Endocrine System Endocrine Disorder Mineral metabolic and Metabolic Bone disease Sex Hormonal Alterations Pituitary Gland Disorder Thyroid Gland Disorder Sex Hormonal Alterations PREGNANCY •Condition of having a developing embryo or fetus in the body •In Human duration of pregnancy is about 266 days after conception. •Roughly divided in three trimesters of about three calendar months each-into the embryonic period lasting from fertilization through the first eight weeks of pregnancy and the fetal period during the remainder of pregnancy Oral Manifestation •The Popular notion that pregnancy cause tooth loss “a tooth for every pregnancy”and that calcium is withdrawn in significant amounts from the maternal dentition to supply fetal requirments has no histologic, chemical, evident to support it. •In other hand, calcium is readily mobilized from bone to supply these demands and demineralization of alveolar processes can result. Caries activity is attributed to an increase in local cariogenic factors Condition that may influence the pregnant patient’s teeth is acid erosion, which may caused by repeated regurgitation of gastric contents associated with morning sickness or esophageal reflux. Periodontal disease occurs in 50% to 100%of all pregnant women Gingival changes occur most frequently in association with poor oral hygiene and local irritants, esp bacterial plaque. Clinically, the appearance of inflamed gingiva during pregnancy is characterized by a fiery red color of marginal gingiva and interdental papillae Tissue is edematous, with a smooth, shiny surface texture, loss of resiliency, and tendency to bleed easily. Interdental papillae may hypertrophy and form pseudopocket. Tumorlike growths, usually on the interdental papillae or other areas of the frequent irritation..it is referred to as a “pregnancy tumor”, epulis gravidarum, or pregnancy granuloma . Poor oral hygiene invariably is present, and often there are deposits of plaque or calculus on the teeth adjacent to the lesion. Etiolog Tissue Main Tx Progno y: of Patholo sis: Origin gic : Process: developm bone developmental bone infantile ental marrow osteopetrosi transplantati s is poor on adult corticoster osteopetrosi oids s is more supportive variable and measure as insidious transfusions and antibiotics hyperberic oxygen Full development granuloma is a sessile or pedunculated lesion that is usually painless. Color varies from purplish red to deep blue. Bone destruction is rarely observed around pregnancy granulomas Oral findings that may be seen in pregnant women is generalized tooth mobility. probably related to the degree of the gingival disease and the disturbance of the atteachment apparatus, as well as to minera; changes in the lamina dura. Condition usually reversed after delivery. Dental Management Pregnant patients begins with thorough medical history. History should note any complications the patient has encountered in the pregnancy to date and record any previous miscarriages, recent cramping, No elective dental care should be undertaken during the tri-semesterl. Prolong chair time is avoided Emergency dental care may be rendered at any time during pregnancy, after consultaion to physician MENOPAUSE Menopause is not a disease, it is a natural transition period in ever woman's life. Menopause is a time of declining ovarian function However, during menopause, many women may experience uncomfortable symptoms such as hot flashes, vaginal dryness, depression, sleeplessness, etc. Traditionally women have sought hormone replacement Some Possible Symptoms Associated with various Stages of Menopause 1.Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling 2. Bouts of rapid heart beat 3. Irritability, Mood swings, sudden tears 4. Trouble sleeping through the night (with or without night sweats) 5. Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles 6. Loss of libido 8. Crashing fatigue 9. Anxiety, feeling ill at ease 10. Feelings of dread, apprehension, doom Dental Management Postmenopausal osteoporosis can be prevented and treated by sound dietary control adequate levels of dietary calcium..The condition may be prevalent because of dietary adequacies of young women and could become an important issue in dental care for postmenopausal women Counseling may be indicated for some patients, and it is most appropriate for the dentist to refer the menopausal patient for medical evaluation and treatment to optimize the befits of dental treatment. ORAL CONTRACEPTIVES The goal of contraception (or birth control) is to prevent an unplanned pregnancy. The majority of methods of contraception enable sexually active couples to temporarily avoid pregnancy. ADVANTAGES · Effective, with lowest failure rate of any nonpermanent method - less than 0.1 pregnancy per 100 women per year, if all pills are taken as prescribed (the same as 1 pregnancy per 1000 women per year). · Freedom from fear of