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Special Patients > Chapter 4: Dental Management Of The Patient With Endocrine-metabolic Pathology > Flashcards

Chapter 4: Dental Management Of The Patient With Endocrine-metabolic Pathology Flashcards

1
Q

The thyroid gland secretes 3 hormones:

A
  1. Thyroxine (T3): metabolic processes
  2. Triiodothyronine (T4): oxygen use
  3. Calcitonin: regulate calcium and phosphorus levels, skeletal remodelling

34C

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2
Q

What do thyroid hormones influence?

A

Growth and maturation of tissues, energy metabolism, and turn over of both cells and nutrients

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3
Q

Hypothyrodism and hyperthyrodism are more common in?

A

Women, 20-50years old, 5 times more likely to develop thyroid disorders

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4
Q

Causes of hyperthyroidism?

A
  • thyroid nodules
  • medications
  • thyroiditis
  • excessive iodine intake
  • grave’s disease

Other risk factors:
- gender
- age
- smoking
- trauma
- major stress

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5
Q

Clinical sings of hyperthyroidism ?

A
  • hypertension
  • accelerated pulse
  • congestive heart failure
  • eye signs: peri orbital tumping, exoftalmos, palpebral ptosis
  • hands: finger in drum sticks, eritema palmar, tremors, humidity with heat in hands
  • weight loss, intolerance to heat
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6
Q

Oral manifestations of hyperthyroidism (non-pathogonomonic):

A
  • enlargement of extra glandular thyroid tissue (lateral posterior tongue)
  • accelerated dental eruption
  • burning mouth syndrome
  • increased susceptibility to caries
  • periodontal disease
  • maxillary or mandibular osteoporosis
  • Sjögren’s syndrome
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7
Q

Hyperthyroid medications:

A
  • anti thyroid drugs: methimazole, propylthiouracil
  • radioactive iodine
  • beta blockers and iodide
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8
Q

Dental management of hyperthyroidism:

A
  • avoid situations of intense stress
  • avoid proliferation of apical foci
  • no VC: tirotoxic crisis/thyroid storm!!
  • the medication administered inteferes with coagulation; INR analysis
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9
Q

Causes of hypothyroidism:

A
  • autoimmune thyroid diseases
  • thyroidectomy
  • secondary to deficit of TSH/TRH
  • hyperthyroid drugs
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10
Q

Clinical signs of hypothyroidism:

A
  • fatigue
  • cold intolerance
  • thin brittle hair or fingernails
  • weight gain, easily with a normal diet
  • weakness
  • goitre
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11
Q

Congenital pathology of hypothyroidism?

A

Cretinism: severely stunned physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism)

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12
Q

Causes of cretinism:

A
  • iodine deficiency
  • defective or absent thyroid gland
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13
Q

Clinical signs of cretinism:

A
  • mental retardation
  • lack of growth development
  • coarse facies
  • dry and wrinkled skin
  • premature aging
  • delayed bone maturation
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14
Q

Acquired pathology of hypothyrodism:

A

Myxedema

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15
Q

Causes of myxedema:

A
  • Hashimoto’s thyroiditis
  • treatment of overactive thyroid
  • severe iodine deficiency
  • Long term lithium intake
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16
Q

Clinical signs of myxedema:

A
  • facial swelling with hair loss
  • dry and thickened skin
  • bradycardia
  • edemas in extremeites
  • obesity, decreased appetite
  • palpebral swelling
  • cold intolerance
  • hoarsely
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17
Q

Oral manifestations of hypothyroidism (cretinism and myxedema):

A
  • delayed dental eruption (myxedema)
  • salivary gland enlargement
  • macroglossia
  • hypoplasia of enamel
  • compromised periodontal health: delayed bone formation
  • dysgeusia
  • lack of maxillary and condylar development (open bite) (cretinism)
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18
Q

Hypothyrodism medication:

A
  • synthroid
  • armour thyroid
  • levothyroxine
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19
Q

Patient management:

