Oral manifestations of endocrine problems

1. ORAL MANIFESTATIONS OF
ENDOCRINE PROBLEMS
ARSALAN WAHID MALIK

2. ENDOCRINE PROBLEMS
• NORMAL ENDOCRINE CHANGES
• PREGNANCY
• MENOPAUSE
• ADRENOCORTICAL CHANGES
• ADDISON’S DISEASE
• CUSHING SYNDROME
• PHEOCHROMOCYTOMA AND
ADRENAL MADULA
• THYROID CHANGES
• HYPERTHYROIDISM
• HYPOTHYROIDISM
• DIABETES MELLITUS

3. PREGNANCY
• EXACERBATION OF UNRECOGNIZED GINGIVITIS
• HYPERPLASTIC, PURPLE GINGIVAL CAPILLARIES
• HALITOSIS BECAUSE OF FALSE POCKETING AND STAGNATION
• PREGNANCY EPULIS
• TREATMENT
• MAINTENANCE OF ORAL HYGIENE

4. MENOPAUSE
• NO MARKED CHANGES IN ORAL MUCOSA
• SECONDARY CHANGES MAY BE PRESENT

5. ADDISON’S DISEASE
• LACK OF FUNCTION OF ADRENAL CORTEX USUALLY THE RESULT OF
AUTOIMMUNE DISORDER
• DISTURBANCES IN FEEDBACK MECHANISM BETWEEN ADRENALS AND PITUITARY
• MELANOTIC PIGMENTATION OF ORAL MUCOSA
• ORAL CANDIDIASIS SECONDARY TO ADDISON’S DISEASE

6. CUSING’S SYNDROME
• HYPER FUNCTION OF ADRENAL CORTEX
• ACTH-SECRETORY PITUITARY ADENOMA
• PROLONGED CORTICOSTEROID THERAPY MAY HAVE THE SAME EFFECTS

7. PHEOCHROMOCYTOMA AND ADRENAL MEDULLA
• TUMOR OF ADRENAL MEDULLA WHICH SECRETS CATECHOLAMINE
• CAN BE ASSOCIATED WITH NEUROFIBROMATOSIS
• MULTIPLE ENDOCRINE ADENOMA SYNDROME

8. INVESTIGATIONS IN MELANOTIC PIGMENTATION
• IMPAIRED ADRENAL RESPONSE TO SYNTHETIC ANALOGUE OF ACTH
• MEASUREMENT OF SERUM ELECTROLYTES (NA ↓, K ↑)
• MEASUREMENT OF PLASMA CORTISOL ↓ AND ACTH ↑
• BLOOD PRESSURE MEASUREMENT

9. HYPERTHYROIDISM
• NOT PRIMARILY ASSOCIATED WITH ORAL MUCOSAL CHANGES BUT EFFECTS
PATIENT MANAGEMENT
• PATIENT WITH EXOPHTHALMOS MY REPORT WITH WEIGHT LOSS AND
TACHYCARDIA
• TREATMENT
• DRUGS (CARBIMAZOLE)
• RADIOACTIVE IODINE
• PARTIAL THYROIDECTOMY

10. HYPORTHYROIDISM
• USUALLY AUTOIMMUNE BUT MAY BE DUE TO EXCESSIVE REMOVAL OF THYROID
GLAND
• ACQUIRED HYPOTHYROIDISM MANIFEST AS WEIGHT GAIN, INABILITY TO
TOLERATE, DRY SKIN, LOSS OF HAIR AND SLOWING DOWN OF MENTAL
PROCESS
• ORAL CANDIDIASIS
• ENLARGEMENT OF TONGUE
• DELAYED ERUPTION OF TEETH

11. DIABETES MELLITUS
• COMMON ENDOCRINE DISORDER AS A RESULT OF DEFICIENCY OF INSULIN OR
RESISTANCE TO INSULIN
• SYMPTOMS ARE POSSIBLY BECAUSE OF GENERAL LACK OF RESISTANCE TO THE
INFECTIONS
• INCREASED SUSCEPTIBILITY TO INFECTIONS

12. DIABETES MELLITUS
• DRY MOUTH
• COMPROMISED PERIODONTAL HEALTH
• ORAL CANDIDIASIS
• BMS
• LICHENOID DRUG REACTIONS

13. RENAL DISEASES

14. CHRONIC RENAL FAILURE (CRF)
• IRREVERSIBLE DETERIORATION IN RENAL FUNCTION
• WHEN PLASMA CREATININE EXCEEDS 300 UMOL/L THEN THERE IS PROGRESSIVE
DETERIORATION IN RENAL FUNCTION
• AT 100 UMOL/L HEMODIALYSIS IS REQUIRED TO MAINTAIN PROPER
FUNCTIONING

15. ORAL MANIFESTATIONS
• DRY MOUTH
• MUCOSAL ULCERATION
• BACTERIAL AND FUNGAL PLAQUES
• PALLOR OF THE MUCOSA
• ORAL PURPURA
• WHITE PLAQUES
• GIANT CELL LESIONS

16. DENTAL MANAGEMENT OF HEMODIALYSIS
PATIENTS
• IMPAIRED REACTION TO DRUGS BY KIDNEY
• BLEEDING TENDENCY
• HEPARINIZATION PRIOR TO DIALYSIS
• AV SHUNTS SUSCEPTIBLE TO INFECTIONS
• ANEMIA
• INCREASED CARRIAGE OF HEPATITIS B & C
• HYPERTENSION

17. RENAL TRANSPLANT PATIENTS
• MAIN PROBLEM IS SIDE EFFECT OF IMMUNOSUPPRESSIVE THERAPY
TO AVOID TRANSPLANT REJECTION
• CICLOSPORIN IS NEPHROTOXIC DRUG AND GINGIVAL
OVERGROWTH IS WELL KNOWN ABNORMALITY

18. ORAL COMPLICATIONS OF TRANSPLANT PATIENTS
• DRUG INDUCED GINGIVAL HYPERPLASIA
• BACTERIAL AND FUNGAL PLAQUES
• INCREASED INCIDENCE OF ORAL MALIGNANCY
• ORAL CANDIDIASIS
• HERPES SIMPLEX INFECTION