20 Hormone - Professor Fink

Chapter 20
Other Hormones
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Thyroid Hormones
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Hyperthyroidism
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Due to an excessive secretion of thyroid hormone
Can affect multiple body systems
Commonly reported symptoms include diarrhea,
flushing, increased appetite, tachycardia, fatigue,
irritability, sleep disorders, and heat intolerance.
Oral manifestations include accelerated tooth eruption,
marked loss of alveolar process, diffuse demineralization
of the jaw bone, and rapidly progressing periodontal
destruction.
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Thyroid Hormones
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Hyperthyroidism
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Hyperthyroidism can be treated with medication.
Methimazole and propylthiouracil (PTU) are antithyroid
drugs.
Methimazole inhibits the incorporation of iodine
molecules into the amino acid tyrosine.
PTU inhibits the conversion of T4 to T3 in the peripheral
circulation.
Both drugs cause a loss of taste, drowsiness, headache,
lymphadenopathy, and enlarged thyroid.
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Thyroid Hormones
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Hyperthyroidism
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Saturated solution of potassium iodide (SSKI) and
Lugol’s solution (potassium iodide) are two more options
used to treat hyperthyroidism.
SSKI inhibits thyroid hormone synthesis.
Lugol’s solution prevents the release of thyroid
hormones from the thyroid gland.
Adverse effects include skin rash, conjunctivitis, metallic
taste, burning in the mouth, sore throat, and head cold
symptoms.
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Thyroid Hormones
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Hyperthyroidism
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Most patients usually receive either one of
these drugs prior to thyroidectomy.
Many patients also under radiation therapy.
Patients receive radioactive iodine (131I) orally.
The drug is sequestered in the thyroid gland
and its use results in the localized destruction
of thyroid tissue.
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Thyroid Hormones
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Hyperthyroidism
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Patients with uncontrolled hyperthyroidism
should not receive a vasoconstrictor because
of the increased risk for a cardiotoxic event.
Patients may have an increased tolerance to
opioid analgesics and other CNS depressant
drugs.
Larger doses of these drugs may be required
until the patient is considered euthyroid.
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Thyroid Hormones
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Hypothyroidism
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Hypothyroidism is due to either primary thyroid
gland failure or a decrease in thyroid hormone
synthesis.
Signs and symptoms include mental and
physical retardation in children, dry skin,
coarse skin and hair, cold intolerance,
bradycardia, weight gain, periorbital puffiness,
constipation, weakness, lethargy, and fatigue.
Oral findings include delayed tooth eruption,
malocclusion, periodontal disease, poorly
shaped and carious teeth, and inflamed, pale
or enlarged gingiva.
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Thyroid Hormones
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Hypothyroidism is treated with thyroid supplementation.
This is a life-long treatment.
Thyroid supplements can be either synthetic or natural.
Thyroid supplements work by giving the body an
exogenous supply of thyroid.
Common adverse effects of thyroid supplements include
tachycardia, palpitations, hypertension, insomnia, tremors,
headache, anxiety, and weight loss.
The adverse effects mimic hyperthyroidism.
Patients who are hypothyroid may require lower doses of
CNS depressant drugs because their livers are
metabolizing drugs at a much slower speed than someone
who is euthyroid.
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Pancreatic Hormones
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Diabetes
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Diabetes mellitus is a group of metabolic disorders
characterized by persistent hyperglycemia.
Type I diabetes usually develops in people <30 years of
age and results from an autoimmune destruction of
pancreatic β cells.
These people need exogenous insulin to survive.
Type II diabetes usually develops in people over the age
of 40.
Type II diabetes is a result of impaired insulin action,
insulin resistance, and defective pancreatic β cells.
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Pancreatic Hormones
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Oral Complications of Diabetes
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Uncontrolled diabetes can cause many oral complications.
Tight control of plasma glucose levels can help minimize oral
complications.
Patients with diabetes are at higher risk for xerostomia.
These patients are also at a higher risk for caries.
Patients with uncontrolled diabetes are at a higher risk for
periodontal disease.
Patients with diabetes have fragile blood vessels, delayed
wound healing, and a tendency to develop infections.
Epinephrine, steroids, and opioid analgesics should be used
with caution in diabetic patients because they can decrease
insulin release or increase insulin requirements.
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Pancreatic Hormones
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Diabetes
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Evaluating Dental Patients with Diabetes
• Ask the patient what their most current plasma glucose
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levels have been.
Ask the patient when they last measured plasma glucose
levels.
Ask for the results of those levels.
Ask the patient when they last took their insulin or oral
hypoglycemic medicine and when they last ate.
If the patient has not eaten or taken medicine then the
appointment should be rescheduled.
If the patient becomes hypoglycemic then glucose should
be given.
Fruit juice, cake frosting, or icing are excellent sources of
glucose.
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Pancreatic Hormones
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Diabetes
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Drugs Used to Manage Diabetes
• Insulin is the only drug used to manage type I
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diabetes.
It is ultimately used to manage type II diabetes.
It must be injected several times a day, dependent
upon the patient’s plasma glucose levels.
Hypoglycemia is its most common adverse effect.
Oral antidiabetic drugs are initially used to manage
type II diabetes.
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Pancreatic Hormones
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Diabetes
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Drugs Used to Manage Diabetes
• There are several different classes of medication
available to treat type II diabetes.
• Patients usually receive a combination of a second
generation sulfonylurea and a biguanide to help them
maintain tight control of their plasma glucose levels.
• α glucosidase inhibitors, thiazolidinediones, and
newer agents are also available to help patients
achieve and maintain tight control of their plasma
glucose levels.
