DISEASES OF THE
ENDOCRINE SYSTEM
Diabetes Mellitus
(and other)
Reading Assignment:
Chapter 9: Endocrine Diseases
1
ENDOCRINE DISEASES
Hypersecretion from Tumors or
Hyperplasias
Hyposecretion from Damage or Destruction
•
•
•
•
•
2
Pancreas - Insulinoma / Diabetes Mellitus (DM)
Thyroid - Hyper / Hypo Thyroidism
Parathyroid - Hyper / Hypo Parathyroidism
Pituitary - Gigantism / Dwarfism
Adrenal - Cushing’s Syndrome / Addison’s Disease
DIABETES MELLITUS (DM)
Definition
• Insulin Deficiency Resulting in:
– Defective Glucose Metabolism
– Other Secondary Metabolic Derangements
• Classified As:
– Type I - Insulin Dependent DM
(IDDM) ~10%
• Requires Insulin Replacement
• “Juvenile Onset”
– Type II - NON-Insulin Dependent DM (NIDDM) ~90%
3
• Treated by Diet and Oral Hypoglycemic Medication
• “Adult Onset”
DIABETES MELLITUS (DM)
• Clinical Features
– Polyuria
- Increased
Frequency and Volume
– Polydipsia
- Increased Thirst
– Polyphagia - Increased
Hunger/appetite
• Laboratory Features
– Hyperglycemia - Increased Blood
Glucose
– Glucosuria
- Sugar in Urine
– Hyperlipidemia - Increased Blood
Lipids
4
DIABETES MELLITUS (DM)
Diagnosis and Monitoring
• DIAGNOSIS
– Fasting Blood Glucose
– 2-Hour Post-Prandial Blood Glucose
– (Glucose Tolerance Test)
• MONITORING
– Fructosamine Test (Short Term = 2-3 Weeks)
– Glycosylated Hemoglobin (Long Term = 2-3 Months)
5
DIABETES MELLITUS (DM)
Complications - Short Term Metabolic
• Diabetic
Ketoacidosis/Coma
– Extremely High Blood
Sugar
– Too Little Insulin over
Long Term
• Insulin Shock
– Low Blood Glucose
– Too Much Insulin or Too
6 Little Food
DIABETES MELLITUS (DM)
Complications - Long Term Vascular
• Accelerated Atherosclerosis with
Associated:
– Coronary Heart Disease - MI’s
– Cerebrovascular Disease - Strokes
(CVA’s)
– Peripheral Vascular Disease Extremity Gangrene
• Hypertension
• Diabetic Retinopathy Blindness
• Diabetic Nephropathy - Renal
Failure
• Diabetic Neuropathy - Loss of
7
Nerve Function
DIABETES MELLITUS (DM)
Complications - Oral
Periodontal Abscess
• Delayed Wound Healing
• Accelerated Periodontal Disease
with Periodontal Abscesses
• Poor Response to Periodontal
Therapy
• Candidiasis
• Xerostomia
• Occasional Enlarged Parotid
Glands (Metabolic Sialadenosis)
Candidiasis
8
More
Common in Long Standing and/or Poorly Controlled Patients
DIABETES MELLITUS (DM)
Health History Findings
H E A L T H H IS T O R Y
U n ive rsity of th e P a cific S ch o o l of D e n tistry
P a tie n t N a m e :
S o c . S e c . N o .:
B irth D a te :
I. C IR C L E A P P R O P R IA T E A N S W E R (le a v e B la n k if yo u d o n o t u n d e rs ta n d q u e s tio n ):
1.
Yes
No
Is yo u r g e n e ra l h e a lth g o o d ?
2.
Yes
No
H a s th e re b e e n a ch a n g e in y o u r h e a lth w ith in th e la s t y e a r?
3.
Yes
No
H a v e y o u b e e n h o s p ita liz e d o r h a d a s e rio u s illn e ss in th e la s t th re e ye a rs ?
If Y E S , w h y?
4.
Yes
No
A re y o u b e in g tre a te d b y a p h y sic ia n n o w ? F o r w h a t?
D a te o f la st m e d ic a l e xa m ?
D a te o f la st D e n ta l e x a m
5.
Yes
No
H a v e y o u h a d p ro b le m s w ith p rio r d e n ta l tre a tm e n t?
6.
Yes
No
A re y o u in p a in n o w ?
II. H A V E Y O U E X P E R IE N C E D :
7.
Yes
No
C h e s t p a in (a n g in a )?
8.
Yes
No
S w o lle n a n k le s ?
9.
Yes
No
S h o rtn e s s o f b re a th ?
10.
Yes
No
R e c e n t w e ig h t lo s s, fe v e r, n ig h t s w e a ts?
11.
Yes
No
P e rs is te n t c o u g h , c o u g h in g u p b lo o d ?
