What if your dental patient has a thyroid disorder?
We come across patients with thyroid disorders in our clinical practice sometimes, don’t we? Most thyroid disorders can affect dental treatment protocols. A dental professional should be familiar with the manifestations of thyroid disorders and take the necessary precautions.
So the question is what are these precautions? Are these precautions different for patients with hyperthyroidism and hypothyroidism? What if the patient is undiagnosed? Don’t get bogged down by all these things you just read. Find these important answers here:
It is the state of normal thyroid gland function. They are treated like routine dental patients with a follow-up scheduled twice a year.
This category represents patients with reduced hormone levels. Clinical manifestations include macroglossia, dysgeusia, poor periodontal condition, delayed eruption and delayed wound healing. Look for these signs.
Any medical conditions to be careful about?
They are also unusually susceptible to cardiovascular disease. Patients with atrial fibrillation can be on anticoagulant therapy. Make sure you have checked with a physician.
During treatment of a diagnosed and medicated patient, attention should be given to lethargy and the respiratory rate which can indicate an uncontrolled state (myxedema coma) which is a life-threatening condition.
What to do in case of Myxedema coma?
The dental professional should terminate the dental procedure, place the patient in a supine position with slightly elevated legs, establish a patent airway (head-tilt-chin-lift), assess breathing, administer O2, assess circulation and summon medical assistance.
Does epinephrine have any effect in patients with hypothyroidism?
In patients with cardiovascular symptoms like atrial fibrillation, local anesthetic and retraction cord with epinephrine should be used cautiously. People who are on a stable dosage of hormone replacement for a long time have no problem undergoing dental treatment. In the case of postoperative pain control, narcotics should not be prescribed as these patients are unusually sensitive due to extreme overreaction.
These patients have increased levels of thyroid hormone and present with classic symptoms such as intolerance to heat, weight loss, muscle wasting, increased blood pressure, exophthalmos (bulging eyes), menstrual changes.
Any dental treatment modifications required?
Epinephrine can stimulate the CVS and can precipitate cardiac dysrhythmias, tachycardia and thyroid storm in hyperthyroid patients. Injecting the smallest volume of anesthesia to be effective, increasing the dilution of epinephrine, aspiration before any injection is all minor but important measures which must be kept in mind by the dentist as it prevents epinephrine from entering the systemic circulation and exaggerating CVS symptoms.
Betadine mouthwash contains Iodine and should not be given to these patients as it gets absorbed systemically interfering with the existing hormonal levels.
Any life-threatening conditions to be expected on the dental chair?
In the uncontrolled state, thyroid storm is considered. Management includes termination of dental treatment, supine placement of the patient with slightly elevated legs, the establishment of a patent airway (head-tilt-chin-lift), assessment of breathing, administration of O2, assessment of circulation and summoning medical assistance. Patients with thyroid storm crisis are more susceptible to infection due to reduced leucocytes.
In patients taking medication such as thyroid hormone replacement therapy, anticoagulants or barbiturates should report for dental treatment only after a physician’s approval.
Patients who present with thyroid problems are a challenge to the dental professional. It is important to know the condition of the disease to be able to modify the treatment protocols accordingly. Reducing stress, being aware of drug interactions, and being vigilant for the appearance of signs or symptoms are the responsibilities of the dental professional apart from his/her routine treatment.
About the author:
Dr. Paresh Lotlekar is the Founder and CEO at Studio32 Dental Care Pvt. Ltd. He has completed his BDS from Goa Dental College and Hospital and MDS from the prestigious KLE University, Belgaum. He offers passionate insight and smart advice on oral health and wellness through his blogs. Connect with him at firstname.lastname@example.org.