Podcast
Questions and Answers
Which thyroid hormone is primarily secreted by the thyroid gland that regulates metabolism?
Which thyroid hormone is primarily secreted by the thyroid gland that regulates metabolism?
What is a common cause of hyperthyroidism?
What is a common cause of hyperthyroidism?
Which of the following is NOT a clinical manifestation of hypothyroidism?
Which of the following is NOT a clinical manifestation of hypothyroidism?
What is one of the main goals in the management of thyroid dysfunction?
What is one of the main goals in the management of thyroid dysfunction?
Signup and view all the answers
Which question is relevant during a dialogue history for assessing thyroid dysfunction?
Which question is relevant during a dialogue history for assessing thyroid dysfunction?
Signup and view all the answers
Which of the following is NOT a precaution when using local anesthetics (LA) with vasoconstrictors?
Which of the following is NOT a precaution when using local anesthetics (LA) with vasoconstrictors?
Signup and view all the answers
What is the first step in the management of a hypothyroid emergency during a dental procedure?
What is the first step in the management of a hypothyroid emergency during a dental procedure?
Signup and view all the answers
When managing a patient with hyperthyroid emergency, which medication is administered to block adrenergic-mediated effects of thyroid hormone?
When managing a patient with hyperthyroid emergency, which medication is administered to block adrenergic-mediated effects of thyroid hormone?
Signup and view all the answers
What should be established as part of the definitive care in a hyperthyroid crisis?
What should be established as part of the definitive care in a hyperthyroid crisis?
Signup and view all the answers
In the management of both hypothyroid and hyperthyroid emergencies, what position should the patient be placed in?
In the management of both hypothyroid and hyperthyroid emergencies, what position should the patient be placed in?
Signup and view all the answers
What is the major function of insulin in the body?
What is the major function of insulin in the body?
Signup and view all the answers
When should dental procedures be ideally performed for diabetic patients?
When should dental procedures be ideally performed for diabetic patients?
Signup and view all the answers
What should be done in case of doubt regarding insulin shock or diabetic coma during a procedure?
What should be done in case of doubt regarding insulin shock or diabetic coma during a procedure?
Signup and view all the answers
Which adjustment is necessary to insulin administration for patients undergoing moderate surgical intervention?
Which adjustment is necessary to insulin administration for patients undergoing moderate surgical intervention?
Signup and view all the answers
What is a common characteristic of hyperglycemia in diabetic coma?
What is a common characteristic of hyperglycemia in diabetic coma?
Signup and view all the answers
What is the term for the condition where there is an absolute insufficiency of insulin?
What is the term for the condition where there is an absolute insufficiency of insulin?
Signup and view all the answers
What is one key dental management consideration for diabetic patients undergoing surgery?
What is one key dental management consideration for diabetic patients undergoing surgery?
Signup and view all the answers
In case of massive surgery, when should prophylactic antibiotic administration take place?
In case of massive surgery, when should prophylactic antibiotic administration take place?
Signup and view all the answers
What is a key characteristic that differentiates hypothyroidism from hyperthyroidism in physical examination?
What is a key characteristic that differentiates hypothyroidism from hyperthyroidism in physical examination?
Signup and view all the answers
Which ASA risk category represents patients who are euthyroid during dental treatment?
Which ASA risk category represents patients who are euthyroid during dental treatment?
Signup and view all the answers
Which condition may present with symptoms that are confused with thyrotoxicosis?
Which condition may present with symptoms that are confused with thyrotoxicosis?
Signup and view all the answers
What precaution should be taken when prescribing sedation for a patient with hypothyroidism?
What precaution should be taken when prescribing sedation for a patient with hypothyroidism?
Signup and view all the answers
What action should be taken for a patient with severe hyperthyroidism before performing dental procedures?
What action should be taken for a patient with severe hyperthyroidism before performing dental procedures?
Signup and view all the answers
What effect does atropine have that may be detrimental to a hyperthyroid patient during dental treatment?
What effect does atropine have that may be detrimental to a hyperthyroid patient during dental treatment?
Signup and view all the answers
Which of the following is a correct consideration when treating a patient with mild hyperthyroidism during dental procedures?
Which of the following is a correct consideration when treating a patient with mild hyperthyroidism during dental procedures?
Signup and view all the answers
Which of the following medications should be used with caution in a hyperthyroid patient?
Which of the following medications should be used with caution in a hyperthyroid patient?