A
  • Prevent malocclusion (macroglossia). (Interceptive dentistry)
    • Prevent caries (hypoplasia).
    • Metabolise drugs badly: risk of infections.
    • Avoid giving depressants, sedatives, or narcotic analgesics: may cause exaggerated response
    in patients.
    • Susceptible to cardiovascular diseases: consult primary care provider to seek whether
    prophylaxis is required. (NB: normal prophylaxis 2-3 days before treatment and 5-7 days
    after).
    • EMERGENCY—> MYXEDEMA COMA: not frequent, not treating infections, exposition to cold air. Symptoms: hypotension, hypothermia, hypoglucemia, respiratory distress —> if not treated= coma or death.
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20
Q

Parathyroid gland:

A
  • 4 parathyroid glands behind the thyroid gland
  • controls amount of calcium in the blood and within the bones
  • PTH: increases blood calcium by increasing bone resorption, stimulating osteoclasts, increases GI calcium absorption by activating vit D, increases renal absorption of calcium by kidneys
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21
Q

Hyperparathyroidism causes:

A
  • tumour
  • hyperplasia of the gland
  • chronic renal failure (HPT secondary)
  • intestinal malabsorption syndrome (HPT secondary)
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22
Q

Hyperparathyrodism clinical signs:

A
  • abnormal deposits of calcium—> kidney stones
  • bone deformities
  • bone tumours
  • bone and joint pain
  • nausea, vomiting, loss of appetite
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23
Q

Hyperparathyroidism oral manifestations:

A

• Malocclusions.
• Weak teeth.
• Giant cell lesions.
• Loss of lamina dura on radiographs.
• Loss of bone thickness.
• Soft tissues calcifications.
• Lytic lesion.

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24
Q

Hyperparathyrodism dental considerations:

A

• No special considerations.
• Higher risk of bone fracture: take precaution in surgical treatment.
• Recognise presence of brown tumour.
• Perform correct differential diagnosis.

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25
Q

Hypoparathyrodism causes:

A

• Decreased function of the parathyroid glands.
• Underproduction of PTH.
• Can be inherited but is also encountered after thyroid or parathyroid surgery.

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26
Q

Hypoparathyrodism oral manifestations:

A

• Lingual paresthesias.
• Alteration of facial muscles.
• Dental malformations.
• Mandibular exostoses (that will be avascular so we cannot use it.
• Calculus pulp.
• Shortened roots.

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27
Q

Hypoparathyrodism clinical signs:

A

• ** Twitching or spasms of muscles **, particularly around mouth, hands, arms or throat.
• Dry, coarse skin.
• Brittle nails.
• Anxiety or nervousness.
• Decrease in the bone calcium mobilisation.

28
Q

Hypoparathyrodism dental management:

A
  • Due to dental anomalies:
    Prevention of caries with periodic reviews, advise regarding diet.
    Before preforming dental Tx, find out serum calcium level (must be 8mg/100ml).
    • Prevents cardiac arrhythmias, seizures.
29
Q

Function of suprarenal gland?

A

Regulate response to stress

30
Q

Cortical portion:

A

Mineralocorticoids (Aldosterone), glucocorticoids (Cortisol), and androgens

31
Q

Medullary portion:

A

Adrenalin, noradrenaline, dopamine, and progesterone

32
Q

Addison’s syndrome

A

Insufficiency in the secretion of glucocorticoid and mineralocorticoids hormones

33
Q

Clinical signs of Addison’s syndrome:

A
  • Increased heart rate, increased diuresis, asthenia, decreased blood glucose, hypotension, weight loss, immunosuppression, and decreased tolerance to stress (NB: prescribe diazepam).
34
Q

Oral manifestations of Addison’s syndrome?

A

Pigmentation of brownish color frequent in jugal mucosa, but also in gums, palate, tongue and lips.

35
Q

Addison’s crisis:

A

A situation occurs in patients with Addison’s disease when stress causes a sudden failure of the function of the adrenal cortex.

It’s manifested with:
Nausea and vomiting.
Abdominal pain.
Decreased level of consciousness.
Intense dehydration.
Peripheral vascular collapse with shock.
Cardiac arrest.

36
Q

How to treat Addison’s crisis?

A

If this situation is reached, it would be advisable to transfer the patient to a hospital, where he is replaced hydrically with saline serum and administered corticoid in high doses.

