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SPECIAL NEEDS:!
Endocrine Diseases
Tan Li Ting, Melissa Lee Lay See,
Nurul ‘Adilah Jumati, Syahirah Malek

2. OVERVIEW
• Endocrine System
• Common Endocrine Diseases
• Risk factors
• Signs and symptoms
• Dental Management & Considerations

3. ENDOCRINE SYSTEM
- Responsible for hormonal secretion
- Diversify it's function through hypothalamus and pituitary
- Controls physiological process and homeostasis

4. MAJOR ENDOCRINE GLANDS
1. Pineal gland
2. Pituitary gland
3. Thyroid gland
4. Thymus
5. Adrenal gland
6. Pancreas
7. Ovaries
8. Testes

5. TOP 4 COMMON ENDOCRINE
DISEASES (NOT IN ORDER)
䐟 Osteoporosis
䐠 Diabetes mellitus
䐡 Hyper/Hypothyroidism
䐢 Hyper/Hypoparathyroidism

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7. ENDOCRINE DISEASES:
OSTEOPOROSIS
• Define Osteoporosis (U.S. National Library of Medicine):
o A disease in which bones become fragile and more likely to
fracture.
o Usually the bone loses density, which measures the amount of
calcium and minerals in the bone
ENDOCRINE DISEASE:
Osteoporosis

8. ENDOCRINE DISEASES:
OSTEOPOROSIS
• Commonly found amongst women
• Causes:
o Lack of intake of Calcium/Vit. D
o Menopause: decreased estrogen level
ENDOCRINE DISEASE:
Osteoporosis

9. RISK FACTORS:
OSTEOPOROSIS
Low Body Weight
Family History
Smoking & High
Alcohol Consumption
RISK FACTORS
ENDOCRINE DISEASE:
Osteoporosis

10. SYMPTOMS:
OSTEOPOROSIS
Early Stages:
• Almost no symptoms
More than often, many will have experienced a fracture before
finding out.
Later Stages:
• Pain (Due to compression fractures)
• Loss of height
ENDOCRINE DISEASE:
Osteoporosis

11. • Assoc. with alveolar bone loss & increased risk of
periodontal disease
o Weakened bone structure
o Increased risk of alveolar bone resorption, attachment loss,
tooth loss and edentulism
• Bisphosphonate therapy
o Increased risk of Osteonecrosis after dental extraction
ENDOCRINE DISEASE:
Osteoporosis
DENTAL CONSIDERATIONS:
OSTEOPOROSIS

12. DENTAL CONSIDERATIONS:
OSTEOPOROSIS
• Frequent dental visits
o Scaling and Root Planing to prevent progression of
periodontal disease resulting in bone loss
• Denture fit
o Ill-fitting dentures
• Susceptible to periodontal bacteria
o Increase risk for periodontal diseases and tooth loss
ENDOCRINE DISEASE:
Osteoporosis

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14. • High blood sugar, because pancreas does
not produce enough insulin or cells do
not respond to the insulin.
• Most common endocrine disease in
Singapore
• Prevalence: 11.3% in 2010
• M>F
• Indian 17.2%, Malay 16.6% and Chinese
9.7%
ENDOCRINE DISEASE:
Diabetes Mellitus
ENDOCRINE DISEASES:
DIABETES MELLITUS

15. TYPES:
• Type I Diabetes Mellitus
o Juvenile diabetes
o Insulin dependent
• Type II Diabetes Mellitus
o Adult onset
o Non-insulin dependent
• Third type
o Gestational diabetes
o pregnant women
ENDOCRINE DISEASE:
Diabetes Mellitus
TYPES:
DIABETES MELLITUS

16. SYMPTOMS
• Excessive thirst, urination and hunger
• Sudden weight loss
• Increased fatigue
• Increased susceptibility to infections due to lowered
immunity
ENDOCRINE DISEASE:
Diabetes Mellitus
SYMPTOMS:
DIABETES MELLITUS

17. ! Hemoglobin joins with glucose " HbA1C
! Glycosylated hemoglobin
! Measured 3-6 monthly to check if DM is under control
! Blood sample from vein or finder prick is needed to measure
! 6.5% is good for DM patient
! > 7% is not well controlled
ENDOCRINE DISEASE:
Diabetes Mellitus
HB1AC:
DIABETES MELLITUS

