The thyroid gland regulates the body’s metabolic and systemic functions. Hormones produced by the thyroid support overall homeostasis for the systems of the body. When the thyroid is impaired or inflamed, systemic imbalances occur. The oral cavity frequently reveals preliminary indications of these imbalances.
While at face value, thyroid function may seem extraneous in relation to dental care. However, there are a wide range of oral, and head & neck manifestations linked to thyroid imbalance and/or disorders. Some common expressions experienced by individuals with thyroid insufficiency are, but may not be limited to:
Oral health care providers should familiarize themselves with the various oral and systemic manifestations of the various thyroid disorders. Skilled and astute clinicians are critical in screenings, as their attentiveness may lead to early diagnosis and treatment.
Elective dental treatment should be suspended if thyroid disease is suspected, and the patient’s care is not being managed or sufficiently diagnosed. Bidirectional care between the dentist and the patient’s endocrinologist should be pursued to determine a treatment plan that minimizes stress, and the risk of infection.
When thyroid function decreases, there is a decrease in thyroid hormone production. Low levels of thyroid hormone result in a lower metabolic rate, lethargy, weight gain, sensitivity to cold, dry skin, and a slower heart rate, to name a few.
Hashimoto’s Disease is an autoimmune disorder and is the most common form of hypothyroidism. Women are more prone to Hashimoto’s and are usually diagnosed between the ages of 40 and 60. Other factors, such as heredity may have a bearing on the likelihood and susceptibility of diagnosis.
In caring for dental patients with hypothyroidism, attention to medications and dentifrices should be noted. Fluoride should be avoided as it is a halogen that interferes with iodine. The result is an impairment in thyroid hormone production. Unless patients display increased caries risk, an anti-fluoride toothpaste such as Tom’s of Maine Anti-Plaque Natural Whitening Toothpaste should be recommended. Additionally, these patients have extreme sensitivity to central nervous system depressants and barbiturates. Prescribing of such medications should be avoided unless approval from the attending endocrinologist or general practitioner is received.
Hyperthyroidism occurs when there is an overproduction of thyroid hormones. Symptoms may include nervousness or mental instability, weight loss, increased heart rate, hypertension, increased susceptibility to heart failure, and heart problems.
Graves Disease is one of the more common and well-known forms of hyperthyroidism. Like Hashimoto’s, Graves is more common among women. In addition to bulging eyes, these patients may show increased sensitivity to heat, resulting in obvious perspiration.
For dental treatment, epinephrine is contraindicated due to the hyperthyroid patient’s increased level of anxiety. In addition, these patients are more susceptible to cardiac issues and may be on blood thinners such as warfarin. A thorough review of the medical history is essential to ensure patient safety and procedural efficacy.
While dental care is necessary for all, attention to medical history, symptoms, and contraindications is essential for patients with compromised thyroid function.
Her clinical and support team experiences are the inspiration for her writing and the motivation for coaching clients to success. She is a regular contributor to various publications within dentistry and beyond. In addition to feeding the homeless, starting a non-profit, and being involved in her church and other community organizations, she sings professionally and enjoys several creative outlets. She resides in Florida where she enjoys the company of her husband, three children, and four beautiful grandchildren.