Optimise Thyroid function before Dental work!
If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed.
Patients with history of thyroid diseases should be carefully evaluated to determine the level of medical management, and they should be treated in a way that limits stress and infection.
Oral manifestations of hypothyroidism
The common oral findings in hypothyroidism include the characteristic enlarged tongue, distortion of the sense of taste, delayed eruption of teeth, poor periodontal health, altered tooth morphology and delayed wound healing.
Before treating a patient who has a history of thyroid disease, the dentist should obtain the correct diagnosis and etiology for the thyroid disorder, as well as past medical complications and medical therapy.
Dental Management of Hypothyroidism
Hemostasis - Patients with long standing hypothyroidism may have a decreased ability of small blood vessels to constrict when cut and may result in increased bleeding. Local pressure for an extended time will probably control the bleeding from the small vessels adequately.
Susceptibility to infection - Patient with hypothyroidism may have delayed wound healing associated with an increased risk for infection because of the longer exposure of the unhealed tissue to pathogenic organisms. Hypothyroid patients are not considered to be immunocompromised.
Patients who have hypothyroidism are susceptible to cardiovascular disease from arteriosclerosis and elevated LDL.
Drug actions and interactions - Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates, so these medications should be used sparingly.
It has been found that recent exposure to a surgical antiseptic that includes iodine (such as Povidone) can increase the risk of thyroiditis or hypothyroidism. Patients with underlying thyroid antibodies and a tendency toward autoimmunity appear to be at more risk.
Drug interactions of l-thyroxine include increased metabolism due to phenytoin, rifampicin and carbamazepine, as well as impaired absorption with iron sulfate, sucralfate and aluminum hydroxide.
When l-thyroxine is used, it increases the effects of warfarin sodium and, because of its gluconeogenic effects; the use of oral hypoglycemic agents must be increased. Concomitant use of tricyclic antidepressants elevates l-thyroxine levels. Appropriate coagulation tests should be available when the patient is taking an oral anticoagulant and thyroid hormone replacement therapy.