18. TYPE 1 TYPE 2
Genes Age > 45 years old
Environment Pre-diabetes (DM during prev.
pregnancy)
Diet Given birth to a baby > 9 pounds
Chemicals and Drugs
Impaired glucose tolerance
Distribution of fats: Excess body
weight(esp. around waist)
Family history of DM
Inactivity: Low activity level (exercising
< 3 times a week)
ENDOCRINE DISEASE:
Diabetes Mellitus
RISK FACTORS:
DIABETES MELLITUS

19. • Gestational diabetes
o Greater than 25 years old
o Family or personal health history
o Excess weight
o Nonwhite race
ENDOCRINE DISEASE:
Diabetes Mellitus
RISK FACTORS:
DIABETES MELLITUS

20. • Oral manifestations
o compromised periodontal health/worsen due to DM
o candidosis (denture wearers)
o dry mouth and sialosis-> increased caries
o glossitis
o burning mouth syndrome
o oral, facial dysasthesia
• Poor response/healing to periodontal therapy
• Priority given to dental infections
ENDOCRINE DISEASE:
Diabetes Mellitus
DENTAL CONSIDERATIONS:
DIABETES MELLITUS

21. • Enlarged salivary glands and xerostomia
• Increase susceptibility to periodontal disease
• More severe case of periodontal disease
• Poorer wound healing
ENDOCRINE DISEASE:
Diabetes Mellitus
DENTAL CONSIDERATIONS:
DIABETES MELLITUS

22. Diabetes Mellitus: Patient Management
ENDOCRINE DISEASE:
Diabetes Mellitus
PATIENT MANAGEMENT:
DIABETES MELLITUS

23. • Scheduling dental visits:
o Early morning, since their blood sugar level is higher at this
time.
o Regular dental visits
• Infection and wound healing:
o Post-op antimicrobial or antibiotic therapy
o Avoidance of smoking
ENDOCRINE DISEASE:
Diabetes Mellitus
PATIENT MANAGEMENT:
DIABETES MELLITUS

24. Diabetes Mellitus: Patient Management
• Diet:
o Ensure patient has eaten normally and
taken medicines as usual.
• Advice:
o Eat healthily
o Exercise regularly
o Take medication on time
o Frequent medical check up (HbA1c)
ENDOCRINE DISEASE:
Diabetes Mellitus
PATIENT MANAGEMENT:
DIABETES MELLITUS

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26. Metabolic processes
Oxygen use
ENDOCRINE DISEASE:
Thyroid gland disorders
ABOUT THE THYROID
Secretes 3 hormones:
䐟 Thyroxine (T4)
䐠 Triiodothyronine (T3)
䐡 Calcitonin- Regulate Ca and phosporus
levels, skeletal remodeling
Thyroid hormones influence the
growth and maturation of tissues,
energy metabolism and turnover of
both cells and nutrients.

27. ENDOCRINE DISEASE:
Thyroid gland disorders
Hypothyroidism and hyperthyroidism are the two most common thyroid
disorders in women between the age of 20 and 50, who are also five times more
likely than men to develop thyroid disorders. #
-singhealth
Hyperthyroidism is the condition caused by unregulated production of
thyroid hormones. (decrease TSH, increase T3 and T4)
Hypothyroidism is defined by a decrease in thyroid hormone production
and thyroid gland function. (increase TSH, decrease T3 and T4)

28. CAUSES:
HYPERTHYROIDISM
Other risk factors:
Gender
History
Age
Smoking
Trauma to the
thyroid
Major stress
ENDOCRINE DISEASE:
Thyroid gland disorders
Thyroid
nodules
CAUSES
Thyroiditis
Excessive
iodine
intake
Medications
Graves’
disease

29. TYPES AND CAUSES:
HYPOTHYROIDISM
1) CRETINISM (CONGENITAL)
• Iodine deficiency
• Defective or absent thyroid gland
2) MYXEDEMA (ACQUIRED)
• Hashimoto’s thyroiditis
• Treatment of overactive thyroid
• Severe iodine deficiency
• Pituitary gland disorder
• Long -term lithium intake
ENDOCRINE DISEASE:
Thyroid gland disorders

