Presented by :Dr. Venisha PanditaPG Ist YearDepartment of Public Health Dentistry

CONTENTS:-

Introduction Anatomy and physiology. Hormones of pituitary gland and

associated diseases Hormones of thyroid gland and

associated diseases Hormones of parathyroid gland

and associated diseases

Hormones of adrenal gland and associated diseases

Hormones of gonads and associated diseases

Pregnancy Menopause Conclusion References

The word hormone is derived from the Greek “hormao” meaning “I excite or arouse”, was given by Starling in 1905.

Hormones are secretory products of ductless(endocrine) glands released directly into the circulation in small amounts in response to a specific stimulus and on delivery in circulation produces response on the target cells or organs.

CHEMISTRY OF HORMONES

Steroids Proteins and polypeptides Amino-acid derivatives.

MECHANISM OF ACTION:- Hormone receptors found on target

cell membrane are termed as external receptors and those within cytoplasm and nucleus are termed internal receptors.

The endocrine system is specifically designed to integrate and control the human body’s innumerable metabolic activities.

Its functioning components are endocrine glands.

In most instances, the agent stimulating or inhibiting their activity is the hormone produced by the corresponding target gland

Hormones secreted by anterior lobe- 1. Growth hormone,2. Adrenocorticotropic hormone, 3. Thyroid stimulating hormone,4. Follicle stimulating hormone, 5. Leutinizing hormone6. Prolactin Hormone secreted by intermediate – melanocytes stimulating hormone Hormone secreted by posterior lobe-1. Vasopressin2. oxytocin.

HYPERPITUITARISM It results from hyper function of anterior

lobe of pituitary gland, most significantly with increased production of growth hormone.

TYPES:-a) Gigantism b)Acromegaly

DISEASES OF PITUITARY DISEASES OF PITUITARY GLANDGLAND

Clinical features of gigantism: Stature of individual- generalized

overgrowth of most tissue in childhood Symptoms Skull

ORAL MANIFESTATIONSSymptoms Teeth Jaw bone Palate Macroglossia Lips

Radiological features Skull changes Air sinuses Teeth Jaw bone

Surgery- trans sphenoidal surgery may result in cure of growth hormone excess especially in patients with macroadenoma.

Medical therapy- octreotide, a long acting analogue of somatostatin, lowers growth hormone.

Radiotherapy

HYPOPITUITARISM It results due to reduced secretion of

pituitary hormone which may occur due to pituitary adenoma that compresses the pituitary gland. It results in pituitary dwarfism.

Total absence of all pituitary secretions is known as panhypopituitarism.

Etiology: Disease of pituitary gland Space occupying lesion Sheehan’s syndrome

Clinical features:- Short stature of individual Hypocalcemia Diabetic insipidus Symptoms Sexual characteristics Skull

ORAL MANIFESTATIONS Jaw bone Teeth

Radiographic features:- Teeth-Complete absence of third molar

bud. Roots of teeth are short and apices are wide open.

Alveolar bone- there is loss of alveolar bone.

Management:- Removal of cause Growth hormone replacement therapy

Thyroid hormones are:1. Thyroxine (T4)2. Tri-iodo-thyronine (T3)3. calcitonin

Hyperthyroidism It is a syndrome in which there is

excessive production of thyroxin in thyroid gland.

Etiology Exophthalmic goiter Toxic adenoma Pituitary disease

Clinical features

Age and sex- higher predilection for females between 20 and 40 years.

Thyroid features- thyroid is diffusely enlarged, smooth, possible asymmetrical and nodular, a thrill may be present, may be tender.

Neuromuscular Gastrointestinal Cardiorespiratory

Ocular Reproductive Dermatological Others- heat intolerance, sweaty and warm

extremities, thin shiny skin, increased pulse rate and fatigue, thirst and osteoporosis.

Management

Anti thyroid drugs Subtotal thyroidectomy Radioactive iodine Beta-blockers.

ORAL MANIFESTATIONS Teeth- advanced rate of dental

development and early eruption with premature loss of primary teeth.

Alveolar bone- generalized decrease in bone density or loss of some areas of edentulous alveolar bone.

Radiographic features Generalized osteoporosis Alveolar resorption

HYPOTHYROIDISM

It is caused by insufficient secretion of thyroxin by the thyroid gland.

Failure of thyrotropic function on the part of the pituitary gland or any atrophy or destruction of the thyroid gland or an atrophy or destruction of thyroid gland leads to an inability of the gland to produce sufficient hormone to meet the requirement of the body.

