalities of thyroid anatomy on physical examination, and an unknown percent of these practise non complete a diagnostic evaluation. Information technology has been suggested that the number of people affected may be twice equally many as the undetected cases.[2] This means patients with undiagnosed hypothyroidism or hyperthyroidism are seen in the dental chair, where routine treatment has the potential to effect in adverse outcomes.[4]
The oral health care professional person should be familiar with the oral and systemic manifestations of thyroid disease so he or she can identify any complexity and assess the level to which the condition is controlled [Table 1]. If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed. Patients with history of thyroid diseases should be advisedly evaluated to determine the level of medical management, and they should be treated in a way that limits stress and infection. Consultation with the patient's primary intendance physician or an endocrinologist is warranted if any sign or symptom of thyroid disease is noted on examination. If an emergent dental process is needed in the initial weeks of thyroid handling, close work-upward with the endocrinologist is needed.
Tabular array i
Common oral manifestations of patients with thyroid gland disorders
HYPOTHYROIDISM
Hypothyroidism is defined by a decrease in thyroid hormone production and thyroid gland function. It is acquired by, chronic thyroiditis (Hashimoto'southward disease), radioactive iodine, surgery and pharmacological agents such as lithium and amiodarone. Bereft levels of thyroid hormone cause symptoms such as slower metabolic charge per unit, weight gain, lethargy, intolerance to cold, dry and cool peel, and puffiness of the face up and eyelids, as well as others. The blood pressure appears to be normal, only the middle charge per unit is dull.
Oral manifestations of hypothyroidism
Childhood hypothyroidism known as cretinisim is characterized by thick lips, large protruding tongue (macroglossia), malocclusion and delayed eruption of teeth. Thickening of the lips and macroglossia is due to increased accumulation of subcutaneous mucopolysaccharides i.e., glycosaminoglycans due to decrease in the degradation of these substances. The long-term effects of astringent hypothyroidism on craniofacial growth and dental development accept also included impaction of the mandibular 2d molars. This seems to be caused by a dissociation of ramus growth and failure of normal resorption of the internal aspect of the ramus, resulting in insufficient space for proper eruption of these teeth.[five]
The common oral findings in hypothyroidism include the characteristic macroglossia, dysgeusia, delayed eruption, poor periodontal health, altered tooth morphology and delayed wound healing.[vi] Before treating a patient who has a history of thyroid disease, the dentist should obtain the correct diagnosis and etiology for the thyroid disorder, as well equally past medical complications and medical therapy.
HYPERTHYROIDISM
Hyperthyroidism is a condition caused by unregulated product of thyroid hormones. It is characterized by tremor, emotional instability, intolerance to heat, sinus tachycardia, marked chronotropic and ionotropic furnishings, increased cardiac output (increased susceptibility to congestive heart failure), systolic heart murmur, hypertension, increased appetite and weight loss.[7]
Oral manifestations of hyperthyroidism
The oral manifestations of thyrotoxicosis, includes increased susceptibility to caries, periodontal disease, enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue), maxillary or mandibular osteoporosis, accelerated dental eruption[eight] and called-for mouth syndrome.
Called-for mouth syndrome, a condition that causes a burning pain in the mouth, and Sjogren's syndrome, a condition that causes dry out mouth, are more common in people with thyroid affliction.[4]
In Graves disease, on actress-oral examination the thyroid may be enlarged or noticeably palpable. The enlarged gland may be more than visually noticeable when the patient is in a supine position in the dental chair. Only in more severely enlarged thyroids, the bulge in the neck is noticeable even when the patient is sitting upright or continuing.
ROLE OF ENDOCRINOLOGIST
Physicians who treat children and adults with thyroid disorders could be a good referral source of patients whose oral health care needs may not be satisfied fairly. Thus, treating patients with thyroid disorders too represents an opportunity to expand a dentist'southward referral base.
Regular advice of dentist with endocrinologist is a critical component of condom and optimal treatment of thyroid patients. Advice must be bidirectional. The endocrinologist must be apprised of oral manifestations of the illness, and dentists must be updated on thyroid control medications to help them to maintain patient'south oral health.
ROLE OF DENTIST
Obtaining an understanding of thyroid dysfunction is of meaning importance to the dentist for ii reasons. Outset, the dentist may exist the first to doubtable a serious thyroid disorder and aid in early diagnosis. Thus, as part of a wellness intendance squad, the dentist plays an important role in detecting thyroid abnormalities. The 2nd reason is to avert possible dental complications resulting from treating patients with the thyroid disorders. Modifications of dental care must be considered when treating patients who have thyroid illness.
1 manner the dental professional can protect the thyroid gland is to use a thyroid collar while taking patient X-rays. The thyroid is extremely sensitive to radiation, and excessive radiation exposure is a known gamble factor for various thyroid conditions.
Patients who have thyroid disease nowadays a treatment challenge to dentists. Awareness of the condition and electric current stage of treatment is of import in understanding the possible modifications needed for dental treatment. Length and current state of therapy are important in agreement the metabolic control of patients. The principal complications of patients with hyperthyroidism and hypothyroidism are associated with cardiac comorbidity. Consultation with the patient's primary care md or an endocrinologist is warranted if any sign or symptom of thyroid disease is noted on examination.
Stress reduction, sensation of drug side effects or interactions, and vigilance for appearance of signs or symptoms of hormone toxicity are among the responsibilities of the oral health care provider. Dental professionals have a responsibility to be enlightened of the unlike dimensions of the disease and treatment that could affect a patient whose medical history reverberate thyroid problems.
