Chapter 52- pt w/ endocrine disorder Flashcards
Endocrine glands are glands of what?
Internal secretion
What do endocrine glands do?
secrete hormones with the nervous system, to maintain body homeostasis.
How are hormones transported?
by the blood or lymph system
What do the endocrine glands do?
They regulate many vital functions, including growth and development, energy production, food metabolism, reproductive processes, and the responses of the body to stress.
What are the major endocrine glands?
pineal, hypothalamus, pituitary, thyroid, parathyroids, thymus, pancreas, adrenals, and gonads (ovaries and testes).
What is known as the master gland and why?
Anterior pituitary; because it controls the output of hormones by other glands.
How is the pituitary gland regulated?
by other hormones produced by the other endocrine glands.
Hormone functions
can act directly or indirectly on a cell controlling hormones of other glands.
Regulation of hormones
-The regulation process is complex (and not fully understood), but the hormones are secreted when needed (under normal conditions).
The stimulus for hormones being secreted is many times a what?
Chemical signal in the blood
What the hormone is released the signal what?
disappears
When the hormone is needed the signal what?
returns
Hyposecretion and hyper secretion of a hormone can cause what?
both physical and mental problems
Not enough or too much of a hormone can do what?
Can affect the oral cavity and cause response to infection, healing, or stress to differ.
Hormonal changes in puberty, a pregnant pt., or a menopausal patient can do what?
Affect the periodontium and affect the tissue response.
Pituitary gland is called master gland because
It has a great impact on body organs, other endocrine glands, and overall wellbeing.
What are the two parts of the pituitary gland?
- Anterior
- Posterior
Pituitary Tumors
- These benign tumors usually secrete too much hormone.
- Develop at any age
What are the common symptoms of Pituitary Disorder?
- Headaches
- Vision problems
- Mood swings/behavior changes
- Weight change
- Reproductive issues
- Hypertension
During oral health assessment clinician may notice patients with pituitary disorders having what?
- Macrocephaly
- Macrognathia
- Unequal mandibular growth; prognathic
- Open anterior bite
- Large pulp chambers
- Delayed eruption of primary and permanent teeth
- Increased risk for perio bc of growth factor and hormone imbalances.
What is the patient management for Pituitary disorders?
- Ortho eval
- Increased risk of hypertension
- Increased risk of dev. Insulin resistance or Type 2 Diabetes
- General anesthesia may be contraindicated bc of electrolyte imbalance.
The thyroid gland plays a part in what?
normal physiologic function in the body including growth and development and energy metabolism.
What is used to treat thyroid gland disorders?
Levothyroxine (synthroid)
What is the most common thyroid disorder?
Hypothroidism
Occurrence of hypothyroidism
-More in women than in men and more common over age 60
If hypothyroidism is left untreated it can cause what?
increase in susceptibility to infections.
What is the most common cause of hypothyroidism?
An autoimmune disease called Hashimoto’s
Patient’s with hypothyroidism is at an increased risk for what?
- Perio
- Oral candidiasis
- Gingiva bleed easily
- Poor wound healing
Patient management for patients with hypothyroidism
- Monitor vitals (bp and pulse)
- Avoid aspirin bc of increased gingival bleeding and poor wound healing.
- Increased Myxedema coma bc of low levels of thyroid level and can be a life-threatening emergency.
Hyperthyroidism is when the thyroid does what?
Produces too much thyroid hormone.
What can cause hyperthyroidism?
- Excess iodine in diet
- Autoimmune disease/Graves that affects the thyroid
- Viral infection
- Taking too much thyroid medication
Oral health assessment in patient with hyperthyroidism
- Can have quicker tooth development possible malocclusion
- Analgesics/NSAID’s can increase amt. of hormone and make it difficult to control hyperthyroidism.
- Vasoconstrictors should be used with caution (can increase tachycardia).
Patient management with patients with hyperthyroidism
- Check vitals
- Patient could have a thyroid crisis/storm (sudden worsening of hyperthyroidism) can be caused by infection or stress.
Where are the parathyroid glands located?
embedded int he thyroid gland.
The Parathyroid hormone (PTH) is in response to what?
serum-ionized calcium.
the parathyroid hormone controls what?
Calcium, phosphorus and Vitamin D levels in the blood and bone.