30. Thyroid Gland Disorders:
SYMPTOMS
HYPERTHYROIDISM HYPOTHYROIDISM
1. Nervousness
2. Anxiety
3. Hand tremors
4. Goiter
5. Weight loss, despite
increased appetite
6. Heart palpitations
7. Heat intolerance
8. Increased perspiration
1. Fatigue
2. Cold intolerance
3. Thin brittle hair or
fingernails
4. Weight gain, easily
with normal diet
5. Weakness
6. Goiter

31. DENTAL CONSIDERATIONS:
HYPERTHYROIDISM
Oral manifestations:
• Enlargement of extraglandular thyroid tissue (mainly in the lateral
posterior tongue)
• Accelerated dental eruption
• Burning mouth syndrome
• Increased susceptibility to caries
• Periodontal disease
• Maxillary or mandibular osteoporosis
• Sjogren's syndrome
• Thyroid may be enlarged or noticeably palpable (Graves’ disease)
Medications:
o anti-thyroid drugs- methimazole, propylthiouracil
o radioactive iodine
o beta-blocker and iodides
ENDOCRINE DISEASE:
Thyroid gland disorders

32. Our role: Look out for signs and symptoms to aid in early diagnosis. If a
suspicion of thyroid disease arises for an undiagnosed patient, all
elective dental treatment to put on hold until full medical evaluation.
1. Brief and stress-free appointments
2. NO local anaesthetic with epinephrine and epinephrine
ENDOCRINE DISEASE:
impregnated cord for uncontrolled hyperthyroidism
3. Side effects: Propylthiouracil
! agranulocytosis
! Sialolith
! prolonged bleeding due to warfarin
4. Susceptible to infections due to drug side effects
5. Dietary advice: Avoid iodized salt, seafood
Thyroid gland disorders
PATIENT MANAGEMENT:
HYPERTHYROIDISM

33. DENTAL CONSIDERATIONS:
HYPOTHYROIDISM
Oral manifestations: • Delayed dental eruption • Salivary gland enlargement • Macroglossia • Glossitis (swollen tongue) • Compromised periodontal health- delayed bone formation • Dysgeusia (distortion of taste) • Delayed wound healing
Medications: Synthroid. levothyroxine, armour thyroid
ENDOCRINE DISEASE:
Thyroid gland disorders

34. PATIENT MANAGEMENT:
HYPOTHYROIDISM
1. Susceptible to cardiovascular disease (e.g atrial fibrillation)
! Consult primary care provider to seek whether antibiotics
prophylaxis is required
2. Focus on lethargy, may indicate uncontrolled state and a
risk for patients and respiratory rate
! possibility of an iatrogenic hyperthyroid state caused by hormone
replacement therapy used to treat hypothyroidism
3. Avoid giving depressants, sedatives or narcotic analgesics
! may cause exaggerated response in patients with mild to severe
hypothyroidism
ENDOCRINE DISEASE:
Thyroid gland disorders

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36. ENDOCRINE DISEASE:
Parathyroid gland disorders
Parathyroid glands
• small endocrine glands that produce parathyroid hormone (PTH)
• there are four parathyroid glands usually located behind the thyroid gland
• controls the amount of calcium in the blood and within the bones so that
nervous & muscular systems can function properly
• PTH increases blood calcium levels by stimulationg osteoclasts to break
down bone, increasing resorption
• PTH increases gastrointestinal calcium absorption by activating Vitamin D
• PTH increases renal absorption of calcium by the kidneys
ENDOCRINE DISEASE:
Parathyroid Disorders

37. Hyperparathyroidism
• Overactivity of the parathroid glands
• Excess production of PTH
• Raised PTH levels are harmful to bone
• Primary hyperparathyroidism / Secondary
hyperparathyroidism
ENDOCRINE DISEASE:
Parathyroid Disorders
ENDOCRINE DISEASES:
DIS:
DIABETES MELLITUS
HYPERPARATHYROIDISM

38. Symptoms
• Fragile bones that easily fracture
• Kidney stones
• Excessive urination
• Abdominal pain
• Tiring easily or weakness
• Depression or forgetfulness
• Bone and joint pain
• Frequent complain of illness with no apparent cause
• Nausea, vomiting or loss of appetite
ENDOCRINE DISEASE:
Parathyroid Disorders
SYMPTOMS:
HYPERPARATHYROIDISM