Types: Cretinism Juvenile myxedema Myxedema Primary hypothyroidism Secondary hypothyroidism

Clinical Features:Cretinism and juvenile

myxedema Age Symptoms Bones Signs

MyxedemaSymptoms

Early symptoms- weakness, fatigue, cold intolerance, lethargy, dryness of skin, headache, menorrhagia and anorexia

Late symptoms- slowing of intellectual and motor activity, absence of sweating, weight gain, constipation, pallor, decreased sense of taste and smell, aches and pains.

Signs Face Eyes Skin Tendon reflexes Other features- bradycardia , disorientation,

thickened nose.

Myxedema

Oral manifestationsCretinism and juvenile myxedema Teeth Jaw bone Tongue Skull Face LipsMyxedema Tongue and lip Face Teeth

Management Levothyroxine, which is available as 25,

50,100ug tablets. It is customary to start slowly and a

dose of 50ug/day is given for 3 weeks to finally 150ug/day.

In elders and patients with ischemic heart disease, the initial dose should be 25ug/day.

Lowering the body temperature Other therapies like supporting respiration,

narcotic antagonist and oxygen if necessary Hospitalization if severe.

Precaution- the use of sedative and analgesic are dangerous as these agents tend to precipitate coma in patients with hypothyroidism.

Inpatients with severe hyperthyroidism the emergencies likely to occur thyroid crisis, emotional disturbances, cardiac difficulties.

Parathyroid hormone- PTH is a single chain polypeptide of 84- amino acid which are synthesized by the chief cells and released in response to a fall in serum ionized calcium concentration.

Hyperparathyroidism It is an endocrine disorder in which there is

an excess of circulating parathyroid hormone.

Excess PTH stimulates osteoclast to mobilize calcium from skeleton leading to hypercalcemia in addition to PTH increased renal tubular reabsorption of calcium.

Types:- Primary Secondary Tertiary

Clinical features

Age and sex- female :male ratio is 3:1. mainly 30-60 years of age.

Classic triad- bones, grones and stones Renal calculi Gastrointestinal problems Hypercalcemia Bone pane and fractures. Cartilage Eyes

Oral manifestations Brown tumor Teeth- drifting and loss of teeth,

malocclusion

MANAGEMENT

Surgery- hyperplastic tissue should be removed surgically

Vitamin D supplement Parathyroidectomy Precaution-restriction of dietary phosphate,

phosphate binding agent and aluminum salts should be done.

Hypoparathyroidism It is an uncommon condition in which

there is insufficient secretion of parathyroid hormone.

Etiologya) Surgical damage to parathyroid glandb) Damage from radiotherapyc) Autoimmune

Clinical features Hypocalcaemia Symptoms Trousseaus sign

ORAL MANIFESTATIONS Teeth- hypoplasia of enamel. Delayed

eruption, external root resorption and root dilacerations

Chvostek sign Candidiasis

Calcium and Vit D supplement. Intravenous calcium gluconate

Pseudohypoparathyroidism It is also called Albright hereditary

osteodystrophy. In this normal parathyroid hormone is

present in the body but biochemical pathway responsible for activating target cells are defective in function.

TypesType I:- Type I a- molecular defect of

intracellular binding protein prevents formation of cyclic adenosine monophosphate. This will hamper cell metabolism.

Type I b- defective receptor for the PTH on the surface of target cells. It Is an autosomal dominant trait.

Type I c- there is defective adenylate cyclase

Type II- There is induction of camp by PTH in target cells, but function response by cell is not invoked

Clinical features Stature Shortened finger Osteoma cutis

ORAL MANIFESTATIONS Facial features-mid facial hypoplasia, the

face is rounded in appearance Teeth- generalized enamel hypoplasia,

oligodontia, delayed eruption of teeth.

Management- vitamin D and calcium

Parts of glands each gland is divided into adrenal medulla and a cortex.

ADRENAL MEDULLA- it arises from ectodermal tissues and function as a part of the sympathetic nervous system.

It manufactures and secretes two catecholamine:

1. epinephrine 2. nor-epinephrine

ADRENAL CORTEX – it secretes three major classes of hormone:-

a) Glucocorticoids or cortisolsb) Mineralocorticoids/ aldosteronec) Sex hormones( testosterone,

estrogen, progestrone)

Addison’s disease It is also called as chronic adrenal

insufficiency of the adrenal cortex.

Etiology:- Autoimmune Infection Drugs

Clinical features Age and sex- more common in males

and frequently seen in 3rd and 4th decade.

Symptoms- feeble heart action, general debility, vomiting, diarrhea, postural hypotension, reduced resistance to infection, trauma and stress.

Sign- bronzing of skin and pigmentation of oral mucosa.

Metabolic function- decreased cortisol level interferes with the manufacture of carbohydrates from proteins, causing hypoglycemia and diminished glycogen storage in liver.