Parathyroid disorders are rare and usually occurs when
glands are taken out accidentally during thyroidectomy
hyperparathyroidism
- Occurs when parathyroid produces too much PTH.
- Can cause hypercalcemia which can aid in osteoporosis.
Oral assessment in patient with hyperparathyroidism
- Loss of alveolar bone evident on x-rays
- Spontaneous fracture of mandible
- Pulp chambers widened
- Tooth demin
Patient management in pt with hyperparathyroidism
- home fluoride
- increased risk of osteoporosis
Hypoparathyroidism
- Occurs when there is not enough PTH
- Causes blood calcium levels to decrease and phosphorus to increase.
- Most common cause injury to parathyroid gland.
Oral care risk assessment for hypoparathyroidism
- Delayed eruption of teeth
- Congenitally missing teeth
- Short roots
- Delay in dental development
- Enamel hypoplasia
- Poorly calcified dentin
- Wide pulp chambers
- Mandibular tori
- Chronic candidiasis
- Paresthesia tongue and lips
- Twitching spasm in face muscles
Adrenal Glands
- Two glands that sit on top of each kidney
- They work with the hypothalamus and pituitary gland to produce adrenaline, noradrenaline, dopamine, progesterone, and glucocorticoids.
Treatment for adrenal gland disorders
corticosteroids
Hyperadrenalism is also known as
Cushing’s syndrome
Hyperadrenalism is caused by what?
too much cortisol. possibly a tumor
Oral health assessment in pt with hyperadrenalism
- Increased melanic pigmentation (black-bluish on buccal mucosa, palate, tongue, lips.
- Delayed wound healing
- Loss of collagen
- Oral tissue and skin fragile
- Oral candidiasis
Patient management with hyperadrenalism
- antifungal treatment
- antiviral medication
Hypoadrenalism is also known as what?
Addison’s disease or Adrenal insufficiency
Oral health assessment for hypoadrenalism
- Hyperpigmentation of skin and mucosa
- Long-term immune suppression can lead to Kaposi’s sarcoma, lymphoma, or lip cancer.
- Oral candidiasis.
Patient management for pt with hypoadrenalism
- Monitor vitals
- Provide antifungal meds for candidiasis
- Provide pain control
- Possible antianxiety med bf dental visits
- Delay non-emergency dental treatment until well controlled
Improper use of the pancreas leads to what?
Diabetes
What is the most common disorder of the pancreas?
Diabetes
Period considered adolescence
between ages 10 and 21
Early adolescence
ages 10 to 13
Middle adolescence
ages 14 to 17
Late adolescence
ages 18 to 21
Pubertal changes
- Period of development by which there is rapid changes in body size, shape, and composition.
- Some go thru earlier/faster than others.
- Physiologic changes due to hormone production and secretion of endocrine glands (esp. gonads)
males have
testes that produce testosterone
females have
ovaries that produce estrogen, progesterone and inhibit hormones
Hormonal influences
- Responsible for dev. of sex organs, accessory sex organs, and secondary sex characteristics.
- As these hormone levels fluctuate, they have strong physical, mental, and emotional influences throughout the body.
Oral health assessment during pubertal changes
- Gingival inflammation due to increase sex hormones released.
- Diet analysis recommended to look at diet related dental disease pattern.
- Hyperplastic gingiva (related to ortho)
- Acute intraoral infections involving the periodontium.
- Periodontal infection can be localized or generalized.
Menstrual Cycle
- the cycle is the period of time from the beginning of one menstrual flow to the beginning of the next menstrual flow.
- Each cycle approx. 28 days.
- It occurs in cyclic manner from puberty to menopause.
- Rise and fall of hormone levels during the month control the cycle.
Estrogen levels rise first half of cycle to do what?
prepare for pregnancy
If conception doesn’t occur what happens?
estrogen decreases and menstruation begins.
Factors that affect cycle
climate, cogs. in work schedule, emotional trauma, acute or chronic illness, weight loss, excessive exercise.
PMS occurs
7-10 days prior to cycle
Oral health Assessment for menstraution
- Exaggerated response to local irritants or unusual gingival bleeding.
- Or may be no significant gingival changes.
Different types of hormonal contraceptives
- Oral contraceptives (BC pills)
- Intramuscular injection lasts 12 weeks
- Transdermal patch releases hormones to prevent pregnancy
- Ring releases hormones in the vaginal area monthly
- Sponge, round piece of plastic foam inserted into the vagina to block sperm.