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Pancreatic Hormones
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Diabetes
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Drugs Used to Manage Diabetes
• Most of these drugs can cause GI upset, nausea,
vomiting and diarrhea.
• Sulfonylureas can cause hypoglycemia.
• There have been reports of metformin causing a
metallic taste.
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Pancreatic Hormones
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Diabetes
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Managing Dental Patients that are Taking
Insulin or Oral Hypoglycemic Drugs
• Hypoglycemia - Question patient about last meal ingested.
• Infection more likely - Monitor closely and give antibiotics if
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needed (treat aggressively).
Healing prolonged - Follow patient with any surgical
procedure.
Drug interactions - Large doses of salicylates may produce
hypoglycemia.
Appoint patient in morning after breakfast and insulin or
oral hypoglycemic agent.
Provide quick glucose source for hypoglycemia (cake icing,
orange juice).
Check for oral complications related to diabetes.
Ask patients what the results of their blood glucose
monitoring have been (if checked).
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Female Sex Hormones
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Both male and female sex hormones occur in
both sexes in different proportions.
The 2 major female sex hormones are estrogen
and progesterone.
They are largely responsible for female sexual
characteristics, developing the reproductive
system, and preparing the reproductive system for
contraception.
Estrogen and progesterone levels vary on a daily
basis.
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Female Sex Hormones
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Estrogen
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Estrogens are primarily responsible for the
changes that take place in girls during puberty.
Synthetic estrogens are used in combination
with progesterone to prevent therapy.
Estrogen is used to treat dysmenorrhea,
dysfunctional uterine bleeding, osteoporosis,
atrophic vaginitis, cancer, acne, and symptoms
of menopause.
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Female Sex Hormones
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Estrogens
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Adverse effects include nausea, vomiting,
uterine bleeding, vaginal discharge, edema,
thrombophlebitis, weight gain, and
hypertension.
Oral adverse effects include gingivitis, gingival
inflammation, dry socket after extraction, and
increased gingival fluid.
Meticulous, home oral health care can help
minimize oral adverse effects.
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Female Sex Hormones
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Progestins
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Progesterone promotes secretory changes in the endometrium
and prepares the uterus for implantation of the fertilized egg.
Progestins are used alone or in combination with estrogen for
contraception.
Progestins are used in combination with estrogen to treat the
symptoms of menopause.
Progestins are available as an intramuscular injection
administered every 3 months, as a progestin-only pill, in the
form of an intrauterine device, or as an implant under the skin
on the arm, all as contraception.
Adverse effects include abnormal menstrual bleeding,
breakthrough bleeding, and amenorrhea.
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Female Sex Hormones
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Oral Contraceptives
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Oral contraceptives are made up of estrogens and
progestins in varying combinations.
Combination oral contraceptives are taken for 21 days
each month.
The last 4-7 days of each packet contain no active
ingredients.
The newest oral contraceptive available is designed to
be given daily for three months. As a result, women only
bleed every 3 months, or 4 times a year.
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Female Sex Hormones
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Oral Contraceptives
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Oral contraceptives interfere with fertility by inhibiting the
release of FSH and LH, which prevents ovulation.
There are many adverse effects associated with oral
contraceptive therapy.
Adverse effects include thrombophlebitis and the risk for
thromboembolism.
Minor adverse effects include nausea, dizziness,
headache, weight gain, and breast discomfort. These
side effects are usually noted during the first six months
of therapy.
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Female Sex Hormones
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Oral Contraceptives
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Oral contraceptives increase gingival fluid, stimulate
gingivitis, and are associated with gingival inflammation.
Oral contraceptives are associated with a significant
increase in the frequency of dry socket after tooth
extractions.
This risk can be minimized by performing extractions
during days 23-28 of a tablet cycle or the end of the
extended-cycle tablet dispenser.
Use caution if antibiotics are necessary. The patient
should use an additional method of birth control during
antibiotic therapy through the end of the oral
contraceptive cycle.
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Female Sex Hormones
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Managing Dental Patients Taking Oral
Contraceptives
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Because of the increased risk for thrombophlebitis have
patients stretch or move their legs.
Give the patient the chance to walk around if the
appointment is long.
Check the patient’s blood pressure at each visit because
oral contraceptives can cause hypertension.
More frequent recall appointments may be necessary
because of oral contraceptive effects on oral tissue.
Meticulous, home oral health care is necessary to
minimize oral adverse effects.
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Male Sex Hormones
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The main male sex hormone is testosterone.
Testosterone has both androgenic and anabolic
effects.
Androgens are responsible for the development of
secondary male sex characteristics.
Anabolic effects include increases in tissue protein
and nitrogen retention in the body.
Other effects include increased osteoblastic activity
and increased sebaceous gland activity (acne).
Androgenic steroids are used to treat breast cancer or
as hormonal replacement therapy.
Its use as an athletic performance enhancer is illegal.
Androgenic steroids are Scheduled III drugs because
of their abuse by athletes.
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Male Sex Hormones
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Androgens
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The adverse effects of androgens include
nausea, cholestatic jaundice, types of liver
cancer, increased serum cholesterol levels,
habituation, depression, psychosis, and
aggressive behavior.
 In women, these drugs can cause virilization.
 Women experience acne, hirsutism, deepening
voice, clitoral enlargement, and male-pattern
baldness.
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Other Agents that Affect Sex
Hormone Systems
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Other drugs are used to affect sex hormone
systems for a variety of reasons.
They can either mimic hormonal activity or inhibit
the action of naturally occurring sex hormones.
Hormones of the opposite sex are used to treat
prostate, breast, or uterine cancer when the
cancer is stimulated by the patient’s own
hormones.
Other drugs are used to treat endometriosis and
fertility.
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