Introduction

Thyroid gland dysfunction can occur through overproduction (Thyrotoxicosis) or underproduction (Hypothyroidism) of thyroid hormone. The clinical manifestations range from subclinical dysfunction to acutely life-threatening situations. Thyroid gland dysfunction presents initially as a slow, insidious process in which nonspecific signs and symptoms develop over months. Untreated thyrotoxicosis can lead to an acute life-threatening situation known as a thyroid storm. It can manifest as severe hypermetabolism, high fever, neurologic, and gastrointestinal dysfunction.

Dental Therapy Considerations:

Euthyroid:

Patients with thyroid gland dysfunction who are receiving therapy to treat the condition have normal levels of circulating thyroid hormone and have no symptoms are considered euthyroid.

Hypothyroid:

Certain precautions are recommended if clinical hypothyroidism is suspected. Physician consent must be obtained before the start of the dental treatment. Care must be taken while prescribing any CNS depressant drugs. There is increased sensitivity to CNS depressant drugs in hypothyroid patients.

Administration of a normal dose can lead to an overdose causing respiratory or cardiovascular depression.

Hyperthyroid:

Dental care must be postponed until the patient’s metabolic disturbance is corrected. In these patients, epinephrine and other vasopressors must be used with caution. Vasopressors can stimulate the cardiovascular system and can precipitate cardiac dysrhythmias, tachycardia, and thyroid storm. Local anesthetics with vasoconstrictors can be used when the following precautions are taken:

• Least-concentrated effective solution of epinephrine is used (1:200,000 is preferred to 1:100,000, which is preferred to 1:50,000)

• The smallest volume of anesthetic/vasopressor is injected.

• Aspiration is done before every injection

Oral Manifestations:

Hypothyroidism:

• Glossitis

• Macroglossia

• Dysgeusia

• Compromised periodontal health

• Delayed dental eruption

• Delay in wound healing

• Salivary gland enlargement

Hyperthyroidism:

• Burning mouth syndrome

• Increased susceptibility to caries

• Severe periodontal issues

• Extra glandular thyroid tissue enlargement

• Mandibular or maxillary osteoporosis

• Accelerated dental eruption

Management:

It's improbable for acute emergencies related to the thyroid to occur during dental procedures.  Immediate management is supportive when loss of consciousness occurs.

Hypothyroid patients are unusually sensitive to the following drugs:

• Anxiolytics and sedatives

• Opioids

• CNS depressants such as histamine blockers

Effective management can be achieved through oral administration of desiccated thyroid hormone. Therapy is continued in the patient’s remaining life. The patient returns to normal body weight within 30 days of the start of therapy. Symptoms of hypothyroidism include:

• Weakness

• Fatigue

• Cold intolerance

• Puffy skin

• Thick tongue

Step 1: Termination of dental procedure

Step 2: The patient is placed supine with the legs elevated slightly.

Step 3: (Circulation- Airway- Breathing), Basic life support: Management includes the assessment of circulation, establishment of a patent airway, assessment of breathing, and the administration of oxygen.

Step 4: (definitive care)

Step 4a: When the patient does not regain consciousness after the implementation of BLS, medical assistance should be sought out immediately.

Step 4b: Establishment of an intravenous (IV) line: An IV infusion of 5% dextrose and water, lactated Ringers solution, or normal saline can be started before the arrival of emergency personnel.

Step 4c: Administration of oxygen

Step 4d: Definitive management includes admitting the patient to the emergency department, intravenous administration of appropriate doses of thyroid hormones, and the reversal of hypothermia.

Conclusion:

Understanding the ramifications of thyroid gland dysfunction is paramount in dentistry. Thyroid disorders can present in various oral health issues, impacting the oral mucosa, periodontal tissues, and salivary glands. Dentists hold a pivotal role in recognizing potential signs and symptoms of thyroid dysfunction during routine examinations, facilitating early identification and referral for suitable medical intervention. Collaborative efforts between dental professionals and endocrinologists are imperative to deliver comprehensive care to patients with thyroid disorders, ensuring optimal oral health and overall well-being. By keeping abreast of the intricate connections between thyroid health and oral health, dental practitioners can actively contribute to their patients' holistic care and enhance health outcomes.

References:

1. Pyle MA, Faddoul FF, Terezhalmy GT. Clinical implications of drugs taken by our patients. Dent Clin North Am. 1993;37:73–90. [PubMed] [Google Scholar]

2. Klein I. Thyroid hormone and the cardiovascular system. Am J Med. 1990;88:631–7. [PubMed] [Google Scholar]

(By Anjali KV)

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