12.
Yes
No
B le e d in g p ro b le m s , b ru isin g e a s ily ?
13.
Yes
No
S in u s p ro b le m s ?
14.
Yes
No
D ifficu lty s w a llo w in g ?
15.
Yes
No
D ia rrh e a , c o n s tip a tio n , b lo o d in s to o ls ?
16.
Yes
No
F re q u e n t vo m itin g , n a u se a ?
17.
Yes
No
D ifficu lty u rin a tin g , b lo o d in u rin e ?
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
D iz z in e s s ?
R in g in g in e a rs ?
H e a d a ch e s ?
F a in tin g s p e lls ?
B lu rre d v is io n ?
S e iz u re s ?
E x c e s siv e th irs t?
F re q u e n t u rin a tio n ?
D ry m o u th ?
J a u n d ice ?
J o in t p a in , s tiffn e s s ?
III. D O Y O U H A V E O R H A V E Y O U H A D :
29.
Yes
No
H e a rt d is e a s e ?
30.
Yes
No
H e a rt a tta ck , h e a rt d e fe c ts?
31.
Yes
No
H e a rt m u rm u rs ?
32.
Yes
No
R h e u m a tic fe v e r?
33.
Yes
No
S tro k e , h a rd e n in g o f a rte rie s ?
34.
Yes
No
H ig h b lo o d p re s s u re ?
35.
Yes
No
A s th m a , T B , e m p h ys e m a , o th e r lu n g d is e a s e s ?
36.
Yes
No
H e p a titis , o th e r liv e r d ise a s e ?
37.
Yes
No
S to m a c h p ro b le m s , u lc e rs ?
38.
Yes
No
A lle rg ie s to : d ru g s , fo o d s, m e d ic a tio n s , la te x?
39.
Yes
No
F a m ily h isto ry o f d ia b e te s , h e a rt p ro b le m s , tu m o rs ?
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
A ID S
T u m o rs , c a n c e r?
A rth ritis , rh e u m a tis m ?
E y e d is e a s e s ?
S k in d ise a se s?
A n e m ia ?
V D (s y p h ilis o r g o n o rrh e a )?
H e rp e s ?
K id n e y , b la d d e r d is e a s e ?
T h y ro id , a d re n a l d ise a se ?
D ia b e te s ?
IV . D O Y O U H A V E O R H A V E Y O U H A D :
51.
Yes
No
P s y ch ia tric c a re ?
52.
Yes
No
R a d ia tio n tre a tm e n ts ?
53.
Yes
No
C h e m o th e ra p y ?
54.
Yes
No
P ro s th e tic h e a rt va lve ?
55.
Yes
No
A rtificia l jo in t?
56.
57.
58.
59.
60.
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
H o s p ita liz a tio n ?
B lo o d tra n s fu s io n s ?
S u rg e rie s ?
P a c e m a ke r?
C o n ta ct le n s e s ?
V . A R E Y O U T A K IN G :
61.
Yes
No
62.
Yes
No
63.
64.
Yes
Yes
No
No
T o b a c c o in a n y fo rm ?
A lc o h o l?
Yes
No
T a k in g b irth c o n tro l p ills ?
R e c re a tio n a l d ru g s?
D ru g s , m e d ic a tio n s , o v e r-th e -c o u n te r m e d ic in e s
(in c lu d in g A s p irin ), n a tu ra l re m e d ie s ?
P le a se lis t:
V I. W O M E N O N L Y :
65.
Yes
No
V II. A L L P A T IE N T S :
67.
Yes
No
If s o , p le a se e x p la in :
A re y o u o r c o u ld yo u b e p re g n a n t o r n u rs in g ?
66.
D o y o u h a v e o r h a v e y o u h a d a n y o th e r d is e a s e s o r m e d ic a l p ro b le m s N O T lis te d o n th is fo rm ?
T o th e b e s t o f m y k n o w le d g e , I h a v e a n s w e re d e v e ry q u e s tio n c o m p le te ly a n d a c cu ra te ly . I w ill in fo rm m y d e n tis t o f a n y ch a n g e in m y h e a lth
a n d /o r m e d ica tio n .