Signup and view all the answers
Signup and view all the answers
Study Notes
Medically Compromised Patients in Dentistry
- Endocrine diseases are a concern for dental procedures
- Diabetic Mellitus, Thyroid Disease, Pregnancy, and Steroid use are examples of endocrine diseases
- Dr. Lamia Mohammed Hail is an expert in oral surgery and implantology
- Diabetes Mellitus is a metabolic disorder characterized by insufficient insulin leading to metabolic disturbances
Part I: Diabetic Mellitus Management in Oral Surgery
- This section focuses on managing diabetes patients during oral surgery
Introduction to Diabetes Mellitus
- Diabetes mellitus is a metabolic condition
- Insulin's role is to regulate blood sugar levels and counter other hormones that increase blood sugar
- Insufficient insulin or resistance to insulin results in high blood sugar levels
Etiologic Classification of Diabetes Mellitus (DM)
- Two main types of DM:
- Type 1 (insulin-dependent or juvenile-onset diabetes)
- Type 2 (non-insulin-dependent or adult-onset diabetes)
- Other types include genetic defects impacting beta cells or pancreatic exocrine function deficiencies, endocrine pathologies, and drug/chemical usage or infections.
Other Specific Types of Diabetes Mellitus
- Genetic defects in beta cells' functions
- Decrease in exocrine pancreas functions
- Endocrine pathologies
- Drug or chemical usage
- Infections
Gestational Diabetes Mellitus (GDM)
- Glucose intolerance during pregnancy
- Affects approximately 4% of pregnancies in the US
Blood Sugar Levels Chart
- mg/dL and mmol/l tables show normal, pre-diabetes, and diabetes ranges for fasting and post-meal blood sugar levels
Pathophysiology of Diabetes Mellitus
-
Normal blood glucose levels are maintained between 60-150 mg/dL
-
Insulin is released by pancreas in response to elevated blood sugar to keep blood sugar low
-
Glucose is absorbed and stored as glycogen
-
Fatty acids and amino acids are converted into triglycerides and protein stores
-
Lack of insulin or resistance to insulin results in glucose not being used by cells
-
Triglycerides break down into fatty acids causing increased blood ketones leading to ketoacidosis
-
High blood sugar results in glucose in urine due to osmotic diuresis causing dehydration and increased thirst (polyuria and polydipsia).
-
Cells not receiving glucose causes increased hunger (polyphagia)
-
Patients may experience weight loss
Diagnosis of Diabetes Mellitus
- Casual plasma glucose level ≥200 mg/dL accompanied by symptoms (indicates diagnosis)
- Fasting plasma glucose ≥126mg/dL
- Oral glucose tolerance test (OGTT) with blood sugar ≥200mg/dL.
- ADA recommends screening for patients over 45 years old every 3 years.
Oral Manifestations and Complications of Diabetes Mellitus
-
No specific oral lesions are associated with diabetes. However, hyperglycemia leads to issues like:
- Increased risk of periodontal disease due to altered immune response/ impaired neutrophil chemotaxis, increased collagen breakdown, plaque formation
- Salivary gland dysfunction: xerostomia, tenderness, pain, burning sensation, and enlarged salivary glands
- Increased risk of dental caries due to decreased saliva production/ oral hygiene
- Increased risk of infection because of impaired macrophage function and deficient immune system
- Delayed healing
- Increase in dry socket
-
Miscellaneous conditions like pulpitis, neuropathies (facial nerves), and drug-induced effects (e.g., sulphonylureas like chlorpropamide) and ulcers can occur
Dental Management Considerations for Medically Compromised Patients
- Thorough patient history and evaluation of glycemic control (Glucose levels, hypoglycemic episodes frequency, medication dosages and times) by a dentist
- Scheduling visits for dental procedures in optimal times (avoiding peak hormone/glucose levels)
- Ensuring patients have eaten normally before procedures and have taken necessary medications
- Blood glucose monitoring before starting procedures and keeping glucose levels within acceptable ranges
- Recommended level being <70 mg/dL.
- Prophylactic antibiotics for established infection or during high-risk procedures (e.g., major surgery, pre-op contamination)
- During treatment, hypoglycemia is a major complication and must be monitored
- Post-treatment monitoring for infection control and dietary intake.
- Medications like salicylates increase insulin sensitivity - avoid administering Aspirin to DM patients
- Referrals to physicians are often necessary for complex cases
- Adjust insulin dosages before surgeries
- Use of smallest amount of epinephrine during local anesthesia
- Minimizes the risk of raising blood glucose
- Maintaining proper hydration of patients.
