Thyroid Disease and Oral Health

In this article:

• Dental issues and hypothyroidism

• Dental issues and hyperthyroidism

• Do dental issues cause thyroid dysfunction?

• Strategies for better dental health

The thyroid is a small, butterfly-shaped endocrine gland located at the base of the neck, responsible for metabolism, growth, and development in every cell in the body. When the thyroid does not function correctly, virtually every system in the body is affected, including the mouth.

Yet, when we think of thyroid disease, we rarely think of our dental health. Instead, we pay attention to our weight issues, cardiovascular symptoms, digestive ailments, fatigue, and temperature dysfunction. However, when it comes to optimizing your thyroid health, you also need to make sure you take care of your oral health. 

Dental issues and hypothyroidism

The most common thyroid disease is hypothyroidism, which is when the thyroid produces too little thyroid hormone. Our cells need thyroid hormone to dictate our metabolic rate and to regulate developmental processes. When we do not have enough thyroid hormone, it can lead to a general slowing of body systems. 

Hypothyroidism can cause several oral health problems, including:

• Enlargement of the salivary glands

• Poor gum health (periodontal disease)

• Tongue enlargement (macroglossia)

• Too little enamel (enamel hypoplasia)

• Altered taste

• Thick lips

• Mouth breathing

Infants with congenital hypothyroidism can also have oral health issues, including a very small lower jaw (micrognathia) and slowed tooth eruption.

In general, an underactive thyroid puts you at risk for slower healing time, poor gum health, and changes in your tooth composition. 

 Dental issues and hyperthyroidism

Hyperthyroidism is where the thyroid produces too much thyroid hormone. Graves' disease (an autoimmune disorder), thyroid nodules, and thyroiditis are the most common causes of hyperthyroidism. Where a general slowing of body systems characterizes hypothyroidism, hyperthyroidism is just the opposite: the body systems speed up. Thus, common symptoms include a rapid and irregular heartbeat, weight loss, nervousness, and heat sensitivity. 

Hyperthyroidism can cause oral health problems as well, including:

• Increased risk for tooth decay (also known as dental caries)

• Heightened risk for gum disease

• Burning mouth syndrome

• Osteoporosis of the jaw

Additionally, people with hyperthyroidism are more likely to develop other autoimmune disorders like Sjogren's syndrome or systemic lupus erythematosus, which can affect your connective tissues in your jaw and face. 

Dentists should feel your glands and lymph nodes as part of their dental exam. If you have hyperthyroidism, your doctor may feel an enlarged thyroid gland when palpating your neck. 

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Can dental issues trigger thyroid dysfunction?

Hashimoto's thyroiditis is an autoimmune disorder that damages the thyroid gland. Autoimmunity occurs when immune cells attack healthy tissue instead of protecting it, leading to chronic inflammation.

In Hashimoto's thyroiditis, immune cells mistakenly attack the healthy thyroid tissue, causing inflammation of the thyroid. This damage can eventually lead to inadequate thyroid hormone production (hypothyroidism).

Researchers aren't entirely sure why the immune system, which is supposed to defend the body from harmful viruses and bacteria, sometimes turns against the body's healthy tissues.

Some scientists think a virus or bacterium might trigger the response, while others believe it may involve a genetic flaw. A combination of factors—including heredity, sex, and age—may determine your likelihood of developing the disorder.

In the case of dental health, something like an infection, metal filling, dental x-ray, or fluoride could trigger an autoimmune response like Hashimoto's.

Infections

Dental infections like gingivitis or periodontitis most often happen when bacteria invade the pulp (the portion of the tooth that is alive) and spread to surrounding tissues. These infections may be due to tooth decay, trauma, or dental procedures. Infections like these may trigger thyroid autoimmunity. It's wise to regularly see your dentist to stay on top of your dental health, check for dental infections, and create a dental care plan.

