Corticosteroids in dentistry

 Adrenal cortex-produces Glucocorticoids

 Hyperfunction of adrenal cortex-Cushing
syndrome
 Hypofunction of adrenal cortex-Addisons
disease
Indications of corticosteroids
 Allergic disorders
Asthma
 Connective tissue disorder
Rheumatoid arthritis
Systemic Lupus erythematosis
 Renal disorders
Nephrotic syndrome
Renal transplant
 GIT disorders
Ulcerative colitis
Chrons disease
 Blood dyscrasias
Idiopathic Thrombocytopenia
Lymphoma
 Adrenal insufficiency
Addison's disease
Adrenalectomy
 Mucocutaneous diseases
Pemphigus
 Post-transplantation
Any Organ transplant
 Indication in dentistry
 Lichen planus
 Pemphigus
 Benign mucous membrane pemphigoid
 Aphthous ulcer
 Oral submucous fibrosis
 Treatment of allergies
 Reduce swelling and inflammation after major surgeries
 Facial palsy
 Pulp capping- to reduce inflammation
 TMJ pain-intraarticular injection
Steroid administration in dentistry
 Topical application
 Intralesional injections
 Intra-articular injections
 Intra muscular injections
 Intravenous administration
 Oral administration
 Systemic steroid preparations
Duration of Name of drug Glucocoticoid
action potency
Cortisol (hydrocortisone) 1
Cortisone 0.8
Short acting
Prednisone 4
Prednisolone 4
Methyl prednisolone 5
Intermediate Triamcinolone 5
acting
Long acting Betamethasone 25
Dexamethasone 30
 Topical corticosteroids in dental
practice
 Fluocinolone
 Triamcinolone
 Betamethasone
 Clobetasol
 Side effects of corticosteroids:
 Moon face
 Buffalo hump
 Truncal obesity
 Increased susceptibility to infections
 Cardiovascular instability
 Change in moodspsychosis,depression,euphoria
 Change in glucose tolerance Worsen preexisting DM
 Fluid retention
 Hypertension
 Gastric irritation with gastritis,peptic ulceration and
GIT bleeding
 Tendency to bruise easily and poor wound healing
 Proximal muscle weakness
 Weight gain
 Osteoporosis
 Pathologic fractures
 Premature development of cataracts
Contra indications
 Tuberculosis
 Local or systemic infections
 Diabetes Mellitus
 Peptic ulcer
 Renal dysfunction
 Hypertension
 Congestive heart failure
 Glaucoma
 Thromboembolic disorders
 Osteoporosis
 Mental disease
 General guide lines for the dental
management of pts with steroid therapy
 Steroid supplements in patients who can develop
adrenal insufficiency
 Early morning appointments
 Shorter appointments
 Minimize stress
 Use of sedation technique
 Modify treatment plan
 Avoid precipitation of adrenal insufficiency
 If needed antibiotics should be given
 Management of patients with a history of systemic corticosteroid
No steroids Steroids taken during Steroids currently taken
for previous 12 months
previous
12 months
Restoratio No cover Usual Oral steroid in Double oral
ns/single required morning/Hydrocortis steroid/Hydrocortisone 25-
extraction one 25-50mg IV 50mg IV preoperatively
under LA preoperatively continue normal steroid
medication postoperatively
Multiple Consider Give usual steroid in Double oral steroid+
extraction cover if morning+ Hydrocortisone 25-50mg IV
,surgery large hydrocortisone 25-50 preoperatively & IM 6hrly for
under GA doses are mg IV preoperatively 24 hrs then continue normal
given &IM 6hrly for 24 hrs. medication
Maxillofaci Consider Give usual steroid in Double oral steroid+
al surgery cover if morning+ Hydrocortisone 25-50mg IV
or trauma large hydrocortisone 25-50 preoperatively & IM 6hrly for
doses are mg IV preoperatively 72 hrs then continue normal
given &IM 6hrly for 72 hrs medication
Alternate day therapy
 A single dose of short acting steroid is
administered on alternate mornings in
quantities equivalent to a total dose
ordinarily employed over a 48 hour
period
 Adrenal crisis
Sign
 Rapid loss of consciousness

 Pallor of skin

 Rapid ,weak pulse

 Hypotension

Management
 Lay patient flat and raise legs

 Administer oxygen

 200 mg Hydrocortisone IV

 Transfer to hospital
Thank you