pregnancy. · Spontaneity of sexual experiences, doesn't interrupt sex. · Regulation and less painful menstrual periods. · Decrease in the amount of menstrual bleeding in most women. · · No increase in risk of breast cancer and decrease in risk of initiating benign breast disease (noncancerous breast tumors). · Less likelihood of anemia or arthritis. · Decrease in incidence of pelvic inflammatory disease. · Decrease in incidence of cancer of the lining of the uterus and ovarian cancer · May decrease acne. · It is easy to use. DISADVANTAGES · Must be prescribed by a health care provider. · Can cause side effects, such as mood changes, headaches, nausea or spotting. · Must be taken every day. · May be hard to swallow pills. · Can cause serious health problems, such as strokes. · Extra hair growth on the face or other parts of the body. · Breast fullness or tenderness. Breasts may increase in size. · Increase of serum copper and iron levels. Dental Management The dentist should be aware of the systematic and oral side effects of oral contraceptives. A comprehensive medical history and assessment of vital signs, particularly blood pressure. Teeth extraction (especially 3rd molars) be performed on no estrogenic days (day to 23-28) of the pill cycle, to reduced the risk of postoperative localized osteitis When prescribing a drugs, We dentist should advised the patient to use an additionalmethod of contraceptives during the period of concurrent drug ues. Mineral metabolic and Metabolic Bone disease Osteoporosis is a condition in which there is a thinning of the bones, causing them to fracture (break) more easily. most common with older people. stage when the bone mass reaches a level at which fracture is likely to occur. The most commonly characteristic of osteoporosis is fragility fractures. Fragility fractures occur most often in the wrist, hip and spine. Osteoporosis can occur in men and it can occur at any age from childhood onwards, however both of these cases are rare. It is more commonly associated with post- menopausal women. What is going on in the bones? Bone is a living tissue which needs to be constantly renewed. Old bone is constantly being broken down and replaced by new, stronger bone. This process is called bone remodelling. There are two main types of cell in the bone; osteoclasts which destroy bone and osteoblasts which make new bone. These are both formed in the bone marrow. As a person gets older, the osteoclasts become more active, while the osteoblasts become less active. This basically means more bone is removed and less bone is formed, resulting in a thinning of the bones. factors which help determine peak bone mass . They include: Calcium intake. Genetic (hereditary) predisposition. Physical exercise. Sex hormones. The amount of bone in the skeleton starts to decrease around the age of 40 and continues throughout life. Oral Manifestations •Alveolar Bone is highly susceptible- particularly in patient who have lost teeth and developed disuse atrophy. •Edentulous Px, one w/o denture, disuse atrophy results in loss of normal trabeculation, and contour of alveolar process •Alveolar bone loss its cortical layer; residual ridges are sharp and covered with spicules from uneven resorption. •There is a big risk of Md. Fracture due to decreased bone mass. •Radiograph for osteoporosis there is increased radioluscency of the bone and fine, indistinct trabeculae and thinning of the cortex In Senile and postmenopausal osteoporosis-the lamina dura of tooth socket is thinner but still discernable Cushing Syndrome-lamina dura may be completely obliterated. Osteoporosis in MAXILLA- increased in paranasal sinus often marked thinning of the bone. Cases like inflammation in the antrum , causes pain in the maxillary teeth. The extension of the mx. Antrum weakens the bone and increased a likehood of tuberosity fracture during extraction of maxillary tuberosity. How is osteoporosis diagnosed? Your doctor will take a detailed medical and family history, which will help to determine your risk of developing osteoporosis. Established osteoporosis may be visible on routine X-rays, but this is not always the case. If osteoporosis or slight bone thinning is suspected, a particular type of bone scan, a DEXA scan, can measure the density of the bones. What can I do to reduce my chances of developing osteoporosis? Ensure you are getting enough calcium in your diet. Calcium helps to achieve a good peak bone mass and reduces age- related bone loss later on in life. The best source of calcium is in dairy products, such as milk and cheese. Ensure that the rest of your diet is balanced. Avoid excessive dieting. This can have a very harmful effect on the bones. People with anorexia nervosa can get severe osteoporosis, even if they are still young. Do not smoke. If you already do, try to give up. Smoking is bad for your bones. Moderate alcohol intake may actually be beneficial. However