Endocrine DisordersIntegrated glands and cells secrete hormones. Dysfunction may result from:
Overproduction (hyperfunction)
Underproduction (hypofunction)
Definition: Excess hormone production by the pituitary gland.Cause: Often due to a benign tumor (pituitary adenoma).Growth Hormone Effects:
During Development: Hypersecretion during growth can lead to gigantism, resulting in individuals exceeding 8 feet tall.
In Adults: Leads to acromegaly, characterized by excess growth hormone production after the closure of growth plates.
Clinical Features of Hyperpituitarism:
Excessive skeletal growth
Headaches stemming from increased intracranial pressure
Chronic fatigue impacting daily activities
Muscle pain due to abnormal hormone levels
Poor vision caused by optic nerve compression
Facial Changes: Enlarged maxilla and mandible may cause malocclusion, deepened voice, and macroglossia (enlarged tongue).
Treatment: Measurement of growth hormone; often treated by surgery to remove the tumor from the pituitary gland or medication to control hormone levels.
Definition: Excess production of thyroid hormone, more common in women than in men.Causes: Hyperplasia, tumors, pituitary disease, and metastatic tumors from other primary sources.Most Common Cause: Graves' Disease, an autoimmune disorder leading to overstimulation of the thyroid gland.
Clinical Features:
Symptoms include goiter (enlarged thyroid), rosy complexion, excessive sweating, fine hair, and exophthalmos (protruding eyes).
Oral Manifestations in Children: Can cause premature loss of baby teeth and early eruption of permanent teeth; may lead to osteoporosis in adults due to excessively high metabolic activity.
Treatment: Medications to suppress thyroid activity, radioactive iodine therapy, and sometimes surgery to remove part of the thyroid gland.
Definition: Decreased thyroid hormone output resulting in slowed metabolic processes.Types:
Cretinism: Infants with untreated congenital deficiency leading to stunted growth and developmental issues.
Myxedema: Swelling of skin and soft tissues in older children/adults, associated with severe deficiency.Causes: Autoimmune diseases (like Hashimoto's thyroiditis), iodine deficiency, certain medications, and pituitary disease affecting hormone production.
Oral Changes:
In infants: Thickened lips, enlarged tongue, and delayed eruption of teeth can hinder nutritional intake.
In adults: Enlarged tongue, dry oral mucosa, and other oral symptoms possible such as periodontitis.
Definition: Excess secretion of parathormone affecting calcium and phosphorus metabolism, leading to elevated calcium levels in blood.Causes: Hyperplasia, tumors (adenomas), or due to kidney failure; more prevalent in middle-aged women.
Clinical Features: Symptoms range from mild cases being asymptomatic to severe lethargy, fatigue, kidney stones, and even coma in critical cases.
Oral Manifestations Include: Changes in the bone density, radiographically presenting as radiolucencies (dark areas) in the jawbones; can lead to pathologic fractures.
Definition: Chronic disorder affecting carbohydrate (glucose) metabolism, leading to hyperglycemia due to inadequate insulin production or utilization.
Types of Diabetes:
Type 1: Insulin-dependent, with onset at any age but predominantly in younger populations, characterized by polyuria, polydipsia, and polyphagia.
Type 2: Non-insulin dependent, developing progressively, commonly associated with obesity, sedentary lifestyle, and increased insulin resistance.
Oral Complications: Fungal infections (like Candida), xerostomia (dry mouth), increased incidence of dental caries, periodontal disease, and delayed healing of tissues after injury or surgery.
Definition: Primary adrenal cortical insufficiency characterized by insufficient production of adrenal steroids.Oral manifestations: Brown pigmentation of the skin and oral mucosa occurs due to increased melanocyte-stimulating hormone levels; this may also affect the gums.Treatment: Steroid replacement therapy to manage symptoms and prevent adrenal crises.
AnemiaDefinition: Decrease in the number of red blood cells or hemoglobin, leading to reduced oxygen delivery. Common forms include iron deficiency anemia and pernicious anemia (vitamin B12 deficiency).Oral manifestations: Pallor of the mucosa, atrophy of tongue papillae leading to a smooth or smooth red tongue, and angular cheilitis.
Sickle Cell AnemiaDefinition: Inherited disorder characterized by abnormal hemoglobin that leads to sickle-shaped red blood cells, obstructing blood flow, and causing pain episodes.Clinical Features: Common symptoms include fatigue, joint pain, weakness, and episodes of pain crises. Oral manifestations feature loss of trabeculation on radiographic imaging of the jawbones.
Celiac SprueDefinition: A chronic disorder leading to sensitivity to gluten, which damages the intestinal lining and affects nutrient absorption.Oral Manifestations: Can cause a painful tongue, mucosal ulceration, and delayed eruption of teeth.Treatment: Strict adherence to a gluten-free diet to manage symptoms and promote healing.
HemophiliaTypes:
Type A: Caused by Factor VIII deficiency.
Type B: Caused by Factor IX deficiency.Oral manifestations: Significant risk of spontaneous gingival bleeding, especially after surgical procedures or injuries.
Divided into primary (due to genetic defects) and secondary (acquired from other illnesses or conditions such as HIV/AIDS).
Understanding systemic diseases and their oral manifestations is crucial for diagnosis and management in dental practice. Suitable treatment plans must be integrated based on the systemic condition of the patient.