Chapter 52- pt w/ endocrine disorder Flashcards

1
Q

Endocrine glands are glands of what?

A

Internal secretion

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2
Q

What do endocrine glands do?

A

secrete hormones with the nervous system, to maintain body homeostasis.

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3
Q

How are hormones transported?

A

by the blood or lymph system

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4
Q

What do the endocrine glands do?

A

They regulate many vital functions, including growth and development, energy production, food metabolism, reproductive processes, and the responses of the body to stress.

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5
Q

What are the major endocrine glands?

A

pineal, hypothalamus, pituitary, thyroid, parathyroids, thymus, pancreas, adrenals, and gonads (ovaries and testes).

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6
Q

What is known as the master gland and why?

A

Anterior pituitary; because it controls the output of hormones by other glands.

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7
Q

How is the pituitary gland regulated?

A

by other hormones produced by the other endocrine glands.

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8
Q

Hormone functions

A

can act directly or indirectly on a cell controlling hormones of other glands.

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9
Q

Regulation of hormones

A

-The regulation process is complex (and not fully understood), but the hormones are secreted when needed (under normal conditions).

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10
Q

The stimulus for hormones being secreted is many times a what?

A

Chemical signal in the blood

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11
Q

What the hormone is released the signal what?

A

disappears

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12
Q

When the hormone is needed the signal what?

A

returns

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13
Q

Hyposecretion and hyper secretion of a hormone can cause what?

A

both physical and mental problems

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14
Q

Not enough or too much of a hormone can do what?

A

Can affect the oral cavity and cause response to infection, healing, or stress to differ.

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15
Q

Hormonal changes in puberty, a pregnant pt., or a menopausal patient can do what?

A

Affect the periodontium and affect the tissue response.

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16
Q

Pituitary gland is called master gland because

A

It has a great impact on body organs, other endocrine glands, and overall wellbeing.

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17
Q

What are the two parts of the pituitary gland?

A
  • Anterior

- Posterior

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18
Q

Pituitary Tumors

A
  • These benign tumors usually secrete too much hormone.

- Develop at any age

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19
Q

What are the common symptoms of Pituitary Disorder?

A
  • Headaches
  • Vision problems
  • Mood swings/behavior changes
  • Weight change
  • Reproductive issues
  • Hypertension
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20
Q

During oral health assessment clinician may notice patients with pituitary disorders having what?

A
  • 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.
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21
Q

What is the patient management for Pituitary disorders?

A
  • 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.
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22
Q

The thyroid gland plays a part in what?

A

normal physiologic function in the body including growth and development and energy metabolism.

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23
Q

What is used to treat thyroid gland disorders?

A

Levothyroxine (synthroid)

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24
Q

What is the most common thyroid disorder?

A

Hypothroidism

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25
Q

Occurrence of hypothyroidism

A

-More in women than in men and more common over age 60

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26
Q

If hypothyroidism is left untreated it can cause what?

A

increase in susceptibility to infections.

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27
Q

What is the most common cause of hypothyroidism?

A

An autoimmune disease called Hashimoto’s

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28
Q

Patient’s with hypothyroidism is at an increased risk for what?

A
  • Perio
  • Oral candidiasis
  • Gingiva bleed easily
  • Poor wound healing
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29
Q

Patient management for patients with hypothyroidism

A
  • 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.
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30
Q

Hyperthyroidism is when the thyroid does what?

A

Produces too much thyroid hormone.

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31
Q

What can cause hyperthyroidism?

A
  • Excess iodine in diet
  • Autoimmune disease/Graves that affects the thyroid
  • Viral infection
  • Taking too much thyroid medication
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32
Q

Oral health assessment in patient with hyperthyroidism

A
  • 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).
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33
Q

Patient management with patients with hyperthyroidism

A
  • Check vitals

- Patient could have a thyroid crisis/storm (sudden worsening of hyperthyroidism) can be caused by infection or stress.

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34
Q

Where are the parathyroid glands located?

A

embedded int he thyroid gland.

35
Q

The Parathyroid hormone (PTH) is in response to what?

A

serum-ionized calcium.

36
Q

the parathyroid hormone controls what?

A

Calcium, phosphorus and Vitamin D levels in the blood and bone.

37
Q

Parathyroid disorders are rare and usually occurs when

A

glands are taken out accidentally during thyroidectomy

38
Q

hyperparathyroidism

A
  • Occurs when parathyroid produces too much PTH.

- Can cause hypercalcemia which can aid in osteoporosis.

