Supplemental Steroids and Dental Procedures
When you visit us for a dental consultation, in addition to talking to you about all your dental experiences and concerns, we'll perform a detailed examination of your systemic health. Thus we can get an accurate picture of your oral health and plan for your dental treatment.
The normal adrenal cortices produce about 20 mg of hydrocortisone daily. Any dental procedure that increases the level of physical or emotional stress can challenge the adrenal gland to produce more cortisol in order to fight that stress. Steroids suppress the body’s ability to produce cortisol thus increasing the risk of serious health consequences. A patient receiving steroids or who has received steroids for two or more week within the last 6 to 12 months must be considered to have a variable degree of functional adrenocortical suppression. These patients will need a source of exogenous glucocorticoid during stressful periods. This prevents “hypoglycemia, hypotension, shock”. Short term excess of glucocorticoids is relatively harmless, whereas short-term deficiency during stress may be fatal.
The patients previously taking daily steroids must notify the dental practitioner if he/she has been on steroids 20 mg or higher for longer than two weeks.
In such cases, oral steroid of equivalent dose may be given in a place of injection in patients able to take medication by mouth. Patient undergoing limited oral surgery under local anesthesia, doubling the daily dose the night before surgery and on the day of surgery combined with 50 mg of cortisone 1⁄2 hour before the procedure is recommended.