excessive alcohol intake may be harmful to the bones. Dental Management Individuals who wear dentures may become sensitive to trauma from the denture base material. Therefore bases should be relined with a soft material extending over the entire support area, and the occlusion carefully balanced. OSTEOPETROSIS Osteopetrosis (Albers- Schoenberg Syndrome, Marble Bone Disease ) • Generalized hereditary condition consisting of excessive bone mineralization, resulting in altered stature, frequent fractures, lack of bone marrow hematopoietic function, and a tendency for severe osteomyelitis of the jaws. Clinical Features: • very dense bone, fragile bone. Stunted growth, no proper medullary space, and bon marrow. Short life span. • hydrocephalus, abnormal dental development (oligodontia) • anemia, neutropenia, increased rate of infection, increased rate of bleeding, hepatosplenomegaly. • begins in infancy with breathing and hearing difficulties • pain, deafness, blindness, stroke. •cardiac disease. Radiographic Features: •generalized increase in bone density • cranial plates are thickened • sinus cavities are reduced in size • embedded or unerupted teeth are common Oral Manifestations Maxilla and Mandible may show a diffuse, symmetric sclerosis, with thickened cortices and medullary cavities that may have been replace by bone “Bone-within-bone” appearance. roots of the teeth cannot be distinguished from the supporting bone Abnormal development of the teeth is characterized by delayed eruption, enamel hypoplasia, malformation of the crowns and roots, narrowing of the dental pulp chamber and increased caries Histologic Features: • bone is dense and sclerotic • marrow spaces replaced with bone or fibrous tissue • normal or reduced amount of osteoclasts Dental Management The most frequent problems relate to teeth extraction and to periapical infection. There is a greater risk of root fractures during extraction. ……………………………………………… …… Antibiotic, sequestrectomy and hyperbaric oxygen treatment. Use of vasoconstrictor containing local anesthetic is questionable, since the area is already vascularly compromised. Hyperparathyroidism What is hyperparathyroidism? overactive parathyroid glands. produce too much parathyroid hormones, which in turn stimulate increased levels of calcium in the blood stream. hyperparathyroidism results to kidney stones, because of high levels of calcium excreted into the urine by the kidneys. Causes -include benign tumors on the parathyroid glands or enlargement of the parathyroid glands. What are symptoms of hyperparathyroidism? The following are the most common symptoms of hyperparathyroidism. : · aches and pains · depression · abdominal pain · nausea · vomiting · fatigue · excessive urination · confusion · muscle weakness The symptoms of hyperparathyroidism may resemble other conditions or medical problems. Consult a physician for diagnosis. How is hyperparathyroidism diagnosed? •complete medical history and medical examination, •diagnostic procedures for hyperparathyroidism may include: •bone x-rays •laboratory tests to measure calcium and parathyroid hormone levels Dental correlation Generally, routine dental treatment involves no modifications unless there are associated medical complications present. In any phase of hyperparathyroidism before complete remineralization the dentist should take care to avoid iatrogenic jaw fractures during surgical procedures. Treatment for hyperparathyroidism: Specific treatment for . hyperparathyroidism will be determined by your physician based on: your overall health and medical history extent of the disease your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference Treatment may include removal of parathyroid tissue. Hypoparathyroidism a rare disorder associated with insufficient production of parathyroid hormone, the inability to make a usable form of parathyroid hormone, the inability of kidneys and bones to respond to parathyroid hormone production. A deficiency that lowers blood calcium levels and raises phosphate levels. Hypoparathyroidism either may be inherited or acquired; the acquired form usually results from parathyroid surgery or an underlying disorder, such as cancer or neck trauma. Signs, symptoms and diagnosis Hypocalcemia is the only real result of parathyroid dysfunction and low PTH levels. This presents with tremor, tetany and, eventually, convulsions. In contrast hypoparathyroidism does not have consequences for bone. Diagnosis is by measurement of calcium, albumin (for correction) and PTH in blood. PTH degrades rapidly at ambient temperatures and the blood sample therefore has to be transported to the laboratory on ice. If necessary, measuring cAMP (cyclic AMP) in the urine after an intravenous dose of PTH can help in the distinction between hypoparathyroidism and other causes. Causes Hypoparathyroidism can have a number of divergent causes: • Removal of the