Adult cretinism /dental courses
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Adult cretinism /dental courses
- 1. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing Dental Education
- 2. Height-100 cm Weight-17.5 kg Arm span-97 cm Pulse -76 beats/min www.indiandentalacademy.com
- 3. Lethargic Voice not mature Fish scale appearance - skin Hypertelorism Sparse hair www.indiandentalacademy.com
- 4. www.indiandentalacademy.com Indian Dental academy • www.indiandentalacademy.com • Leader continuing dental education • Offer both online and offline dental courses
- 5. Cold extremities Deep tendon reflexes difficult to elicit Protuberant abdomen Secondary sexual characters not developed www.indiandentalacademy.com
- 6. Gingival hyperplasia Over-retained deciduous teeth Tongue size is proportional to jaw size Carious involvement of teeth www.indiandentalacademy.com
- 7. Differential diagnosis • Hypothyroidism • Hypopituitarism www.indiandentalacademy.com
- 8. Investigations Blood investigations: • T3 - <0.01 ng/L (0.52 – 1.85 ng/ml) • T4 - <0.04mcg % (f= 4.8 – 11.6 mcg%, m= 4.4 – 10.8mcg%) • TSH - >40.0IU/ml (0.53 – 5.6IU/ml, by ELISA) • Serum Na+ -138.0 mmol/L (136-145 mmol/L) • Serum K + - 4.1 mmol/L (3.5 – 5.1 mmol/L) • Serum Cl+ - 106 mmol/L (97- 111mmol/L) • Blood glucose – 65 mg% (70-140 mg%) www.indiandentalacademy.com
- 11. Lateral skull Lateral cervical spine www.indiandentalacademy.com
- 14. Treatment • Parent counseling was done. Parents were made aware of the deficiency disorder. • Extraction of the over-retained teeth was done. • Patient was put on thyroid hormone supplement, Thyronorm od dose. Initially 25 gm was used which was increased up to 50 gm per day. www.indiandentalacademy.com
- 15. Follow up • Significant improvement was observed, – appetite increased, – Bowel movements improved, – phonation and physical activity improved, – Mental alertness increased. www.indiandentalacademy.com
- 16. Discussion • Cretinism is a condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormone (hypothyroidism). • 1 in 4000 newborn infants • Twice as common in girls as in boys Harrison’s Principles of Internal Medicine - 17th edition www.indiandentalacademy.com
- 17. Etiology Cretinism: Sporadic Endemic Areas with deficiency of iodine M. I. PAPILSKY, S.A. MEDICAL JOURNAL 1957, 9 June 1956,547-549 Partial or complete agenesis of the thyroid gland. Deficiency of anterior pituitary thyrotrophic hormone. www.indiandentalacademy.com
- 18. • Sporadic cretinism is not hereditary. • Endemic cretinism can affect one or more members in the family. • Hypothyroidism does not become apparent in the first few months of life. M. I. PAPILSKY, S.A. MEDICAL JOURNAL 1957, 9 June 1956,547-549 www.indiandentalacademy.com
- 19. • The untreated cases of congenital hypothyroidism may persist and evolve into adolescent or adult cretin. • Relief or decrease in the symptoms can be achieved by adequate thyroid replacement therapy. Seth A Borg, Roentological aspects of adult cretinism, review of literature, April 1975 www.indiandentalacademy.com
- 21. • Salivary gland enlargement • Macroglossia • Glossitis • Delayed dental eruption • Compromised periodontal health • Dysgeusia • Delayed wound healing ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July 2002,849-858) Oral manifestations: www.indiandentalacademy.com
- 22. Diagnose the type of thyroid condition. Assess cardiovascular status. Obtain baseline TSH. Control is indicated by hormone levels, length of therapy and medical monitoring. Assess drug interactions with thyroxine. Before Treatment www.indiandentalacademy.com
- 23. Focus on lethargy Monitor vital signs Avoid sedation If the patient is on treatment for thyroid disease and has achieved euthyroid state, there is no contraindication to treatment. During Treatment www.indiandentalacademy.com
- 24. After Treatment Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates. Postoperative pain control with narcotic drugs should be limited . Continue hormone replacement therapy as prescribed. ANDRES PINTO, D.M.D.; MICHAEL GLICK, D.M.D. (JADA, Vol. 133, July 2002,849-858) www.indiandentalacademy.com
