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LETTER TO THE EDITOR
Year : 2012  |  Volume : 9  |  Issue : 3  |  Page : 105

Dental treatment modifications in thyroid disorders: An overview


1 Department of Prosthodontics, ITS Dental College, Muradnagar, India
2 Department of Oral Pathology, Swami Devi Dyal Dental College and Hospital, Panchkula, India
3 Department of Conservative Dentistry, IDST Dental College, Modi Nagar, Ghaziabad, Uttar Pradesh, India

Date of Web Publication11-Aug-2012

Correspondence Address:
Prince Kumar
Department of Prosthodontics, ITS Dental College, Ghaziabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.99661

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How to cite this article:
Kumar P, Singh HP, Kumar A, Goel R. Dental treatment modifications in thyroid disorders: An overview. Thyroid Res Pract 2012;9:105

How to cite this URL:
Kumar P, Singh HP, Kumar A, Goel R. Dental treatment modifications in thyroid disorders: An overview. Thyroid Res Pract [serial online] 2012 [cited 2017 Mar 23];9:105. Available from: http://www.thetrp.net/text.asp?2012/9/3/105/99661

Sir,

Thyroid hormones play a key role in the regulation of growth, development and metabolic and vital functions and activities of the body. Most of the disorders of thyroid can affect the efficient dental healthcare delivery and associated treatment protocols. Therefore, it is deemed necessary for the dental professionals to take safety measures and treatment amendments when providing dental treatment to such patients. Thorough knowledge of the clinical manifestations of thyroid disorders helps out dentists to recognize any related complication. Any suspicion of thyroid disease in an undiagnosed case must accompany the postponement of every invasive dental treatment until a comprehensive medical assessment is completed. In case of controlled hypothyroidism, minor restorative dental procedures such as cavity filling may be carried out. Physician consultation is mandatory in the patients taking an oral anticoagulant, thyroid hormone replacement therapy for underlying disease or central nervous system depressants like barbiturates. [1] Hypothyorid patients on propylthiouracil treatment should be examined for potential agranulocytosis and bleeding, and a complete blood count test including prothrombin time should be executed prior to any surgical procedure. Treatment of hypothyroid patients having diabetes mellitus (DM) with thyroxin (T 4 ) often results in hyperglycemia, which necessitates immediate attention to complications associated with poor glycemic control. [2] Myxedematous coma comprises of hypothermia, bradycardia, severe hypotension and epileptic seizure. It can occur following the administration of central nervous depressants and surgical procedures. Its unavoidable episode must be accompanied by the discontinuation of dental treatment, and emergency medical services should be provided. [3] Moreover, any invasive dental treatment should be postponed for more than 6 months to 1 year if the patients reveal the symptoms of uncontrolled cardiac disease like tachycardia, irregular pulse, sweating, hypertension and tremor. Patients with thyroid storm crisis will have reduced levels of circulating polymorphonuclear neutrophils. Surgical dental treatment is strictly opposed in this state as it can increase vulnerability to infection after treatment. While making impressions for fixed prosthodontic treatment, epinephrine in local anesthetics of the retraction cords must be used very cautiously as the myocardium of these patients is susceptible to adrenaline and may trigger arrhythmias, palpitations and chest pain. [4] Patients who have hyperthyroidism usually have increased levels of anxiety. That is why stressful dental procedures can elicit a thyrotoxic crisis. The use of epinephrine should be avoided and dental surgery should be delayed for patients who exhibit signs or symptoms of thyrotoxicosis. [5] Dental treatments should be delayed if signs or symptoms of a thyrotoxic crisis develop, and emergency medical services should be on hand. If the dental procedure is unavoidable in the early stages of thyroid disease, critical assessment with the physician and endocrinologist is required with emergency medical services on hand.

 
  References Top

1.Malmed SF. Thyroid gland dysfunction in medical emergencies in the dental office. 5 th ed. St. Louis: Mosby; 2000. p. 275-86.  Back to cited text no. 1
    
2.Landenson P, Kim M. Thyroid. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23 rd ed. Philadephia, PA: Saunders Elsevier;2007.  Back to cited text no. 2
    
3.Little JW. Thyroid disorders. Part II: Hypothyroidism and thyroiditis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:148-53.  Back to cited text no. 3
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4.Yagiela JA. Adverse drug interactions in dental practice: Interactions associated with vasoconstrictors: Part V of a series. J Am Dent Assoc 1999;130:701-9.  Back to cited text no. 4
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5.Woeber KA. Thyrotoxicosis and the heart. N Engl J Med 1992;327:94-8.  Back to cited text no. 5
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