Dental Considerations and Precautions Associated with Oral Excisional Biopsy on a Patient with Cushing ’s Syndrome (Hypercortisolism)
Chronic exposure to endogenous and exogenous glucocorticoids will cause CS. Endogenous CS is uncommon, with an annual incidence of 0.2-5 individuals per million. Endogenous causes could be 1. adrenocorticotropic hormone (ACTH) dependent or 2. ACTH independent. The use of exogenous glucocorticoids to manage chronic autoimmune or inflammatory diseases is the most common cause of CS and results in iatrogenic CS. Cushing disease is caused by excess ACTH production by a pituitary tumor. CS ’s clinical manifestations in the head and neck region include a moon-shaped face, acne flares, and hirsutism. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Sahar Mirfarsi, Dalia Seleem, Airani Sathananthan Source Type: research
A Patient with Addison Disease (Primary Adrenal Insufficiency) Presenting for Surgical Extraction of Third Molars
The local prevalence of primary adrenal insufficiency (PAI) depends on various factors such as genetics, environment, and timely disease diagnosis. PAI is uncommon, and the prevalence is reported to be 2 per 10,000 population. PAI is commonly caused by an autoimmune process that destroys the adrenal gland, resulting in the loss of glucocorticoid and mineralocorticoid secretion from the adrenal cortex. The lack of cortisol results in impaired glucose/fat/protein metabolism, hypotension, increased adrenocorticotropic hormone secretion, impaired fluid excretion, and hyperpigmentation. PAI has a female predominance and is comm...
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Sahar Mirfarsi, Dalia Seleem, Airani Sathananthan Source Type: research
Implant Placement in a Patient with Thyromegaly Associated with Graves Disease
Oral health care providers should obtain comprehensive medical records from patients with hyperthyroidism before dental treatments. Graves disease is the most common cause of hyperthyroidism. Untreated hyperthyroidism can lead to dangerous adverse effects, such as coma or death. Recognizing early signs and symptoms of hyperthyroidism is crucial in reducing complications. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Sahar Mirfarsi, Airani Sathananthan, Joel Laudenbach Source Type: research
The Patient Faints in the Waiting Area with a Suspected Hypoglycemic Event
An older adult with diabetes is taking glipizide, a sulfonylurea class drug. Subsequently, she experiences a hypoglycemic episode in the dental office. Prompt recognition of hypoglycemia and administration of glucose or sugar is vital. Patient and provider education about the risks of hypoglycemia in older adults may help to prevent future hypoglycemic episodes. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Milda Chmieliauskaite, Marie D. Grosh, Ali Syed, Andres Pinto Source Type: research
An Elderly Patient with Undiagnosed Type 2 Diabetes Mellitus Presenting for an Emergency Extraction
In this case a patient has multiple risk factors for diabetes including periodontal disease, family history positive for diabetes, and body mass index of 24 in an Asian American. He has no medical or dental home and upon presenting to the dental office would be a good candidate for diabetes screening. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Milda Chmieliauskaite, Marie D. Grosh, Ali Syed, Andres Pinto Source Type: research
Patient with Type I Diabetes Mellitus Develops Post-Operative Hyperglycemia After Osseous Surgery
A patient with type I diabetes withheld her diabetes medications without consulting her physician and was not able to resume her normal diet after extensive dental surgery resulting in hyperglycemia postoperatively. Clear communication between clinicians and patient about the expected postoperative course and changes to factors that may influence glycemic control could prevent hyperglycemia in the postoperative period. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Milda Chmieliauskaite, Marie D. Grosh, Ali Syed, Andres Pinto Source Type: research
A Patient with a History of Multiple Myeloma Presents for the Evaluation of Oral Lesion and Burning Sensation of the Mouth
Multiple myeloma (MM) is a hematologic malignancy belonging to a class of disorders known as plasma cell dyscrasias. Common oral manifestations of MM include osteolytic lesions in the mandible and maxilla that can present as painful bony swellings, epulis formation, or sudden teeth movement. MM treatment is coordinated by a multidisciplinary team and is dependent upon the age and physical fitness of the patient, as well as the staging of the disease. A large proportion will be treated with intravenous bisphosphonates, such as pamidronate and zoledronic acid, which places the patients at high risk for developing medication-...
