Endocrine Disorder

Question 1

Dental Concern With Diabetes

Answer 1

Tooth Eruption - Accelerated in children with diabetes so lose deciduous teeth early
Other - Diabetics loose more teeth, Patients with uncontrolled or diagnosed diabetes are more prone to periodontal disease, More prone to infections
Appt - Should not interfere with meals, Stress management and check oral complications (Catecholamines and Glucocorticoids increase blood glucose), Perform surgical procedures 1.5-2hr after breakfast and patient has taken meds

Question 2

Corticosteroids in Diabetics

Answer 2

By dentists to treat lichen planus - Cause hyperglycemia - Blood glucose should be monitored during treatment

Question 3

Candidiasis in Diabetics

Answer 3

Treat with antifungals like Ketoconazole or Nystatin (Less drug interactions)

Question 4

Xerostomia in Diabetics

Answer 4

Saliva substitute or stimulants

Question 5

Adverse Effect of Insulin

Answer 5

Hypoglycemia (Sweating, Hunger, Paresthesia, Palpitation, Tremor, Anxiety) autonomic symptoms occur first followed by loss of concentration, confusion, weakness, drowsiness, blurred vision, loss of consciousness
Antidote - Provide Glucose

Question 6

Drug of Choice for Type II Diabetes

Answer 6

Metformin

Question 7

Sulfonylureas and Meglitinides

Answer 7

Interfere with potassium channel on beta cell lowering threshold for exocytosis of insulin; May induce hypoglycemia in some patients - Weight gain problem

Question 8

Thiazolidinediones Pros

Answer 8

Potent insulin sensitizers that act through nuclear receptors peroxisome proliferator-activated receptor-gamma (PPARgamma) and are highly effective oral meds for Type 2 Diabetes; Reduce insulin resistance

Question 9

Thiazolidinediones Cons

Answer 9

Risk for fluid retention, weight gain, bone loss, CHF; Increased angina and MI - anemia, bladder cancer

Question 10

Agents acting on Incretins

Answer 10

GLP Agonists - Exte-, Lixise-, *natide, Lira-, Abi-, Dula- glutide injectables
Dipeptidyl Peptidase-4 (DPP4) Inhibitors (Preserve GLP-1) - Lina-, Saxa-, Sita-, Alo-, Vilda-gliptins
Effects - Reduce post meal excursions, Increases release of insulin, Reduce glucose synthesis, Lower glucagon levels, Slow gastric emptying,
Side Effects - Rhinits, Respiratory infection, Headache, Pancreatic infection

Question 11

Sodium Glucose CoTransporter 2 Inhibitors

Answer 11

Prevent reabsorption of glucose and increases sodium excretion - Compatible with other agents, Oral admin, Good efficacy; More Glucose eliminated, May increase genital yeast infection, Newer agent-Expensive

Question 12

Alpha-glucosidease Inhibitors

Answer 12

acar, vogli, *bose
Block production of glucose in intestine by preventing breakdown of starch to glucose, Excess starch in bowel can lead to flatulence and diarrhea

Question 13

Oral Manifestations of Patients with Hypothyroidism

Answer 13

Salivary gland enlargement, Compromised periodontal health (Delayed bone resorption), Macroglossia, Glossitis, Dysgeusia, Delayed dental eruption, Enamel hypoplasia in both dentitions, Anterior open bite, Micrognathia, Thick lips, Mouthbreathing

Question 14

Oral Manifestations of Patients with Hyperthyroidism

Answer 14

Increased susceptibility to caries, Increased susceptibility to periodontal disease, Enlargement of extra glandular thyroid tissue, Burning mouth syndrome, Accelerated dental eruption, Maxillary and mandibular osteoporosis, Development of connective tissue disease like Sjogrens syndrome or Systemic lupus erythematosus

Question 15

Thyroid Hormone

Answer 15

Increase number of beta-adrenergic receptors increasing sensitivity to adrenaline and noradrenaline; Local anesthetics containing epinephrine cause cardiac problems during hyperthyroid episodes; Thyroid hormones stimulate bone turnover and are required for linear bone growth after birth but mature growth centers in fetal bones; Necessary for regular progression of tooth development and eruption, Accelerates shedding of hair and skin

Question 16

Treatment of Hyperthyroid

Answer 16

Thioamides
Methimazole - Drug of choice
Propylthiouracil - Hepatitis, Side effect of agranulocytosis
Amiodarone - 3% patients develop hyperthyroidism
Iodine 131 - Accumulates in thyroid gland and lesions out of the gland, After treatment patient is placed on supplement

Question 17

Immune Changes with Hormone

Answer 17

Menarche increases blood flow to gingiva and leads to sensitivity
Pregnancy-gingivitis due to progesterone increases inflammation to plaque - Reduces some aspect to immunity
Menopause reduces estrogen (and FSH) and may decrease bone growth - Post menopause women with greater tooth loss

Question 18

Reproductive Hormone Preparations and Adverse Effects

Answer 18

Estradiol, Conjugated estrogens (Premarin), Mestranol (Norethin), Ethinyl estradiol (Estinyl)
Adverse Effects - GI upset, Breast engorgement, Endometrial hyperplasia, Risk of carcinoma increased if progestin is not included, Retention of sodium and water results in hypertension, weight gain, edema or heart failure, Hyperglycemia and migraine headaches, Vaginal or cervical adenocarcinoma with Stilbestrol

Question 19

Oral Contraceptive Dental Concern

Answer 19

Increased clots, Take breaks, Elevated BP, Increased gingivitis, Increased freq of post-extraction dry sockets, Increased susceptibility to candida, Decreased glucose tolerance (Chloasma or melasman), Concern if antibiotics persistent diarrhea or vomiting