parathyroid glands in thyroid surgery (thyroidectomy) is a recognised cause. · Autoimmune invasion and destruction is the most common non-surgical cause. · Hemochromatosis can lead to iron accumulation and consequent dysfunction of a number of endocrine organs, including the parathyroids. · Absence or dysfunction of the parathyroid glands is one of the components of chromosome 22q11 microdeletion syndrome (other names: DiGeorge syndrome, Schprintzen syndrome, velocardiofacial syndrome). · Magnesium deficiency · Some very rare diseases · Idiopathic (of unknown cause), occasionally familial Treatment Severe hypocalcemia, a potentially life-threatening condition, is treated as soon as possible with intravenous calcium (e.g. as calcium gluconate) . Generally, a central venous catheter is recommended, as the calcium can irritate peripheral veins and cause phlebitis. Long-term treatment of hypoparathyroidism is with calcium and Vitamin D3 supplementation (D1 is ineffective in the absence of renal conversion). Teriparatide, a synthetic form of PTH (presently registered for osteoporosis) might become the treatment of choice for PTH supplementation, although further studies are awaited. Hypophosphatasia Hypophosphatasia is one of several disorders that resembles osteogenesis imperfecta. It is an inherited metabolic (chemical) bone disease that results from low levels of an enzyme called alkaline phosphatase (ALP) ALP is normally present in large amounts in bones and the liver. The severity of hypophosphatasia is remarkably variable from patient to patient. The most severely affected fail to form a skeleton in the womb and are stillborn. Odontohypophosphatasia is a disease in which children and adults have only dental, not skeletal, problems. This usually involves premature loss of teeth. Symptoms There are reports of blue sclera (whites of the eyes) during infancy and childhood that may resemble osteogenesis imperfecta. deformity of the arms, legs and chest. Teeth may be lost prematurely and the teeth may have wide pulp chambers that predisposes them to cavities. These symptoms resemble some of those found in osteogenesis imperfecta. Treatment There is no established medical therapy for hypophosphatasia. Dental Correlation If the dentist observes these signs, the patient should be reffered for medical management. Caution is vital during dental procedures to avoid jaw fractures in hypocalcified areas. The oral manifestation of hypophosphatasia usually resolve with treatment of the disorder. Thyroid Gland Disorder What Is Your Thyroid Gland? The function of the thyroid is to regulate the body's metabolism. the biggest gland in the neck. manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions. located in the middle of the lower neck, below the larynx (voice box) and just above your clavicles (collarbones). It is shaped like a "bow tie," having two halves (lobes): a right lobe and a left lobe joined by an "isthmus.". Hyperthyroidism Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of the body. Common symptoms and signs of hyperthyroidism Palpitation Heat intolerance Nervousness Insomnia Breathlessness Increased bowel movements Light or absent menstrual periods Fatigue Fast heart rate Trembling hands Weight loss Diagnosis A diagnosis is made through a blood test, by measuring the level of T4 in the blood. High T4 levels are considered indicativeof hyperthyriodism. If the index of suspicion is low, many doctors prefer to measure thyroid-stimulating hormone (TSH). If TSH is suppressed, there may be uncontrolledproduction of T4, while a normal TSH generally rules out thyroid disease. Measuring specific antibodies , such as anti- TSH-receptor antibodies in Graves' disease, may contribute to the diagnosis.Additionally, scintigraphy may be required. Treatment The major and generally accepted modalities for treatment of hyperthyriodism in humans are: •surgery •radioiodinetreatment •thyrostatics - drugs thatinhibit the production of thyroid hormones, such as methimazole (Tapazole®) If too high a dose is used in pharmacological treatment, patients can develop symptoms of hypothyroidism . Hypothyroidism is also a very common result of surgery or radiation treatment as it isdifficult to gauge how much of the thyroid gland should be removed. Supplementation with levothyroxine may be required in thesecases. Dental Correlation Palpation and inspection of the thyroid gland should be included in the routine head and neck examination performed by the dentist. In he event of dental emergencies in a Hyperthyroid patient, such as an acute oral infection, the dentist must consult with the physician concerning management of emergency. Often conservative treatment, consisting of antibiotic, and analgesic, is advisable. Local anesthetis without epinephrine or other pressor aminesshould be used, if needed THANK YOU VERY MUCH!!!
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