37
Q

Cushing’s syndrome: def and clinical signs

A

Chronic and excessive exposure to glucocorticoids

• Clinical signs:
Face of “full moon”.
Obesity in the upper back.
Muscular weakness.
Hypertension.
Diabetes.
Osteoporosis.
Delayed healing.

38
Q

Oral manifestations of Cushing’s syndrome ?

A

Dental crowding.
Late eruption.
Mandibular osteoporosis.
Enlargement of gums.

39
Q

Surgery or anxious patient taking corticoids, how to modify?

A

<30mg/day or >40mg/day: no mods
30-40mg/day: double the dose the day of the surgery and after

40
Q

Diabetes mellitus:

A

It’s a chronic systemic disease. Decreases insulin activity or synthesis

Insulin= a hormone produced by the pancreas. Anabolizing= regulates the glucose concentration. Increased protein synthesis.
Accelerates lipogenesis.

41
Q

Clinical signs of DM:

A

Polyuria (pee a lot), polydipsia (drink a lot, always thirsty), polyphagia (uncontrolled eating).

Arteriosclerosis (plaque in the arteries, Which can cause a heart attack, patient may have Stent.

Weight loss.

Microangiopathy.

42
Q

Chronic complications of DM:

A

Hypertension.
Ischemic heart disease.
Cerebrovascular disease.
Atherosclerosis.

43
Q

Type I DM:

A

10-20% of diabetics.
Children under 30 years old (children and young people).
** Absolute ** deficiency of insulin secretion.
Starts abruptly. It has chronic complications.
Propensity to ketosis (elevation of ketone bodies in blood and urine).
Treatment: rapid-acting insulin injection.

44
Q

Type II DM:

A

More frequent 80-90%.
In over 40 years (more women).
Moderate insulin deficit.
Gradual, slow start.
Trigger factors are overeating and sedentary life (it is a disease of the well-being).
Treatment: diet, exercise, oral hypoglycemics (sulfonylureas). (Metformin)

45
Q

Secondary DM:

A

Hypertuitarism.
Chronic pancreatitis.
Pancreatic carcinoma.
Cushing’s syndrome.
Induced by drugs (diuretic, phenotynthe).
Others: alcohol.

46
Q

Diabetic ketoacidosis hyperglycaemic state?

A
  • Establishment; slow, in days.
  • Aetiology: absolute or relative insulin deficit due to excess carbohydrate intake or drug interactions. (If you take glucocorticoids for example)
  • Clinical signs: there’s ** rarely ** loss of consciousness, dry and hot skin, hypotension, dehydration.
  • Treatment: administer intravenous insulin, fluid replacement with saline. Transfer to hospital
47
Q

Hypoglycaemic coma DM I:

A
  • glucose: <60mg/ml
  • Instauration : acute and fast.
  • Aetiology: excess insulin or oral hypoglycemic drugs. - Delayed consumption and/ or absorption of food, excessive physical exercise, too much alcohol.
  • Clinical signs: anxiety, confusion, drowsiness, nervous agitation, pallor, convulsions, cold and moist skin, tachycardia and progress to unconsciousness and coma. Shortness of breath, acetone breath.
  • Treatment: administration of sugar, dextrose or glucagon. Transfer to hospital.
48
Q

Oral manifestations of diabetes:

A

Periodontitis: frequent and incidence of periodontal abscesses.
Xerostomy: increase number of caries, burning mouth, taste alterations, halitosis of acetone.
Atypical odontalgia.
Oral ulcers.
Dry alveolitis.
Delayed healing.
Fissured tongue.
More frequent candidiasis.
Angular quelitis.
Liquenoid reactions.
Sialomegalia: increase parotid gland side because of a chronic inflammation.

49
Q

Glucose levels before tx should be?

A

Less than or equal to 140mg/dl

50
Q

Diabetic patients and ATB prophylaxis? ?

A

Before Tx with risk of infection

51
Q

Paracetamol, salicylates and diabetic patients?

A

Compete with oral hypoglycaemic agents for plasma proteins

52
Q

Bone tissues and diabetics?

A

Bone tissues fill the radiolucies slower than in normal patients

53
Q

When does the apical closure in apicoformations occur in diabetics?