Neuromuscular function- it is inhibited producing muscle weakness.

ORAL MANIFESTATION bronze pigmentation

Management Glucocorticoids replacement Supplement mineralocorticoids

Cushing Syndrome It arises from excess secretion of

glucocorticoids by the adrenal glands.

Etiology Adrenal tumor Administration of corticosteroids Ectopic

Clinical features Age and sex Symptoms Moon face Buffalo hump

ORAL MANIFESTATION Dental age- in children growth and

development including skeletal and dental age may be retarded.

Management Surgery Radiotherapy Drugs- Metyrapone 2-6 gm/day in

divided doses by mouth, Aminoglutethimide, ketoconazole are

also given which act by blocking steroid synthesis.

Adrenal insufficiency It is relatively rare and usually occurs in

connection with an acute septicemia and is called as waterhouse-friderichsen syndrome.

Types:- Primary- It occurs due to disorders of

pituitary or adrenal glands. Secondary- it occurs due to chronic

administration of corticosteroid resulting in the suppression of endogenous steroid.

Etiopathogenesis Sudden withdrawal of steroid Following stress Bilateral adrenalectomy Destruction of pituitary gland Trauma

Clinical features Age- occurs primarily in children Onset- rapidly fulminating septic course Symptoms- patient is not able to tolerate

stress. There is anxiety, vomiting, cold clammy skin, lethargy and partial or complete loss of consciousness.

Sign- oral, conjunctival, and vaginal mucosa often show patches of pigmentation.

ORAL MANIFESTATION

Early eruption- teeth may erupt early, compared with the normal, but the eruption is in harmony with the skeletal age.

Management Replacement therapy-it is given in

combination of glucocorticoids, mineralocorticoids and anabolic steroids.

Dental considerations: Defer the treatment Position the patient Airway maintenance Saline-i.v 5% dextrose saline Hydrocortisone-100-200mg of hydrocortisone

Exocrine secretion of pancreas: Pancreatic juices( promote digestion of

carbohydrates,fats and proteins) Endocrine secretion:1. Insulin2. glucagon

Diabetes mellitus It may be caused by autoimmune

response. Principal laboratory sign are

hyperglycemia. It is caused by disorders of carbohydrate

mechanism resulting from insulin deficiency or ineffectiveness, producing hyperglycemia and glycosuria.

TYPES Type I or insulin dependent- it occurs

due to deficiency. There is lack of insulin production resulting in severe hyperglycemia and ketoacidosis.

Type II or non-insulin dependent- it occurs due to insulin resistance.

Pathogenesis Type I diabetes mellitusa) Autoimmune disorder.b) Increase blood glucose level- as there is

deficiency of insulin glucose will remain in blood as absorption of it hampered. So blood glucose level is increased.

c) Glucose as main energy sourced) Polyuria and polydipsia

Type II diabetes mellitusa) Decrease in number of insulin receptor-

This results in non absorption of glucose in the body.

EtiologyType I diabetes mellitus Viruses Diet Stress Immunological factors

Type II diabetes mellitus Genetic Environmental factors- lifestyle,

malnutrition, eg, pregnancy.

Clinical features Polydipsia Polyuria Polyphagia Breath Visual activity Atherosclerosis Diabetic neuropathy Infection Other symptoms- nocturia, weight

loss, fatigue, obesity, temperature and hypertension

Symptoms of type II diabetes mellitus- mild in nature with this disease discovered on routine hematological examination.

ORAL MANIFESTATIONS Effect on periodontium Periodontitis Median rhomboid glossitis Oral candidiasis Localized osteitis Burning mouth Trigeminal nerve involvement Xerostomia and increase caries activity Delayed healing

Radiographic features loss of lamina Dura with blurring of alveolar

crest, bone loss is also seen.

Fasting Post- Prandial

Normal < 110 < 140DM > 126 > 200Impaired fasting > 110 & <126 < 140glycemia IGT < 126 >140

& <200

ADA criteria 1997 endorsed by WHO 1998 for diagnosis of diabetes mellitus 2hours after giving 75gm glucose load:

Complications Microangiopathy Coronary artery disease Blindness Ketoacidosis, diabetic coma, premature

mortality.

Management Diet control Oral hypoglycemic drugs- sulfonylureas,

biguanides, alfa-glucosidase inhibitors Insulin therapy

Diabetes Insipidus Causes- It occurs due to insufficiency of the

posterior pituitary hormone. In these patients there is damage to the neurohypophyseal mechanism for the production of vasopressin.

Symptoms- There is increased thirst and passage of large quantities of urine. There is also dehydration, headache, irritability, and fatigue due to restriction of fluid.

