Table 3.85.

Key considerations for dental management in hypothyroidism (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Myxoedematous coma; hypotension; anaemia; ischaemic heart disease
Appropriate dental care	2	Delay elective dental treatment until the patient rendered euthyroid
Pain and anxiety control
– Local anaesthesia	1
– Conscious sedation	1	Avoid benzodiazepines and opioids
– General anaesthesia	3/4
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	0
Treatment modification
– Oral surgery	2	Rarely, acquired von Willebrand disease can cause bleeding tendency
– Implantology	2
– Conservative/Endodontics	1
– Fixed prosthetics	1
– Removable prosthetics	1
– Non-surgical periodontology	2
– Surgical periodontology	2
Hazardous and contraindicated drugs	2	Avoid benzodiazepines, opioids and povidone-iodine

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.