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Irene H. Kim, Walter W. Hong, Sophia Oak, Brad M. Hong, Mel Mupparapu Source Type: research
A Pregnant Patient with Gestational Diabetes Reports for Scaling and Root Planning
In this case a woman with gestational diabetes and otherwise healthy pregnancy needs scaling and root planning for the treatment of stage I periodontal disease during pregnancy. Her daily blood sugars are in the target range, and there are no contraindications to providing necessary dental treatment under local anesthesia with vasoconstrictors in her case. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Milda Chmieliauskaite, Marie D. Grosh, Ali Syed, Andres Pinto Source Type: research
A Patient with a Diagnosis of Gonococcal Arthritis and Symptomatic Bilateral Temporomandibular Joints Presents for Scaling and Root Planing
A young female patient presents to the dental clinic for scaling and root planing with known gonococcal arthritis. The patient is undergoing treatment for the condition with antibiotics. She endorses bilateral temporomandibular joint pain. For treatment, the scaling and root planning procedure was completed by quadrant. The patient tolerated the procedure well in this fashion. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - July 6, 2023 Category: Dentistry Authors: Roopali Kulkarni, Sunday Akintoye Source Type: research
Child Patient with a History of Status Epilepticus Referred for Management of Grossly Decayed Primary Molar
A patient with status epilepticus presents with a grossly carious primary molar. Medical consultation is requested from the patient ’s neurologist. The patient is treated in the operating room under general anesthesia for comprehensive dental care. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 26, 2023 Category: Dentistry Authors: Elizabeth Bortell, Jayakumar Jayaraman Source Type: research
A Patient with Herpes Zoster of the Maxillary Division of Trigeminal Nerve Presents for Oral Evaluation and Toothache
Herpes zoster (HZ) is an acute and painful neurocutaneous infection caused by the reactivation of a latent varicella-zoster virus in the dorsal root or cranial nerve ganglia. It is characterized by 3 stages: prodromal, acute, and chronic. During the prodromal stage, reactivation in the maxillary branch of the trigeminal nerve closely mimics odontalgia, and HZ should be in the differential diagnosis. Patients with HZ develop painful lesions following the affected dermatome. Laboratory testing confirms the diagnosis; treatment is with antiviral agents. Early detection and treatment shorten the course of the infection and les...
Source: Dental Clinics of North America - June 20, 2023 Category: Dentistry Authors: Irene H. Kim, Archana Mupparapu, Jana N. Yablonski, Mel Mupparapu Source Type: research
A Patient with Cerebral Palsy Presents for Evaluation of Third Molar Pain
Cerebral palsy (CP) is a developmental disorder caused by brain trauma in utero or within the first few days of life, although symptoms may not develop until early infancy. Each of the 4 types of CP has its own signs and symptoms and can present unique challenges to accessing and providing dental care. Providers may be reluctant to treat these individuals due to uncontrolled body movements, primitive reflexes, varying mental capabilities, seizures, visual and hearing impairments, dysphagia, and dysarthria. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 20, 2023 Category: Dentistry Authors: Alicia Risner-Bauman, Miriam Robbins Source Type: research
A Pregnant Patient (First Trimester) Reporting for Pain in Relation to the Maxillary Left First Molar Was Prescribed a Full Mouth Series Radiographs in the Dental Office
This case scenario shows the value of conducting a thorough clinical examination that will direct appropriate radiographic selection and prescription criteria to be able to arrive at a diagnosis. Proper management of a patient ’s chief complaint and imaging needs during pregnancy is of utmost importance. It is prudent to limit ionizing radiation during the first trimester to what is minimally needed and defer elective imaging until after the birth of the baby. It is important for dental health care providers to do what is necessary for the patient for the emergent situation and postpone all elective imaging and follow th...
Source: Dental Clinics of North America - June 20, 2023 Category: Dentistry Authors: Peter W. Duda, Steven R. Singer, Eman Alamodi, Mel Mupparapu Source Type: research
A Patient Who Recently Underwent Total Temporomandibular Joint Replacement Reporting for Endodontic Therapy
A patient who underwent a recent total joint replacement (TJR) of the left temporomandibular joint presents for evaluation and management of #19. The diagnosis was consistent with irreversible pulpitis, and root canal therapy was recommended. Because of the recent TJR and limitations in opening, a bite block was used during the procedure. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 20, 2023 Category: Dentistry Authors: Roopali Kulkarni, Sunday Akintoye Source Type: research
A Patient with Moderate-to-Severe Temporomandibular Joint Degenerative Joint Disease and Unilateral Joint Pain Presents for Oral Medicine Consult
A patient presents with severe one-sided temporomandibular joint (TMJ) pain. Workup reveals a diagnosis of TMJ degenerative joint disease, articular disc disorder with reduction, and myofascial pain of the muscles of mastication. The patient ’s goals were to remain noninvasive in treatment. Conservative recommendations such as physical therapy, analgesics, and current occlusal appliance wear were recommended. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 20, 2023 Category: Dentistry Authors: Roopali Kulkarni, Sunday Akintoye Source Type: research