P a tie n t’s s ig n a tu re :
9
D a te :
R E C A L L R E V IE W :
1 . P a tie n t’s sig n a tu re
D a te :
2 . P a tie n t’s sig n a tu re
D a te :
3 . P a tie n t’s sig n a tu re
D a te :
Go To
Health
History
DIABETES MELLITUS (DM)
UOP Protocol
U n iv e rsity o f th e P a cific S ch o o l o f D e n tistry
• See:
–
–
–
–
Questions to Ask
Diagnostic Tests
Dental Management
Alerts (Complications)
P ro to co ls fo r th e
D E N T A L M A N A G E M E N T O F M E D IC A L L Y
C O M P L E X P A T IE N T S
T O P IC
1 . B le e d in g P ro b le m s (in c lu d in g a n tic o a g u la n ts )
2
2 . C a rd ia c P ro b le m s (h e a rt m u rm u rs , c a rd ia c d e fe c ts )
4
3 . C a rd io v a s c u la r P ro b le m s (h ig h b lo o d p re s s u re , a rrh y th m ia s )
8
4 . C e n tra l N e rv o u s S y s te m P ro b le m s (s e izu re s , s tro k e )
12
5 . D ia b e te s
15
6 . Im m u n o s u p p re s s io n
17
7 . In fe c tio u s D is e a s e s (tu b e rc u lo s is , h e p a titis , H IV , h e rp e s , flu )
19
8 . K id n e y P ro b le m s
24
9 . L iv e r P ro b le m s
25
1 0 . P re g n a n c y
27
1 1 . P ro s th e tic J o in ts
29
P ro to co ls c o m p ile d b y :
10
PAGE
P e te r L . J ac o bs e n, P h .D ., D .D .S
D e p a rtm e n t o f P a th o lo g y a n d M ed icin e
P le a se d ire c t a ll c o m m e n ts , ed its a nd su g g es tio ns to h im a t:
p ja co b se @ u o p.e d u o r c a ll (4 1 5) 9 29 -6 60 9 o r fa x (4 1 5 ) 9 2 9 -6 654 o r w rite to :
D e p a rtm e n t o f P a th o lo g y a n d M ed icin e
U O P S c h o o l o f D e ntistry
2 1 5 5 W e bs te r S tre e t
S a n F ra nc is co , C A 9 41 1 5
Go To
UOP
Protocol
OTHER ENDOCRINE DISEASES
Adrenal Hypocorticism
Chronic Adrenocortical Insufficiency
(Aldosterone, Cortisol, Sex Hormones)
• Addison’s Disease
– Weakness, Fatigue, Nausea and Vomiting, Oral
Freckles
– Hypotensive, Hypoglycemic
– ORAL - New Oral “Freckles”
• Chronic Corticosteroid Disease Treatment
11
– Suppression of Adrenal Cortex
– Decreased “Stress” Response
Go To
UOP
Protocol
ADRENAL FUNCTION
MEDULLA
Zona Glomerulosa
Nor-Epinephrine
Mineralocorticoids
(Aldosterone)
-regulates salt (sodium) and
fluid balance by affecting
distal renal tubules
Epinephrine
EFFECT
Cardiac Output
Peripheral Resistence
Blood Pressure
Heat Production
Increase Blood Glucose
Increase Fatty Acid
Release
Zona Reticulosa
12
Sex Hormones (Estradiol and
Testosterone)
-sexual maturation and
function
CORTEX
Zona Fasciculata
Glucocorticoids (Corticosteroids)
-promotes glucose formation
-increases blood glucose
-suppresses inflammation
ADRENAL FUNCTION
13
ADRENAL / PITUITARY FEEDBACK
Addison’s Disease
New Oral
“Freckles”
14
Cushing’s Disease
Increased Glucocorticoids
• Etiology: Functional Cortical Adenoma or ACTH
secreting Pituitary Adenoma
• Usually Young Adult Females
• Clinical: Weight gain with fatty accumulation in
upper back (“Buffalo Hump”) and face (“Moon
Facies”); Delayed wound healing; Depression
• Laboratory: Hypertension and High Blood Sugar
• Dental: Poor Wound Healing; Risk of Adrenal
(STRESS) Crisis
15
Thyroid Hormone Regulation
16
Hyperthyroidism
• Etiology: Usually from Graves
Disease (other: goiter, adenoma)
• Clinical: Nervousness, emotional
instability, sweating, weight loss,
exophthalmos
• Laboratory: Elevated T3 and T4 and
decreased TSH
• Treatment: Destroy part of thyroid or
inhibit hormone formation
• Dental: Avoid epinephrine unless
disease controlled; Avoid
precipitating Thyrotoxic Crisis
(infection, trauma, surgery)
17
Hypothyroidism
• ADULT: Myxedema (Childhood: Cretinism- Mental and
Physical Retardation)
• Usually Middle Aged Females
• Etiology: Often Hashimoto’s (autoimmune) Thyroiditis
• Clinical: Dull Expression, Puffy Face and Hands, Enlarged
Tongue and Slurred Speech, Delayed Eruption and
Exfoliation of Teeth, Intolerance of Cold
• Dental: No implications EXCEPT avoid depressants and
sedatives and narcotic analgesics (exagerated response)
18
The End
Diabetic
Periodontal Abscess
Hyperthyroidism
Diabetic Angiopathy
Addison’s Disease
19 Pigmentation