39. Complications of Hyperparathyroidism
1. Dental abnormalities
• widened pulp chambers
• development defects
• alterations in dental eruption
• weak teeth
• malocclusions
• loss of lamina dura on radiographs
• giant cell lesions
ENDOCRINE DISEASE:
Parathyroid Disorders
ENDOCRINE DENTAL CONSIDERATIONS:
DISEASES:
HYPERPARATHYROIDISM
OSTEOPOROSIS

40. Complications of Hyperparathyroidism
2. Brown tumor
3.Loss of bone density (bone resorption)
4.Soft tissue calcifications
ENDOCRINE DISEASE:
Parathyroid Disorders
DENTAL CONSIDERATIONS:
HYPERPARATHYROIDISM

41. Patient management
• No special consideration
• higher risk of bone fracture
• Take precaution in surgical tx
• Recognize presence of brown tumor
• Perform correct differential diagnosis so as not to conduct
an inadequate tx
ENDOCRINE DISEASE:
Parathyroid Disorders
PATIENT MANAGEMENT:
HYPERPARATHYROIDISM

42. Hypoparathyroidism
• Decreased function of the parathyroid glands
• Underproduction of PTH
• Leads to low levels of calcium in the blood
• Can be inherited but is also encountered after thyroid or
parathyroid surgery
ENDOCRINE DISEASE:
Parathyroid Disorders
ENDOCRINE DISEASES:
HYPOPARATHYROIDISM

43. Symptoms
• Tingling or burning (paresthesia) on fingertips, toes and lips
• Muscle aches or cramps affecting legs, feet, abdomen or face
• Twitching or spasms of muscles, particularly around mouth, hands, arms
or throat
• Fatigue or weakness
• Dry, coarse skin
• Brittle nails
• Anxiety or nervousness
• Headaches
• Depression, mood swings
• Memory problems
ENDOCRINE DISEASE:
Parathyroid Disorders
SYMPTOMS:
HYPOPARATHYROIDISM

44. Complications of Hypoparathyroidism
1. Dental abnormalities
• Enamel hypoplasia in horizontal lines
• poorly calcified dentine
• widened pulp chambers
• dental pulp calcifications
• shortened roots
• hypodontia
• delay or cessation of dental development
ENDOCRINE DISEASE:
Parathyroid Disorders
DENTAL CONSIDERATIONS:
HYPOPARATHYROIDISM

45. Complications of Hyperparathyroidism
2. Mandibular tori
3. Chronic candidiasis
4.Parasthesia of the tongue or lips
5.Alteration in facial muscles
ENDOCRINE DISEASE:
Parathyroid Disorders
DENTAL CONSIDERATIONS:
HYPOPARATHYROIDISM

46. Patient management
! More susceptible to caries
! Due to dental anomalies
! Dental management:
! Prevention of caries with periodic reviews, advice regarding diet,
OHI
! Before performing dental tx, find out serum calcium level
(must be 8mg/100ml)
! Prevents cardiac arrythmias, seizures
ENDOCRINE DISEASE:
Parathyroid Disorders
PATIENT MANAGEMENT:
HYPOPARATHYROIDISM

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The end.
Thank you for your attention.

48. References
• http://jada.ada.org/content/137/suppl_2/26S.full • http://www.ugr.es/~jagil/lalla_diabetes.pdf • http://jada.ada.org/content/137/8/1144.full.pdf+html • http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Oral_Health/default.asp • http://www.medicinaoral.com/odo/volumenes/v2i4/jcedv2i4p196.pdf • http://www.fourthmolar.com/blogs/entry/The-Dental-Management-of-Patients-with-Endocrine-Disease • http://webcache.googleusercontent.com/search?q=cache:e-dTttBHpwQJ:web.squ.edu.om/med-Lib/
MED_CD/E_CDs/Essential%2520of%2520Oral%2520Medicine/docs/ch09.pdf+endocrine+and
+dental&cd=9&hl=en&ct=clnk&client=safari • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Thyroid-Disorders-
Hyperthyroidism.aspx • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Diabetes-
Mellitus.aspx#section3 • http://www.cgh.com.sg/Medical_Specialities/Medical_Services/Pages/endocrinology.aspx • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Thyroid-Disorders.aspx • http://thyroid.about.com/od/hyperthyroidismgraves/a/risks-symptoms.htm • http://www.webmd.com/drugs/condition-584-Hypothyroidism.aspx?d.. • http://www.medicinenet.com/hyperthyroidism/index.htm