Estrogen and progestin combo
- Nearly 100% effective in preventing pregnancy
- Oral contraceptives hinder the release of gonadotropin-releasing hormones and the ovum cannot be released from the ovary.
Oral health assessment for oral contraceptives
- Exaggerated response to biofilm and other local irritants. The gingival response is similar to pregnancy gingivitis.
- Record the use of oral contraceptives each time Med History is reviewed.
Menopause
- Is the complete and permanent cessation of menstrual flow.
- Menopause generally occurs between the ages of 47 and 55.
- This is the end of fertility due to decreased production of estrogen and progesterone by the ovaries.
- Menopause is usually confirmed when a woman no longer has a menstrual period for 12 consecutive months and there is no other cause for this change.
Characteristics of menopause
- Prior to menopause, menstruation changes in frequency, duration, and amount of flow over a period of about 12-24 months.
- Menopause is accompanied by a number of characteristic physiologic changes.
- Although many women experience minor symptoms, a small percentage have problems during menopause.
Vasomotor reactions
- Hot flashes, defined as periodic surges of heat involving the whole body; may be accompanied by sweats.
- Hot flash may begin with a headache; proceed to a flushing of the face, with heart palpitations and dizziness, followed by a chill.
- Episodes may last a few minutes to 30 minutes.
- Night sweats and sleeping problems may lead to feeling tired, stressed, or tense.
Mucosal Changes
- Associated with decreased estrogen levels.
- Dry, thinning of tissue.
Emotional disturbances.
- Alterations in estrogen level may cause mood swings, depression, irritability, and difficulty with concentration/memory.
- Decreased interest in sexual activity and changes in sexual response.
- Some women experience anxiety, tension, and irritability and feel useless.
- Weight gain or increase of body fat around waist.
Postmenopausal effects
- Reproductive organs atrophy.
- Bone problems have been associated with the menopausal patient.
- Skin and mucous membranes decrease in thickness and keratinization, becoming fragile and easily injured.
- Predisposition to conditions including atherosclerosis, diabetes, and hypothyroidism.
Burning Mouth syndrome
- Burning sensation in the mouth without recognizable oral lesions.
- Describe it as burning, tingling, hot, scalding, numbness.
- Unknown etiology
- Treatment benzodiazapam, antidepressants, or analgesics.
Oral Health assessment for menopause
- Oral changes can be due to menopause but not common.
- Gingival changes usually exaggerated response to biofilm.
- Hormonal changes influence oral tissue response.
- May develop menopausal gingivostomatitis. May occur after removal of or radiation to ovaries.
- Changes in mucous membranes & tongue
- Tissue may appear shiny and can be from pale to red.
- Burning mouth may occur.
- Altered salivary composition (due to stress).
- Epithelium may become thin and atrophy bc of decreased keratinization.
- Taste may be altered/salty peppery, or sour.
- Inadequate diet may contribute to adverse changes of mucosal tissue. Resembles V-B deficiency.
- Alveolar bone loss.
- —Systemic osteoporosis, ridge resorption and loss of teeth.
- —Osteoporotic jaws may not be able to sustain prosthetic devices or implants.
Patient management for patient with menopause
- During patient ed., consider the relationship of oral conditions to endocrine disorders or hormonal changes.
- Emphasize the need for oral hygiene due to hormonal fluxes or imbalances.
- Considers medications and their effects on oral cavity.
- Preventive dental hygiene appointments with daily home care.
- Want to decrease stress level for the patient.
Patient approach for pt with menopuase
- Review patients HH
- Be courteous, give these pts. personal attention, and friendly, unhurried manner.
- Seat patient promptly, treat them with assurance.
Instructions to patient with menopause
- Saliva substitute may be needed for xerostomia and aid in preventing caries.
- Measures for prevention of perio explained.
- Emphasize importance of —-Explain correlation bt good health and oral health.
Diet for pt with menopause
- Assessment of diet may show pt. how to correct poor diet selection.
- Recommend whole grain products, veggies, and fruits. Choose low fat low cholesterol. Recommend Calcium and limit alcohol.
- Caries prevention through nutritious foods.
Fluoride treatment
Fluoride recommendations based on pt needs