39
Q

Oral assessment in patient with hyperparathyroidism

A
  • Loss of alveolar bone evident on x-rays
  • Spontaneous fracture of mandible
  • Pulp chambers widened
  • Tooth demin
40
Q

Patient management in pt with hyperparathyroidism

A
  • home fluoride

- increased risk of osteoporosis

41
Q

Hypoparathyroidism

A
  • Occurs when there is not enough PTH
  • Causes blood calcium levels to decrease and phosphorus to increase.
  • Most common cause injury to parathyroid gland.
42
Q

Oral care risk assessment for hypoparathyroidism

A
  • 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
43
Q

Adrenal Glands

A
  • 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.
44
Q

Treatment for adrenal gland disorders

A

corticosteroids

45
Q

Hyperadrenalism is also known as

A

Cushing’s syndrome

46
Q

Hyperadrenalism is caused by what?

A

too much cortisol. possibly a tumor

47
Q

Oral health assessment in pt with hyperadrenalism

A
  • Increased melanic pigmentation (black-bluish on buccal mucosa, palate, tongue, lips.
  • Delayed wound healing
  • Loss of collagen
  • Oral tissue and skin fragile
  • Oral candidiasis
48
Q

Patient management with hyperadrenalism

A
  • antifungal treatment

- antiviral medication

49
Q

Hypoadrenalism is also known as what?

A

Addison’s disease or Adrenal insufficiency

50
Q

Oral health assessment for hypoadrenalism

A
  • Hyperpigmentation of skin and mucosa
  • Long-term immune suppression can lead to Kaposi’s sarcoma, lymphoma, or lip cancer.
  • Oral candidiasis.
51
Q

Patient management for pt with hypoadrenalism

A
  • Monitor vitals
  • Provide antifungal meds for candidiasis
  • Provide pain control
  • Possible antianxiety med bf dental visits
  • Delay non-emergency dental treatment until well controlled
52
Q

Improper use of the pancreas leads to what?

53
Q

What is the most common disorder of the pancreas?

54
Q

Period considered adolescence

A

between ages 10 and 21

55
Q

Early adolescence

A

ages 10 to 13

56
Q

Middle adolescence

A

ages 14 to 17

57
Q

Late adolescence

A

ages 18 to 21

58
Q

Pubertal changes

A
  • 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)
59
Q

males have

A

testes that produce testosterone

60
Q

females have

A

ovaries that produce estrogen, progesterone and inhibit hormones

61
Q

Hormonal influences

A
  • 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.
62
Q

Oral health assessment during pubertal changes

A
  • 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.
63
Q

Menstrual Cycle

A
  • 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.
64
Q

Estrogen levels rise first half of cycle to do what?

A

prepare for pregnancy

65
Q

If conception doesn’t occur what happens?

A

estrogen decreases and menstruation begins.

66
Q

Factors that affect cycle

A

climate, cogs. in work schedule, emotional trauma, acute or chronic illness, weight loss, excessive exercise.

67
Q

PMS occurs

A

7-10 days prior to cycle

68
Q

Oral health Assessment for menstraution

A
  • Exaggerated response to local irritants or unusual gingival bleeding.
  • Or may be no significant gingival changes.
69
Q

Different types of hormonal contraceptives

A
  • 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.
70
Q

Estrogen and progestin combo

A
  • Nearly 100% effective in preventing pregnancy
  • Oral contraceptives hinder the release of gonadotropin-releasing hormones and the ovum cannot be released from the ovary.
71
Q

Oral health assessment for oral contraceptives

A
  • 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.
72
Q

Menopause

A
  • 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.
73
Q

Characteristics of menopause

A
  • 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.
74
Q

Vasomotor reactions

A
  • 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.
75
Q

Mucosal Changes

A
  • Associated with decreased estrogen levels.

- Dry, thinning of tissue.

76
Q

Emotional disturbances.

A
  • 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.
77
Q

Postmenopausal effects

A
  • 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.
78
Q

Burning Mouth syndrome

A
  • Burning sensation in the mouth without recognizable oral lesions.
  • Describe it as burning, tingling, hot, scalding, numbness.
  • Unknown etiology
  • Treatment benzodiazapam, antidepressants, or analgesics.
79
Q

Oral Health assessment for menopause

A
  • 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.
80
Q

Patient management for patient with menopause

A
  • 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.
81
Q

Patient approach for pt with menopuase

A
  • Review patients HH
  • Be courteous, give these pts. personal attention, and friendly, unhurried manner.
  • Seat patient promptly, treat them with assurance.
82
Q

Instructions to patient with menopause

A
  • 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.
83
Q

Diet for pt with menopause

A
  • 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.
84
Q

Fluoride treatment

A

Fluoride recommendations based on pt needs