Many signs and symptoms of thyroid affliction are observable during examination of the orofacial complex. Furthermore under or over activity of the thyroid gland can cause life-threatening cardiac events. Consequently, the dental practitioner must be knowledgeable about thyroid pathophysiology and the treatment of thyroid atmospheric condition. Dental treatment modification may be necessary for dental patients under medical management and follow-up for a thyroid condition. If a suspicion of thyroid affliction arises for an undiagnosed patient, all elective dental treatment should be postponed until a complete medical evaluation is performed.[4] A medically well-controlled patient will have no contraindications to take dental treatment.[ix]
DENTAL MANAGEMENT OF HYPOTHYROIDISM
Hemostasis - Patients with long standing hypothyroidism may have increased subcutaneous mucopolysaccharides due to decrease in the degradation of these substances. The presence of excess subcutaneous mucopolysaccharides may decrease the power of small-scale claret vessels to constrict when cut and may result in increased bleeding from infiltrated tissues, including mucosa and skin. Local pressure for an extended time will probably command the bleeding from the pocket-size vessels fairly.[ten]
Susceptibility to infection - Patient with hypothyroidism may accept delayed wound healing due to decreased metabolic activity in fibroblasts. Delayed wound healing may be associated with an increased risk for infection because of the longer exposure of the unhealed tissue to pathogenic organisms. Hypothyroid patients are non considered to be immunocompromised.
Patients who take hypothyroidism are susceptible to cardiovascular disease from arteriosclerosis and elevated LDL. Before treating such patients, consult with their primary care providers who tin provide information on their cardiovascular statuses. Patients who take atrial fibrillation tin can exist on anticoagulation therapy and might require antibody prophylaxis before invasive procedures, depending on the severity of the arrhythmia.[11] If valvular pathology is present, the demand for antibody prophylaxis must exist assessed.
Drug actions and interactions - Patients who accept hypothyroidism are sensitive to central nervous system depressants and barbiturates, so these medications should exist used sparingly.[6,12]
Information technology has been found that recent exposure to a surgical clarified that includes iodine (such as Povidone) can increment the adventure of thyroiditis or hypothyroidism. Patients with underlying thyroid antibodies and a tendency toward autoimmunity appear to be at more than risk.[13]
Drug interactions of l-thyroxine include increased metabolism due to phenytoin, rifampicin and carbamazepine, too equally impaired absorption with iron sulfate, sucralfate and aluminum hydroxide. When l-thyroxine is used, it increases the effects of warfarin sodium and, considering of its gluconeogenic effects; the apply of oral hypoglycemic agents must be increased. Concomitant utilize of tricyclic antidepressants elevates l-thyroxine levels.[14] Advisable coagulation tests should be bachelor when the patient is taking an oral anticoagulant and thyroid hormone replacement therapy.
DENTAL ThouANAGEMENT OF HYPERTHYROIDISM
Hemostasis - Patients with hyperthyroidism may take elevated blood pressure and eye rate on the basis of the effects of thyroid hormone on sympathetic nervous system activity. Patients with high arteriolar pressures may require increased attention and a longer elapsing of local force per unit area to terminate bleeding. Hyperthyroid patients who are on warfarin sodium have increased metabolism of this drug, leading to alteration in previously therapeutic coagulation indices.[10]
Anti-thyroid drugs namely propylthiouracil (PTU) has anti-vitamin Chiliad activity and can crusade hypoprothrombinemia and bleeding that poses a risk for hemorrhage. Thus, patients taking PTU must be carefully evaluated before surgery or invasive dental handling.[4]
Susceptibility to infection - Thionamides may cause a very rare reaction of agranulocytosis (0.5% of patients) that can effect in oral infections and inadequate wound healing. These post-operative complications could be prevented if clinicians carefully follow precautions stated with thionamides.
Drug deportment and interactions – Combination analgesics containing acetylsalicylic acid (ASA) are contraindicated in patient with hyperthyroidism because ASA interferes with the protein binding of T4 and Tthree, thereby increasing their costless form. This may worsen the symptoms of thyrotoxicosis.[15]
NSAIDs should besides exist used with caution in the patients who accept hyperthyroidism and who take β-blockers, as the former can decrease the efficiency of the latter.[xvi] Pain, nonetheless, can complicate cardiac functions in patient who accept hyperthyroidism and symptomatic affliction, and alternative pain medications demand to be instituted.[4]
Patients who have hyperthyroidism have increased levels of anxiety, and stress or surgery can trigger a thyrotoxic crunch. Epinephrine is contraindicated, and elective dental care should exist deferred for patients who have hyperthyroidism and exhibit signs or symptoms of thyrotoxicosis.[17]
Fluoride was used as a drug to care for hyperthyroidism because it reduces thyroid activity quite effectively. This is due to the ability of fluoride to mimic the action of thyrotropin (TSH). Excess fluoride correlates with the other thyroid-related issues such as iodine deficiency. Fluorine and iodine, both existence members of the halogen group of atoms, have an antagonistic relationship. When in that location is backlog of fluoride in the body it can interfere with the function of the thyroid gland. Thus, fluoride has been linked to thyroid problems. Patient who wish to avoid the effect of fluoride on their thyroid can utilise fluoride costless toothpaste such as Carifree, an oral neutralizer gel.[xviii]
CONCLUSIONS
Dental treatment modifications may be necessary for dental patients who are under medical management and follow-up for a thyroid condition fifty-fifty if there are no comorbid conditions. Stress reduction, awareness of drug side effects or interactions, and vigilance for appearance of signs or symptoms of hormone toxicity are amid the responsibilities of the oral wellness care provider.
Footnotes
Source of Support: Nil,
Conflict of Interest: None declared.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169868/
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