A

Later

54
Q

Indicate the false answer regarding a diabetic patient

A

a. The bone tissue fills the radiolucency more slowly b. It’s advisable to prescribe anxiolytics previously
c. They have worse cicatrization of the wounds
d. It’s preferable not to put anesthesia with vasoconstrictor even if they re controlled
e. The apical closure in apexification takes longer

D

55
Q

Which of the following oral manifestations is characteristic of diabetic patients?

A

a. Ulcerative lesions
b.Dry mouth
c. Delayed eruption
d. Parotid gland infection
e.Typical dental pain with persistent pain

A? B?

56
Q

Indicate the steps to be followed before a patient who requires extensive surgical treatment and who takes Dacortin@ 30mg (corticosteroid), 2 times a day for 2 months:

A

a. None is correct.
b. We will double the usual corticosteroid dose for 2 days
c.we will not consider any supplement we will only take precautionary measures taking the patient’s tension and pain control.
d. We will control postoperative pain and take blood pressure.
e.Marcolide-type antibiotics will be avoided

C

57
Q

Point out the false answer:

A

a. Hyperglycemic coma is more frequent in type Il diabetic patients
b. Ischemic heart disease is a complication of diabetes
c. Periodontal abscesses are more frequent in insulin-dependent diabetic patients
d.The type Il diabetic patient who takes various antidiabetic drugs and insulin is an uncontrolled patient
e. Excess insulin causes hypoglycemic coma

A

58
Q

If a patient is suffering oral manifestations: alteration of facial muscles, lingual and labial paresthesias, calculus pulp, mandibular exostoses, and dental malformations, we will suspect which endocrine-metabolism disease?

A

A. Hypothyrodism
B. Hyperthyrodism
C. Hypoparathyroidism
D. Hyperparathyrodism
E. Diabetes

C

59
Q

If a patients suffers from Cushing’s syndrome, what must we take into account for its clinical management:

A

a. The patient will have an accelerated healing, so no measures need to be taken into account
b. Theyre patients that are usually hypertensive, we will check it its controlled
c. They’re usually hypoglucemic, so we will give adjustments with sugary food at the consult

B

60
Q

Page 4 exam 2019

A

Question 18

61
Q

The brown cell tumor is a characteristic oral manifestation of patients who presents?

A

hypoparathyroidism
cushings syndrome
myxedema
hyperparathyroidism
addison syndrome

D

62
Q

INA PATIENT THAT PRESENTS HYPERTHYROIDISM WE HAVE TO TAKE INTO ACCOUNT:

A

A. we must avoid using VC because it always triggers a hypertensive crisis

B. The medication taken interferences with coagulation, INR analysis is needed

C. They are patients who have stress well controlled

D. They never require ATB prophylaxis towards a foci of infection

E. They are patients who metabolise drugs poorly

B

63
Q

Patient comes in the DM II, and needs minor surgery treatment, present a glycemic level of 120mg/dl, what measures will you take?

A

A. Anaesthesia with VC, anxiolytics 1 hour before the appointment, ATB prophylaxis, and ibuprofen after extraction
B. Anaesthesia without VC, prophylaxis previous and after the extraction, ibuprofen after exo
C. We will not do extraction until the glucemic values are under 90
D. The extraction will only be done in hospital because of the risk of decompensation
E. Anaesthesia with VC, anxiolytics 1 hour before the appointment, ATB prophylaxis and ibuprofen without glucosate excipient after extraction

E

64
Q

In the case of a diabetic patient on oral antidiabetic therapy who comes for consultation, our attitude to follow includes all except:

A

a. any local anesthesia that we put will always be without vasoconstrictor
b. to prepare for the extraction of a third molar we will prescribe a previous cycle of prophylactic antibiotic
c. whenever we can, we suture to help a normal healing
d. a and c are false
e. b and c are false

A

65
Q

A patient comes to the consult diagnosed with hyperthyrodism, on exploration and radiological diagnosis a caries is observed on tooth 45, with pulpal alteration and a radicular cyst. In addition, the patient is allergic to macrolides. What should your therapeutic attitude be towards the patient?

A

We will take the appointment first thing in the morning, we give antibiotic (clindamycin 600mg/6 hours), we will ask for the INR on the day of the extraction, we will perform anaesthesia without vasoconstrictor, and we will prescribe post extraction ATB

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