CONSIDERATIONS FOR DENTAL TREATMENT.
BEFORE TREATMENT: ASSESSMENT OF THYROID FUNCTION
Establish type of thyroid condition.
Is there a presence of cardiovascular disease? If yes, assess
cardiovascular status.
Are there symptoms of thyroid disease? If yes, defer elective
treatment and consult a physician.
Obtain baseline thyroid-stimulating hormone, or TSH. Control is
indicated by hormone levels, length of therapy and medical
monitoring. If the patient has received no medical supervision
for more than one year, consult a physician.
Obtain baseline complete blood count. Give attention to druginduced
leukopenia and anemia.
Assess medication and interactions with thyroxine and TSH.
Make proper treatment modifications if the patient is receiving
anticoagulation therapy.
Take blood pressure and heart rate. If blood pressure is elevated
in three different readings or there are signs of
tachycardia/bradycardia, defer elective treatment and consult a
physician.
DURING TREATMENT
Oral examination should include salivary glands. Give attention
to oral manifestations.
Monitor vital signs during procedure:
Is the patient euthyroid? If yes, there is no contraindication to
local anesthetic with epinephrine.
Use caution with epinephrine if the patient taking nonselective
β-blockers.
If the patient’s hyperthyroidism is not controlled, avoid
epinephrine; only emergent procedures should be performed.
Minimize stress–appointments should be brief.
Discontinue treatment if there are symptoms of thyroid
disease.
Make pertinent modifications if end-organ disease is present
(diabetes, cardiovascular disease, asthma).
AFTER TREATMENT
Patients who have hypothyroidism are sensitive to central
nervous system depressants and barbiturates.
Control pain.
Use precaution with nonsteroidal anti-inflammatory drugs for
patients who have hyperthyroidism, avoid aspirin.
Continue hormone replacement therapy or antithyroid drugs as
prescribed.