Diabetic Coma and Insulin Shock
- Diagnostic Table showing differences between hyperglycemia coma and hypoglycemia shock, including symptoms such as consciousness level, skin appearance, thirst, breath odor, and vomiting
Emergency Management
-
Hypoglycemia treatment:
- 15g fast-acting oral carbohydrates
- Measuring blood sugar for confirmation
- Intravenous (IV) administration of 50% dextrose solution (25-30 ml) over a 3-minute period
-
Glucagon 1mg
- Necessary for severe cases
-
Notify emergency services (911, 119) for serious conditions
-
Severe hyperglycemia (long-term):
- Ketoacidosis may occur with nausea, vomiting, abdominal pain, noticeable acetone breath odor
- Difficult to quickly distinguish between hypoglycemia vs. hyperglycemia in emergency situations
-
Medications and insulin administration needed for hyperglycemia
-
Glucose should be administered when in emergency situations
Conclusion & Preventive Measures
- Emphasize the importance of thorough patient history, routine dental checkups, and minimizing complications.
- Detailed medical history including questions about the nature of thyroid dysfunction (hypo/hyper), how it's managed, recent weight changes, sensitivity to temperature/pain relievers, heat sensitivity, and irritability
- Monitoring of blood glucose levels, dietary intake, preventing peak activity periods of insulin
- Evaluating for complications of plaque control and periodontal disease.
- Providing oral hydration and managing oral dryness
- Avoidance of smoking, caffeine, and alcohol
Thyroid Dysfunction in Dentistry
- Thyroid gland, located near the trachea, produces hormones such as thyroxine (T4), triiodothyronine (T3), and calcitonin.
- These hormones have numerous functions impacting metabolism
Introduction
-
Thyroid gland is composed of 2 lobes on either side of the trachea, joined by an isthmus
-
Secretes hormones: thyroxine (T4), triiodothyronine (T3), and calcitonin
-
Thyroid hormones affect growth, carbohydrate and fat metabolism, vitamin metabolism, basal metabolic rate, cardiovascular system function, and muscle function.
Pathophysiology
- Thyroid dysfunction, due to either hypo- or hyper-function, is a concern
- Thyrotoxicosis (hyperthyroidism): results from factors like autoimmune issues, or tumors (adenomas).
- Hypothyroidism (underactive thyroid): typically autoimmune destruction of the thyroid gland causing progressive deterioration leading to absence of thyroid hormone secretion
Clinical Manifestations (Hyperthyroidism)
- Symptoms vary but include intolerance to heat, fine/straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, increased systolic blood pressure, possibly weight loss, muscle wasting
- Diagnostic Table of common and less common symptoms of hyperthyroidism
Clinical Manifestations (Hypothyroidism)
- Symptoms include paresthesia, fatigue, intolerance to cold, muscle weakness, pain in muscles and joints, difficulty concentrating, drowsiness, constipation, forgetfulness
- Diagnostic Table of common and less common symptoms of hypothyroidism.
Prevention
- Thorough medical history including questions about thyroid disease, how it's managed, recent weight changes, sensitivity to temperature/pain relievers, heat sensitivity and irritability.
- Physical exams to check for features like a palpable thyroid, BP, and heart rate
Dental Considerations (Euthyroid Patients)
- Dental procedures can proceed if the patient has normal thyroid levels
- Patients with mild hyper or hypothyroidism can typically have dental treatment with careful monitoring - if they are on medication, consult with the physician about their medications
- Those with more severe cases may require modifications
Physical Status Classification
- Physical status classification based on thyroid function is needed when determining appropriate dental care - ASA II: usual dental care considerations
- ASA III : need more considerations when it comes to dental care (possibly including avoiding vasopressors/CNS depressants for those with hyperthyroidism and taking precautions when prescribing vasopressors and CNS depressants for those with hypothyroidism, monitoring,etc)
Hypothyroidism Management
- Dental procedure termination
- supine position with legs elevated slightly
- basic life support
- definitive care
- summoning medical assistance
- establishment of IV line (normal saline/5% dextrose)
- Oxygen administration
- hospitalization for emergency treatment, massive thyroid hormone administration given intravenously
Hyperthyroidism Management
- Termination of dental procedure
- supine position with legs elevated slightly
- basic life support
- summoning medical assistance
- establishment of IV line (normal saline/5% dextrose)
- Oxygen administration
- hospitalization for emergency treatment, possible administration of anti-thyroid drugs and/or propranolol, additional large glucocorticoid doses to prevent adrenal insufficiency
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the implications of managing medically compromised patients, particularly those with Diabetes Mellitus, in dental procedures. This quiz covers the effects of endocrine diseases and the necessary precautions for providing oral care to diabetic patients during surgery. Enhance your understanding of insulin's role and the classifications of diabetes in a dental context.