Management- Administration of vasoprssin is the treatment of choice. Desmopressin can be given intranasal in a dose of 5-10mg once or twice daily.

DENTAL CONSIDERATIONS Emergency Dental management-a) Appointment should be of short

duration and in the morningb) Glucose drink should be available.c) Local anesthesia without epinephrined) Suturinge) Physician referralf) Antibiotic prophylaxisg) Avoid complicated oral procedure.

Hypergonadism It occurs in children, results in

precocious puberty. The long bone develops quickly and

child may initially turn toward tallness, but this is offset by the early fusion of epiphyses so that adult’s person may be short.

Hypogonadism It occurs in equal frequency in males and

females. The bones are long and slender and

epiphyses are late in fusion. The supracilliary ridges, malar bone, and

mandible show greater development.

The chin is pointed, the palate is high and markedly arched and irregularities of the teeth occur.

The mandible tends to become enlarged.

The skull is small and there is marked or even excessive enlargement of the frontal and sphenoid sinuses and especially mastoid air sinus.

PREGNANCY

•condition of having a developing embryo or fetus in the body

•In Human duration of pregnancy is about 266 days after conception.

•Roughly divided in three trimesters of about three calendar months each-into the embryonic period lasting from fertilization through the first eight weeks of pregnancy and the fetal period during the remainder of pregnancy

ORAL MANIFESTATION

•The Popular notion that pregnancy cause tooth loss “a tooth for every pregnancy”and that calcium is withdrawn in significant amounts from the maternal dentition to supply fetal requirements has no histological, chemical, evident to support it.

•In other hand, calcium is readily mobilized from bone to supply these demands and demineralization of alveolar processes can result.

•Caries activity is attributed to an increase in local cariogenic factors

•Condition that may influence the pregnant patient’s teeth is acid erosion, which may caused by repeated regurgitation of gastric contents associated with morning sickness or esophageal reflux.

•Periodontal disease occurs in 50% to 100%of all pregnant women

•Gingival changes occur most frequently in association with poor oral hygiene and local irritants, esp bacterial plaque.

•Clinically, the appearance of inflamed gingiva during pregnancy is characterized by a fiery red color of marginal gingiva and interdental papillae

•Tissue is edematous, with a smooth, shiny surface texture, loss of resiliency, and tendency to bleed easily.

•Interdental papillae may hypertrophy and form pseudopocket.

Tumor like growths, usually on the interdental papillae or other areas of the frequent irritation..it is referred to as a “pregnancy tumor”, epulis gravidarum, or pregnancy granuloma .

Poor oral hygiene invariably is present, and often there are deposits of plaque or calculus on the teeth adjacent to the lesion.

•Full development granuloma is a sessile or pedunculated lesion that is usually painless. •Color varies from purplish red to deep blue.•Bone destruction is rarely observed around pregnancy granulomas.•Oral findings that may be seen in pregnant women is generalized tooth mobility.•probably related to the degree of the gingival disease and the disturbance of the attachment apparatus, as well as to mineralisation; changes in the lamina dura.•Condition usually reversed after delivery.

•Pregnant patients begins with thorough medical history.

•History should note any complications the patient has encountered in the pregnancy to date and record any previous miscarriages, recent cramping,

•No elective dental care should be undertaken during the tri-semester.

•Prolong chair time is avoided

•Emergency dental care may be rendered at any time during pregnancy, after consultation to physician

Dental Management

Menopause is not a disease, it is a natural transition period in ever woman's life.

Menopause is a time of declining ovarian function

However, during menopause, many women may experience uncomfortable symptoms such as hot flashes, vaginal dryness, depression, sleeplessness, etc.

Traditionally women have sought hormone replacement

MENOPAUSE

Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling

Bouts of rapid heart beat Irritability, Mood swings, sudden tears Trouble sleeping through the night (with or without night

sweats)  Irregular periods; shorter, lighter periods; heavier periods

, flooding; phantom periods, shorter cycles, longer cycles Loss of libido Crashing fatigue Anxiety, feeling ill at ease Feelings of dread, apprehension, doom

Some Possible Symptoms Associated with various Stages of Menopause

•Postmenopausal osteoporosis can be prevented and treated by sound dietary control adequate levels of dietary calcium.

•The condition may be prevalent because of dietary adequacies of young women and could become an important issue in dental care for postmenopausal women

•Counseling may be indicated for some patients, and it is most appropriate for the dentist to refer the menopausal patient for medical evaluation and treatment to optimize the befits of dental treatment.

Dental Management

Hormones form an integrate regulatory system of human body. They regulate various human systems like growth,digestion,reproduction ,etc. Any dearrangement in hormonal function immense effects on human body. Hence a deeper understanding of hormones ,their chemistry, mechanism and side effects are important.

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