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Oral Manifestations (Endocrine - hormone problems (Hyperparathyroidism…
Oral Manifestations
Endocrine - hormone problems
Hypothyroidism
decreased output of thyroid hormone
causes: developmental disturbances, autoimmune disease, iodine deficiency, drugs, pituitary disease
cretinism: when it occurs in infancy and childhood
myxedema: when it occurs in older children and adults
Oral manifestations: in infants - thickened lips, enlarged tongue, delayed eruption of teeth. in adults - enlarged tongue
Hyperthyroidism
excess production of thyroid hormone
greater in women
most common cause is Graves disease - autoimmune disorder which a substance is produced abnormally stimulates the thyroid gland
other causes: hyperplasia of gland, benign and malignant tumors of thyroid, pituitary gland disease, metastatic tumors
Rosy complexion, erythema of palms, sweating, fine hair, softened nails
patient may have exophthalmos
anxiety, weakness, restlessness, cardiac problems
premature exfoliation of deciduous teeth in children and premature eruption of perm. teeth
osteoporosis may affect alveolar bone, caries and periodontal disease may appear more rapidly, burning tongue
Tx: surgery, medications to suppress thyroid activity, administration of radioactive iodine
Hypothyroidism
Hyperpituitarism
Excess hormone production by the anterior pituitary gland
Caused by a benign tumor (pituitary adenoma) produces growth hormone
giantism results if it occurs before the closure of long bones
acromegaly results when hypersecretion occurs during adult life
Men and women; 4th decade - poor vision, light sensitivity, enlarged hands and feet, increase rib size
enlargement of max and mand. may cause separation of teeth and malocclusion. Frontal bossing and enlargement of nasal bones lead to deepening voice
thickened lips and macroglossia
Tx: pituitary gland surgery
Dx: measurement of growth hormone
Diabetes Mellitus
chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels
lack of insulin, defective insulin that does not work to lower blood sugar levels, increased insulin resistance due to obesity
glucose normally signals beta cells of pancreas to make insulin, the hormone is then secreted into bloodstream to facilitate the uptake of glucose into fat and skeletal muscle. In the presence of insulin, fat and skeletal muscle cells can use glucose as an energy source.
Without insulin, tissue is broken down to provide energy and weight loss occurs. Severe hyperglycemia can lead to diabetic coma. Ketone can be produced by the breakdown of fatty acids. Phagocytic activity of macrophages is reduced and neutrophil chemotaxis is delayed. Collagen production is abnormal
Insulin- dependent diabetes mellitus type 1
autoimmune diesase - insulin producing cells of the pancreases are destroyed (3-5% have this type)
Occur at any age, peak at 20yo
Acute onset with excessive thirst and fluid intake, excessive urination and excessive appetite
require insulin their entire life
Non-insulin dependent diabetes mellitus type 2
insulin resistance - 95% have this type, usually 35-40yo or older
many are obese individuals
diet and weight control may help
nervous system can be affected or decrease in resistance to infection if they have atherosclerosis (thickening of blood vessel wall from fatty plaques)
increased oral candidiasis prevalence, mucormycosis
bilateral asymptomatic parotid gland enlargement
xerostomia, accentuated response to plaque, slow wound healing and increased susceptibility to infection
Addison Disease
primary adrenal comical insufficiency - destruction of adrenal gland is unknown may be autoimmune, may be due to a tumor or TB, the pituitary gland increases production of ACTH.
hormone causes stimulation of melanocytes, bronzing of skin, melanotic macule on oral mucosa
Tx: steroid replacement therapy
Hyperparathyroidism
due to excessive secretion of parathyroid hormone from the parathyroid glands - four parathyroid glands are located near the thyroid gland
parathyroid hormone plays role in calcium and phosphorous metabolism
elevated blood levels in calcium and low levels of blood phosphorous
result of hyperplasia of parathyroid glands, benign tumor or parathyroid glands, or malignant parathyroid tumor
found in middle aged adults
more common in women
parathyroid hormone increases the uptake of dietary calcium from the gastrointestinal tract and is able to move calcium from bone to circulating blood when necessary
mild cases may be asymptomatic or have joint pain and stiffness
lethargy and coma may occur with severe disease
well defined unilocular or multilocular radiolucencies, microscopically appear as central giant cell granulomas, bone may have mottled appearance.
Dx: measurement of parathyroid hormone blood levels, serum calcium and phosphorous measurements
Tx: correcting the cause of increased hormone production, cause may include tumors, renal disease, and vitamin D deficiency
Blood
RBC and Hemoglobin
anemia
reduction in oxygen carrying capacity of blood, related to decrease in # of circulating RBC, suppression of bone marrow stem cells
pallor of skin and oral mucosa, angular cheilitis, erythema and atrophy of oral mucosa, loss of filiform and fungiform papillae on dorsal of tongue
iron deficiency anemia
insufficient amount of iron is supplied to bone marrow for RBC development
plummer-vinson syndrome may result from long standing deficiency - predisposition to oral cancer
asymptomatic , non specific symptoms such as weakness and fatigue, in severe cases - angular cheilitis, pallor of oral tissue, erythematous, smooth, painful tongue
Dx: lab tests show low hemoglobin context and reduced hematocrit
Tx: dietary supplements
pernicious anemia
autoimmune, caused by removal of stomach , gastric cancer, gastritis
caused by: deficiency in intrinsic factor - secreted by parietal cels in the stomach, it is necessary for absorption of V B12
weakness, allow, fatigue on exertion, nausea, dizziness, diarrhea, abdominal pain, loss of appetite, weight loss, angular cheilitis, mucosal pallor, painful mucosa, mucosal ulceration, loss of papillae on dorsal of tongue, burning tongue
lab tests reveal low serum b12 levels and gastric achlorhydria (lack of hydrochloric acid)
Tx: b12 injections
Dx: schilling test detects inability to absorb oral vitamin b12
folic acid and vitamin B12 deficiency anemia
thalassemia
sickle cell anemia
celiac sprue
aplastic anemia
polycythemia
WBC
Bleeding Disorder
blood count examines RBC, WBC, and platelets. provides info about # of each type of cell, ratio of types, and appearance of the cells
Cancer Treatment
surgery, radiation, chemotherapy, or combo
Radiation
mucositis - 2nd week of therapy and subsides few weeks after completion, painful and appears as erythematous and ulcerated mucosa. patients have difficulty eating, pain on swallowing, and loss of taste.
xerostomia
chemo
drugs used affect basal cells of epithelium, decrease in blood cells. lower RBC lead to anemia. lower WBC lead to infection. lower platelets lead to bleeding problems