- 25. Conclusion • It is important to diagnose congenital hypothyroidism in early infancy . • It is also important even in later years to diagnose the adult sporadic cretin or the adult hypothyroid endemic cretin. • Awareness of the condition and current stage of treatment is important in understanding the possible modifications needed for dental treatment. www.indiandentalacademy.com
- 26. Acknowledgement • I take this opportunity to express my great sense of gratitude to Dr. Venkatesh G. Naikmasur (HOD)for his constant motivation and encouragement… • Its my pleasure to acknowledge Dr. S.K. Joshi (MD, Radio- diagnosis) and Dr. Shyam Amur (MD, Gen Medicine) for their whole hearted admiration and inspiration… • Special thanks to Dr. Krishna, Dr. Atul Sattur, Dr. Sunil and Dr. Krutika for their support throughout… • My heartfelt regards to my parents for their blessings , to our senior PGs and friends for their patience and cooperation throughout… • Last but not the least, my special thanks to the conference committee for giving this wonderful opportunity. www.indiandentalacademy.com
- 30. Skeletal disorders: • Achondroplasia • Spondyloepiphyseal dysplasia www.indiandentalacademy.com
Hinweis der Redaktion
- C/O:A male dwarf patient of age 18 years Complains of multiple teeth in the lower front region of the jaw. Patient is the third child in the family with two elder sisters one young brother and a younger sister. P/H:STUDYING in fourth grade with poor performance in school. Patient had reduced appetite. Prolonged history of constipation.
- Gingival hyperplasia in the lower anterior region of the jaw Multiple teeth show carious involvement
- Since clinically patient appeared dwarf, a d/d of HTM and HPM were considered. Hormonal and metabolic disorders show proportional dwarfism while skeletal disorders show disproportionate short stature. Mongols have congenital heart diseases. X-rays to determine the bone age which is retarded in the cretin and not in the mongol. Harmonal :Laron syndrome Hall Palistor syndrome Rickets, osteomalacia, osetogenesis imperfecta Skeletal :Dysplasia epiphysealis multiplex
- To asses pitutary function, indirect tests are performed In hypopitiutary there is decrease in ACTH – CORTISOL Decrease.Thus there is hyponatrimia, hypoglycimia. The measurement of serum TSH is the best test to determine thyroid function
- Crown completion of 3rd molar is at 13 years of age.thus his dental age is 13 years.
- COXA VARA :Alteration of the angle made by the axis of the femoral neck to the axis of the femoral shaft so that the angle is less than 135°; the neck becomes more horizontal. Normally, at birth the angle of inclination of the femoral neck is 1500. This angle decreases to 120 - 1300 in the adult(Idiopathic coxa vara, this angle is decreased below the normal 1200)
- Oral prophylaxis along with restoration of decayed teeth was done.
- school children from iodine deficient areas when compared to non-iodine deficient areas, 20 % prevalence of nerve deafness and 3-5 % prevalence of cretinism
- Because the foetus inherits enough thyroid hormone to supply its needs for about 3-4 months There may also be some hormone supplied by the secretion of a rudimentary gland, Difficulty in identifying congenital hypothyroidism leads to cases being left untreated for a length of time.
- 1.The untreated cases of congenital hypothyroidism may persist till adolescence and adulthood and evolve into adolescent or adult cretin. 2.Despite of the chronic history.
- ASSESSMENT OF THYROID FUNCTION 2.Susceptible to cardiovascular disease from arteriosclerosis and elevated LDL. 4.Thyroxine increases the action of warfarin sodium.
- 1.lethargy- indicate an uncontrolled state. Risk of aspiration of dental materials. 3.Sedation might lead to myxoedema coma-manifested as hypothermia, bradycardia and severe hypotension
- so these medications should be used sparingly. Narcotics also cause depression
- Patients who have thyroid disease present a treatment challenge to dentists.