Oral Diagnosis I Third Year

1. Diabetes
Adrenal Insufficiency
Thyroid Diseases
November 11, 2007
Oral Diagnosis I

2. Diabetes
”Overview”
Diabetes mellitus is of great importance to dentists
 Detect new case of diabetes
 Render dental care to diabetic patients without
endangering their well being
 Recognize the level of severity and glycemic
control and the presence of complications from
diabetes to consequently manage the patient
accordingly.

3. Current Classification of Diabetes
 Type l: Beta-cell destruction or defect in beta-cell
function which lead to absolute insulin deficiency.
 Immune mediated: Presence of insulin or islet
cells antibodies.
 Idiopathic: No evidence of antibodies.
 Type 2: Insulin resistance with relative insulin
deficiency.

4. Current Classification of Diabetes
(Cont.)
 Other specific type: Genetic defects of beta-cell
function or insulin action, pancreatic diseases,
endocrinopathies, malnutrition, or drug or
chemical-induced diabetes.
 Impaired fasting glucose.
 Gestational diabetes: Any degree of abnormal
glucose tolerance during pregnancy.

5. Diabetes
Incidence & Prevalence
A dental practice serving an adult
population of 2000 can expect to
encounter about 120 persons with
diabetes.
50% of these patients are unaware of
their condition.

6. Diabetes
Etiology
 The genetic role in type 2 diabetes is much
greater than type 1.
 Obesity plays an important part in the cause of
type 2.
 Type 1 has a sudden onset mainly found under
age 40.
 Type 2 generally occurs after age 40 in obese
individuals.

7. Diabetes
Signs & Symptoms
*Polydypsia *Marked irritability
*Polyuria *Recurrence of bed wetting
*Polyphagia *Drowsiness
*Loss of weight *Malaise
*Loss of strength
Type 1: the onset of symptoms is sudden
Type 2: The onset of symptoms is slow & the cardinal
signs are less commonly seen.

8. Diagnosis of Diabetes Mellitus
1. Unequivocal elevation of plasma glucose conc. >
140 mg/dl at least two separate occasions after
overnight fasting.
2. Glucose tolerance test: Considered positive if
plasma glucose conc. is 200mg/dl or higher, 2 hrs
after giving 75g glucose orally. Pts should be
tested in the morning after 3 days of unrestricted
CHO diet and normal physical activity.

9. Diagnosis of Diabetes Mellitus
contd…
3. Urine sugar.
4. Test paper strips: strips available for direct
estimation of blood glucose levels. Bld obt. by
finger prick is applied directly to strip, which is
washed 1 mnt later. The subsequent colour change
is compared to a standard chart to determine
plasma glucose conc.

10. Diagnosis of Diabetes Mellitus
contd…
5. Hemoglobin A1c (Hb A1c). Hb in RBCs gradually
becomes glycated to form Hb A1c. Greater the
severity of hyperglycemia, higher the conc. of A1c in
Hb.

11. Diabetes
Medical Management
 Type 1
 Diet & physical activity
 Insulin (Conventional Multiple injections,
Continuous infusion, Pancreatic transplantation).
 Type 2
 Diet & physical activities
 Oral hypoglycemic agents
 Insulin plus hypoglycemic agents
 Insulin

12. Diabetes
Dental Management
 Any dental patient who has the cardinal
symptoms of diabetes should be referred to a
physician for diagnosis & treatment.
 Pts with findings that may suggest diabetes:
 Headache, dry mouth, marked irritability,
repeated skin infection, blurred vision,
paraesthesia, periodontal abscesses, loss of
sensation.

13. Diabetes
Oral Complications & Manifestations
Poorly controlled diabetes:
 Xerostomia
 Bacterial, viral & fungal infection
(Candidiasis)
 Poor wound healing
 Increase incidence of caries, gingivitis, &
periodontal disease, periapical abscesses &
burning mouth syndrome

14. Adrenal Insufficiency
Definition
 Disorders affecting the adrenal glands result in
excess or insufficient production of adrenal
products.

15. Secretory Products of the Adrenal
Glands
 Adrenal Cortex: Adrenal Medulla
 Glucocorticoids *Epinephrine
 Cortisol *Norepinephrine
 Corticosterone *Dopamine
 Mineralocorticoids
 Aldosterone
 Deoxycorticosterone
 Sex hormones
 Dehydroepiandrosterone
 Androstenedione

16. Adrenal Insufficiency
Incidence & Prevalence
 A dental practice serving 2000 adults can
expect to encounter 50 patients who use
steroids or have potential adrenal
abnormalities (Chronically use corticosteroids
and thus are at risk for secondary
adrenocortical insufficiency).

17. Adrenal Insufficiency
Signs & Symptoms
Hypoadrenalism
 Primary adrenal insufficiency: (Addison’s
disease): Weakness, fatigue, abnormal
pigmentation of the skin & mucous membrane.
In addition, hypotension & weight less.
 Secondary adrenal insufficiency: (chronic
corticosteroid administration). Usually does not
produce symptoms unless the patient is
significantly stressed.

18. Addison’s Disease

19. Adrenal Insufficiency
Signs & Symptoms
Hyperadrenalism:
 Pts. Who have been receiving long term high-
dose corticosteroid therapy can develop signs &
symptoms of Cushing’s syndrome:
 Weight gain, round or moon shaped facies, a
buffalo hump on the back, abdominal striae
and acne.
 Other symptoms can include hypotension,
heart failure, osteoporosis and bone
fractures, diabetes mellitus, impaired
healing, mental depression & psychosis.

20. Adrenal Insufficiency
Medical Management
Management of the adrenal disease
 Elimination of infection
 Malignant disease
Hormonal replacement
Correcting ACTH
Balancing the beneficial effects of steroids
with unwanted side effects.

21. Adrenal Insufficiency
Dental Management
Dental treatment of a patient with
undiagnosed adrenal insufficiency should
be delayed until the patient is medically
stabilized
No treatment modifications are required for
medically stable adrenal disorders

22. Thyroid Disease
A patient of thyroid disease is of concern to the
dentist
 The dentist may detect early signs and
symptoms (disease or tumor).
 Pt. with untreated thyrotoxicosis may be in
danger if the dentist performs surgical or
operative procedures.

23. Thyroid Disease
Incidence & Prevalence
The most common thyroid disorder is
iodine deficiency (diet related) goiter.
In US the prevalence of goiter ranges from
0.5 to 7%.

24. Thyroid Disease
Signs & Symptoms
Hyperthyroidism
 Nervousness
 Fatigue
 A rapid heart beat & palpitations
 Heat intolerance
 Weight loss
 Soft & friable hair and soften nails
 Graves’ ophthalmopathy (edema &
inflammation).

25. Thyroid Disease
Oral Manifestations
 Hyperthyroidism
 Osteoporosis that may involve the alveolar
bone
 dental caries
 Periodontal disease
 Teeth that may develop rapidly
 Premature loss of deciduous teeth.

26. Thyroid Disease
Signs & Symptoms
Hypothyroidism
 Dwarfism
 Overweight
 Thick lips
 Large protruded tongue
 Delayed eruption teeth
 Malocclusion
 Mental retardation, etc.

27. Thyroid Disease
Medical Management
Hyperthyroidism
 It may involve anti-thyroid agents to block
hormone synthesis.
Hypothyroidism
 Administration of synthetic preparation
containing LT4 or LT3.

28. Thyroid Disease
Dental Management
If the patient is under good medical
management, the dental treatment plan is
unaffected.