It is imperative to remember that emergency treatment for hypoglycemia is immediate administration of glucose. For the conscious patient, fruit juice or glucose paste concentrate administered sublingually is recommended. For the unconscious patient, activating the dental team’s emergency system is prudent, followed by sublingual glucose administration.
The best time to treat a patient with type 1 DM is in the morning, after they have taken insulin and eaten breakfast. This timing helps to ensure adequate glucose in the blood to prevent hypoglycemia. As food is metabolized and insulin activity lowers blood sugar, the patient can pass through various suboptimal glycemic levels.
PITUITARY DISORDERS
all of its hormones. This section will focus on hypopituitarism and its effects on oral health in children. A diagnosis of growth hormone deficiency is made when a child exhibits significant delayed growth, increased fat deposition around the face and waist, delayed onset of puberty, and delayed tooth development. This condition occurs in approximately 1 in 4,000 live births, with a definitive diagnosis being made by measuring the insulin- stimulated release of growth hormone from the pituitary over time. The causes of growth hormone deficiency include central nervous system tumors, perinatal trauma and infection, radiation treatment, and even an inadequate response to normal growth hormone levels (Aguiar-Oliveira & Bartke, 2019; Ranke, 2021). responsible for proper glucose metabolism by stimulating gluconeogenesis in the liver, as well as regulation of blood pressure and the immune response. Cortisol levels are usually measured when a pituitary disorder is suspected. In the unaffected patient, the adrenal cortex releases about 20 mg of cortisol daily into the circulation. During times of stress, five or more times as much cortisol can be released, allowing maintenance of blood pressure and ensuring that adequate energy in the form of glucose is available for use by the body. steroid dose prior to surgical procedures for patients with adrenal cortical insufficiency. In fact, recent studies failed to establish that additional steroids are indicated during oral and maxillofacial surgery and routine dental treatment (Bin et al., 2021; Bowden, 2023). The astute oral healthcare provider should be alert for the signs and symptoms of a pediatric patient with suspected growth hormone deficiency. There could be many causes for retained deciduous teeth, and inadequate growth hormone should be included in the differential diagnosis if the patient has not yet been diagnosed with the disorder. Other findings include delayed tooth development, oligodontia, enamel hypoplasia, and an increased prevalence of malocclusion. The mandible is more commonly affected than the maxilla by the absence of the normal growth hormone levels that account for malocclusion (Torlinska- Walkowiak et al., 2021).
The pituitary is a pea-sized gland located at the base of the skull. It consists of two lobes connected by an intermediate section. The pituitary communicates with the hypothalamus gland via a neurovascular bundle. The anterior pituitary, called the adenohypophysis , produces six hormones: Growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. The posterior lobe, or neurohypophysis, is responsible for the production of antidiuretic hormone and oxytocin. The sole product of the intermediate section is melanocyte-stimulating hormone, which influences skin pigmentation. There are many types of pituitary disorders. The most common is hypopituitarism, a condition in which the pituitary gland fails to produce normal amounts of some or Medical considerations/current medical therapies The typical treatment for growth hormone deficiency is subcutaneous injection of somatotropin (Deal et al., 2022). If the patient responds to this therapy, it is continued until they reach adequate height and development according to published norms. Of children with growth hormone deficiency, it has been reported that between 1 out of 4,000 and 1 out of 10,000 cases also have inadequate thyroid-stimulating hormone and adrenocorticotropic hormone (ACTH) production (Bosch et al., 2021). In response to ACTH, the adrenal glands release cortisol into the systemic circulation. Cortisol is Dental treatment implications For the oral health practitioner, it is critical to identify the patient who is being treated with steroid therapy, which may have affected ACTH production. For procedures that will be moderately to severely stressful, such as bony impacted third molar removal, especially under intravenous conscious or deep conscious sedation, additional steroids should be considered in consultation with the treating physician. The rule of thumb is that when patients have received cortisol- equivalent steroids in daily doses of 20 to 60 mg for at least 2 weeks within the past 2 years, additional steroids may be necessary to counteract adrenal cortical insufficiency. This condition occurs when exogenous steroids depress the ability of the adrenal glands to increase production of cortisol to meet the body’s needs. For most procedures, including routine scaling and root planning, operative dentistry, endodontics, and even simple extractions, the effects of adrenal cortical insufficiency do not warrant additional steroid administration. There is continued debate in medicine and dentistry as to the validity of increasing
BLEEDING DISORDERS
portion of the population with bleeding disorders, even routine procedures can lead to excessive bleeding, poor healing, and serious complications. Dentists must be aware of the effect of bleeding disorders in order to safely manage their patients. In normal conditions, when a blood vessel is damaged, the body responds through a series of events to stop the bleeding. Hemostasis is accomplished via two independent
Hemostasis is the stopping of bleeding or blood flow. There are three mechanisms that work together to stop the flow of blood. They are vasoconstriction, platelet plug formation, and coagulation. Various procedures in dentistry—such as extractions, periodontal surgery, and administration of local anesthesia—may cause bleeding. Under normal circumstances, the postoperative bleeding is nonproblematic and self-limiting. However, for the small
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