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									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that calcium is withdrawn in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
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