Metal fillings

Dental amalgam is a dental filling material use to fill cavities. Amalgam is a mixture of metals, including liquid mercury and a powdered alloy of silver, tin, and copper. About half of dental amalgam is elemental mercury by weight. Studies show that high levels of mercury may negatively affect thyroid hormone levels. Still, other studies show no statistically significant relation of mercury from amalgam with Hashimoto's thyroiditis. That said, because there is an association between a high level of mercury and thyroid dysfunction, you can still test for hypersensitivity to metals. This information may help you determine if you should ask your dentist to remove and replace your metal fillings with porcelain, ceramic, or composite restorations.

Dental X-rays

An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radiation. Research shows that radiation exposure may cause various thyroid problems, including hypothyroidism, hyperthyroidism, and thyroid neoplasia. If dental x-rays are needed, ask the technician to use a thyroid shield or guard in addition to the chest guard. You can also purchase a thyroid guard to bring with you to appointments.

Flouride

Fluoride may affect thyroid function because it shares similar properties with iodine. Both of these elements are part of the same group on the periodic table known as halogens. Iodine doesn't occur naturally in the body, so people must ingest iodine in their diet. Without iodine, the thyroid cannot make thyroid hormones. Because fluorine is structurally similar to iodine, it may take up receptor sites in the thyroid gland, inhibiting iodine absorption, which may, in turn, cause iodine deficiency. Today, fluoride is in nearly every toothpaste, and most Americans using public water sources drink fluoridated water to help prevent tooth decay.

Additional sources of fluoride include:

• Many dental products

• Many processed foods and beverages

• Some pesticides to kill insects and pests

• Tea and coffee plants absorb fluoride from the soil

• Some dietary supplements

• Many pharmaceutical drugs

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Some people notice an improvement in their thyroid symptoms and thyroid hormone levels when they remove halogens from their lifestyle. One step is to switch to a fluoride-free toothpaste. Another is to use household water purification systems like reverse osmosis, electrodialysis, activated carbon, or other adsorption/ion-exchange methods to remove fluoride from your lifestyle.

Strategies for better dental health

Whether you have hypothyroidism or hyperthyroidism, it can compromise your oral health unless you actively take care of your mouth and your thyroid. Employ the following strategies to reduce your risk of poor dental health:

Meet with your thyroid doctor

Keeping your thyroid hormones in check is the key to managing all thyroid symptoms, including oral health problems. Make sure you see your thyroid doctor to assess your symptoms and check your thyroid function.

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Take your thyroid medication correctly

If you have a thyroid condition, you will likely be on thyroid medication. Keep in mind certain things can affect your thyroid medication, which can make it less effective. Thus, you will want to take your thyroid medication correctly. 

See your dentist regularly

Preventative oral health exams and cleanings can reduce your risk for gum disease, tooth decay, and oral cancers. Dentists receive training to feel and look for other conditions of the face, head, and neck.

Try biological dentistry

Biological dentistry is a type of dentistry that considers oral health in relation to the health status of the rest of the body. Biological dentists work to prevent health problems from exposure to specific procedures and materials like amalgam fillings. Visit the International Academy of Oral Medicine & Toxicology's website to find a biological dentist in your area.

Inform your dentist of your thyroid condition

If you have a thyroid condition, your dentist needs to know so they can treat you appropriately. For example, if you do not tell your dentist about your thyroid condition, you may be at greater risk for infection and delayed healing time after a dental procedure. Similarly, your dentist will pay closer attention to monitoring for tooth decay and gum disease.

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Practice good dental hygiene

Of course, we need to brush and floss our teeth daily to gets rid of the germs and plaque that accumulate throughout the day—especially the stuff in between our teeth! We can also take additional measures to eliminate pathogenic bacteria, including:

• Oral irrigation, or water-picking: A stream of high-pressure pulsating water to remove debris between the teeth and below the gum line

• Oil pulling: A traditional folk remedy in which edible oil is swished around in the mouth and then spit out

• Oral probiotics: Probiotic bacteria may help displace pathogenic bacteria and reduce inflammation in the mouth

A note from Paloma Health

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We believe that thyroid health equates to whole-body health. Meet with a trustworthy thyroid doctor to optimize your thyroid function and start feeling better—faster!

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