5. History taking
Chief complaint :
Present illness :
1
Past medical history
- Hyperthyroid treatment
partial thyroidectomy
completed thyroidectomy
-
Current medicine : Thyroxine 50 mg
6. Extraoral examination
• General appraisal : normal
• Skull : normal
• Facial form and profile : normal
• Skin : normal
• Eyes : normal
• Neurologic deficit : normal
• Lymph nodes of head and neck :
normal
• TMJ : normal
• Masticatory muscle: normal
7. Extraoral examination
(Cont.)
• Lymph nodes of head and neck :
normal
• TMJ : normal
• Masticatory muscle: normal
• Opening pattern : straight
• Salivary glands : normal
• Muscles of head and neck : normal
9. Intraoral
examination
• Lip
Vermillion border : normal
Lip commissure : normal
Inner surface of lip : normal
• Buccal mucosa : linear alba
• Salivary flow rate : normal
• Oropharynx : normal
• Soft palate : normal
10. Intraoral examination
(Cont.)
• Hard palate : torus palatinus size
10x10x3 mm3
• Tongue : Hyperpigmentation
• Floor of mouth : normal
• Gingiva : Physiologic
hyperpigmentation
at the anterior area of upper arch
from tooth 32 and 33
24. Role of Dentist
• Suspect a serious thyroid disorder ,
aid in early diagnosis
• Avoid possible dental complications
resulting from treating patients with
thyroid disorder
30. Drug interactions of L-
thyroxine
• increases the effects of warfarin
sodium :
coagulation tests in the patient that
taking an oral anticoagulant
• Tricyclic antidepressants :
elevates L-thyroxine levels
31. Dental anti-thyroid drugs
PTU has
managemen Hemostasis
anti-vitamin K
Stres
t s and Infect
anxie ion
Reduction ty anti-thyroid
protocol drugs
Hyperthyroidism
Thioamind
Drug )
interfere Fliori interac
ASA
thyroid de tions interfere
gland s protein
function
Thyrotoxic
binding
crisis
epinephrin
of T4
e is
and T3
32. Symptoms of
Thyroid crisis
Extreme restlessness, nausea,
vomiting, abdominal pain, fever,
profuse sweating, tachycardia, cardiac
arrhythmias,
pulmonary edema, congestive heart
failure
Stupor,
coma
Severe
hypotension
and death
34. Cardiovascular signs and
symptoms of hyperthyroidism
Conge Palpa Exercis
stive tion e
heart intoler
failure ance
Exertio
Periph
nal
eral
dyspne
edema CVD a
Cardiac Systolic
hypertr hyperte
ophy Angi nsion
Atrial
na
fibrillati
chest
on
pain
35. Dental management of cardiac
arrhythmia in thyroid patient
•
• epinepihrine
•
•
• AF
36. Dental management of cardiac
arrhythmia in thyroid patient (Cont.)
• AF
anticoagulant
drug prothrombin time(PT)
international normalized ratio(INR)
INR ≤ 3.5
•
-
-
-
•
(sedation)
• epinephrine 1:100,000
37. Before treatment
dental treatment
• presence of cardiovascular disease, assess
cardiovascular status.
• symptoms of thyroid disease, defer
elective treatment and consult a physician.
• Give attention to drug-induced leukopenia
and anemia.
• Make proper treatment modifications if the
patient is receiving anticoagulation
therapy.
38. During dental
treatment
• Monitor vital sign during procedure
– Euthyroid no contraindication to local
anesthesia with epinephrine
– Use caution with epinephrine if patient
take nonselective beta blocker
– Hyperthyrodism not controlled should
avoid epinephrine
• Minimize stress
• Discontinue treatment if there are
39. After dental
treatment
• hypothyroidism sensitive to central
nervous system depressants and
barbiturates.
• Control pain
• precaution NSAID for hyperthyroidism,
avoid aspirin.
• Continue hormone replacement therapy or
antithyroid drugs as prescribed
40. Dental management of
thyrotoxic crisis
• Large doses of antithyroid drugs 200 mg
of propylthiouracil
• Potassium iodide
• Propranolol
• Hydrocortisone 100-300 mg
• Dexamethasone
• Intravenous IV glucose solution
