Dental Management of Patients with Thyroid Disorders

Introduction:
- Patients who have thyroid disease present a treatment challenge to dentists.
- Awareness of the condition and current stage of treatment is important in understanding the possible modifications needed for dental treatment.
- Length and current state of therapy are important in understanding the metabolic control of patients.
- The main complications of both patients with hyperthyroidism and hypothyroidism are associated with cardiac co-morbidity.
- Other co-morbid conditions are D.M and asthma.
- Consultation with the patient’s primary care physician or an endocrinologist is warranted if any sign or symptom of thyroid disease is noted on examination.
- Dental treatment modifications may be necessary for dental patients who are under medical management and follow-up for a thyroid condition even if there are no co-morbid conditions.
- Stress reduction, awareness of drug side effects or interactions, and vigilance for appearance of signs or symptoms of hormone toxicity are among the responsibilities of the oral health care provider.

Before Treatment:
ASSESSMENT OF THYROID FUNCTION- Establish type of thyroid condition.
- Is there a presence of cardiovascular disease? If yes, assess cardiovascular status.
- Are there symptoms of thyroid disease? If yes, defer elective treatment and consult a physician.
- Obtain baseline thyroid-stimulating hormone, or TSH. Control is indicated by hormone levels, length of therapy and medical monitoring. If the patient has received no medical supervision for more than one year, consult a physician.
- Obtain baseline complete blood count. Give attention to drug-induced leukopenia and anemia.
- Assess medication and interactions with thyroxine and TSH.
- Make proper treatment modifications if the patient is receiving anti-coagulation therapy.
- Take blood pressure and heart rate. If blood pressure is elevated in three different readings or there are signs of tachycardia/bradycardia, defer elective treatment and consult a physician.

During Treatment:
- Oral examination should include salivary glands. Give attention to oral manifestations.- Monitor vital signs during procedure:
■ Is the patient euthyroid? If yes, there is no contraindication to local anesthetic with epinephrine.
■ Use caution with epinephrine if the patient taking non-selective β-blockers.
■ If the patient’s hyperthyroidism is not controlled, avoid epinephrine; only emergent procedures should be performed.
- Minimize stress–appointments should be brief.
- Discontinue treatment if there are symptoms of thyroid disease.
- Make pertinent modifications if end-organ disease is present (diabetes, cardiovascular disease, asthma).

After Treatment:
- Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates.- Control pain.
- Use precaution with non-steroidal anti-inflammatory drugs for patients who have hyperthyroidism, avoid aspirin.
- Continue hormone replacement therapy or anti-thyroid drugs as prescribed.

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