Clinical Intro to Endocrine

• Control of growth and differentiation • Maintenance of homeostasis • Regulation of reproduction

• Dry mouth from dehydration -> dental caries, peridontal disease, candidosis • Periodontal disease is more common and aggressive in poorly controlled diabetics • Oral candidosis from the immune defect and dryness • Salivary gland enlargement (sialosis) from autonomic neuropathy • Lichenoid reactions from oral hypoglycaemic drugs • Dentoalveolar abscesses may be more common and severe • Dry socket may also be more common following dental extractions. • Increased risk of infections -Diabetic emergencies

• Ensure meals and medications taken as normal • Early morning appointments • Ensure optimal oral hygiene - Care must be taken when patients rise from the dental chair, as they may have postural hypotension (due to autonomic neuropathy).

• Long term steroids suppress the hypothalamus- pituitary-adrenal axis • Potentially reducing patient ability to deal with physiological stress leading to an Addisonian crisis • Increased susceptibility to infections - Impaired wound healing • Reduce stress • Careful pre-op assessment to ensure avoidance of Addisonian crisis - Consider steroid cover

• Macrognathia • Widely spaced teeth • Macroglossia • Cementum deposition

• Avoid stressful situations and the spread of infectious foci. • Restrict the use of adrenaline— myocardium sensitive-> may unleash arrhythmias, palpitations and chest pain. • Severe stress may precipitate thyroid storm crisis- tachycardia, irregular pulse, sweating, high BP, tremor, nausea, vomiting etc