Perioperative Corticosteroid Supplementation and Dento-alveolar Surgery

Abstract

Patients are referred to hospital for dento-alveolar surgical procedures requiring supplemental corticosteroid administration. However, it has been reported that medically compromised patients who require routine dental treatment are being referred unnecessarily. This article reports a retrospective study undertaken at a Regional Maxillofacial Unit over a 24-month period, which reveals the referral pattern and management of patients specifically referred for outpatient dental treatment with corticosteroid supplementation. The paper highlights the dilemma confronting practitioners when reviewing the literature on corticosteroid supplementation and the confusion that still exists in both the primary and secondary care settings as to which patients should be prescribed supplemental corticosteroids. A simplified guide is proposed for the clinical management of these patients.

HPA‐suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus

“…Hypothalamus-pituitary-adrenal axis inhibition is an important issue for the management of patients with severe OLP or OLLs, as there is a risk of Addisonian collapse and the consequent glucocorticosteroid dependence might mandate additional glucocorticosteroid coverage for these patients in stressful clinical situations such as trauma, surgery or severe infections, 22,23 although this is controversial. 24 A few (8%) of the patients using aqueous CP presented with cushingoid features in the initial stages of treatment with CP in aqueous solution, as previously reported, 1 supporting the fact that CP in aqueous solution is absorbed systemically and can inhibit the HPA axis.…”

The use of corticosteroids in the lateral sinus augmentation surgical procedure: A systematic review and meta‐analysis

“…To avoid these side effects, it would be advisable not to administer corticosteroids in patients who are concurrently taking steroid doses for other pathologies, moreover, the most recent evidence-based guidelines advise against this practice. 59,60 Corticosteroids administration may also inhibit fibroblasts activity and proliferation 61,62 causing delayed wound healing and increased rate of infections. The current review gives data in favor of this hypothesis, reporting the highest number of wound dehiscences in the study with the longest duration of corticosteroid therapy.…”

“…However, the dosage and time required to reach these serious consequences are beyond those used in oral surgery. To avoid these side effects, it would be advisable not to administer corticosteroids in patients who are concurrently taking steroid doses for other pathologies, moreover, the most recent evidence‐based guidelines advise against this practice 59,60 …”

The use of topical corticoids in oral pathology

“…Generally speaking, the usual dental procedures (extraction, curettage, gingivectomy, etc.) do not appear to require an exogenous supply of glucocorticosteroids in patients with inhibition of the hypothalamic-pituitary-adrenal axis (13)(14)(15).…”