Concluded Case

HYPOTHYROIDISM WITH DELAYED ERUPTION OF TEETH.

Patient complaint of presence of multiple milky teeth since 15-20 years and wanted to get them removed. History revealed that patient had visited a local dental practitioner for cleaning of his teeth 2 year back, after which he was informed about the presence of deciduous teeth and few missing permanent teeth in the mouth. He gave history of bleeding gums on brushing since 1 year which has decreased now. Patient was known case of controlled hypothyroidism since 7 years and was on regular medication for the same (Tab. Thyronorm 100mg once daily). History of weight loss, lethargy, excessive sleeping habits 16- 17 Hours/day. H/O peripheral oedema along with puffy eyelids. Intraorally, yellowish granules were present w.r.t right & left side of buccal mucosa along with macroglossia. Based on history and clinical examination provisional diagnosis of delayed eruption with primary hypothyrodism was made. Thyroid investigations were done by Chemiluminesence Serum Method, which revealed; T3 test: 106.84 nmol/l (1.30-3.20); T4 test: 10.04 nmol/l (66-181); TSH: 0.08 micro IU/ml (0.35-5.50). Radiographically, Maxillary Cross Sectional View shows tooth like radioopacity can be seen on palatal aspect of retained deciduous canine bilaterally s/o of impacted permanent max.canine bilaterally. Similarly tooth like radioopacity also seen on palatal aspect of 1st & 2nd deciduous molars s/o impacted 1st and 2nd permanent premolars. Radioopacity can also be seen on 27 teeth region embedded in alveolar bone s/o impacted permanent second molar. OPG Revealed that In max. arch only C.I & 1st molar can be seen erupted as permanent teeth expect for L.I which are congenital missing bilaterally and where as other permanent teeth can be embedded in alveolar bone s/o delayed eruption of permanent teeth & multiple retained deciduous teeth. In mandibular arch only C.I & rt. L.I can be seen erupted as permanent teeth & where as other permanent teeth can be embedded in alveolar bone s/o delayed eruption of permanent teeth & multiple retained deciduous teeth. In lateral Ceph, which shows multiple retained deciduous teeth& impacted permanent teeth could be seen s/o delayed eruption of permanent teeth. Similarly in PA skull view multiple retained deciduous teeth seen. In Differential Diagnosis, 1).Nutritional deficiency, 2).Cleidocranial dysplasia and 3).Rickets were considered. Based on investigations, final diagnosis of Hypothyrodism associated with delayed eruption of teeth was made. In the treatment plan multidisplinary approach was followed as extractions of multiple retained deciduous teeth were done and was referred to orthodontist for further treatment. Also patient was referred to endochrinologist for treatment hypothyrodism & was kept on regular follow up. Thank you.

(Edited)

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Concluded answer
@Dr. Saloni Arora ROLE OF A DENTIST: 1) Dentist may be the first to SUSPECT a thyroid disorder and aid in early diagnosis And should consult ENDOCRINOLOGISTS. 2) If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed. 3) As the thyroid is extremely sensitive to radiation, one way the dental professional can protect the thyroid gland is to use a thyroid collar while taking patient X-rays.  @Dr. Saloni Arora In an addition we can take Handwrist RG as well in which we can appreciate BONE GROWTH...
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Impeccable case presentation @Dr. Saloni Arora . Thank you for sharing. Deficient thyroid hormone secretion leads to common oral findings like the characteristic macroglossia, dysgeusia, delayed eruption, poor periodontal health, altered tooth morphology and delayed wound healing. Childhood hypothyroidism known as cretinisim is characterized by thick lips, macroglossia, malocclusion and delayed teeth eruption in advanced cases it can lead to subnormal growth of the maxilla and mandible with a marked reduction in the dimensions of the facial complex and lack of coordination between mandibular growth and dental development. Nutritional deficiency, cleidocranial dysplasia, rickets and renal failure can be considered as differential diagnosis.
Thank you so much @Dr. Kausar Yadwad for elaborating this case discussion further. Well explained.
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What that patient was doing since so many years. Hypothyroidism is a preventable disease. It has impact on patient well being too. Particularly mental retardation n slow growth . Anyways a well presented case . Plus good d/d too. Vit d3 deficiency should also b considered in delayed eruption of teeths. Thank u dr arora for sharing the case. U r a gem .
Thanks alot @Dr. Nitesh Prasad Sir for appreciating. Regards.
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@Dr. Saloni Arora ROLE OF A DENTIST: 1) Dentist may be the first to SUSPECT a thyroid disorder and aid in early diagnosis And should consult ENDOCRINOLOGISTS. 2) If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed. 3) As the thyroid is extremely sensitive to radiation, one way the dental professional can protect the thyroid gland is to use a thyroid collar while taking patient X-rays.  @Dr. Saloni Arora In an addition we can take Handwrist RG as well in which we can appreciate BONE GROWTH...
Absolutely @Dr. Haritma Nigam mam, well explained.
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Very well presented case @Dr. Saloni Arora .. hypothyroidism has noticeable clinical features but this finding of retained teeth amazed me. Did the patient had macroglossia? Also appreciate your differential diagonosis.
Good question @Dr. Ashish Tiwari , I forgot to mention this finding, just uploaded picture of macroglossia too. Thanks for appreciating.
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Very good and informative case with challenging case for treatment aesthetically
Thank you doctor
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Excellent case and diagnosis skills @Dr. Saloni Arora
Thank you doctor
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Wow what a case presentation. Kudos to u. Thanks for enlightening me
Thank you so much @Dr. Shaleen Bhatia Sir.
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VERY NICELY EXPLAINED..... AND USEFUL UPDATE.....
Thank you @Dr. Dinesh Gupta Sir.
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Very good case at present TFT are controlled
Thank you so much @Dr. Pk Jain Hrh Sir. Regards
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very informative excellent case dr.
Thank you @Dr. Ajay Upadhyay Sir.
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