Steroid Supplementation in Dentistry (ADA recommendations, 1997)

• Dentist, with MD, should establish dose supplementation needed in a pt taking corticosteroids chronically… Rule: dose is increased temporarily, with subsequent decrease back to regular dose levels. E.g., dentist may administer 60mg of Prednisone to a SLE (systemic lupus erythematosus) pt taking the steroid regularly. This dose approximates the physiological amount of steroid released during “dental stress” in a normal subject
• Procedures associated with mild-moderate stress require dentist to supplement steroid (inject dexamethasone to pre treat the pt, as anti-inflammatory agent to prevent swelling).
• Usually, have pt take double their usual dose of steroid on the day of surgery or other stressful procedure, and decrease back to original dose within 2 days.
• For more severe surgical procedures, pt should be given 60mg of Prednisone (or an equivalent) on day of surgery, then taper dose by 50% daily until reqular dose is reached. (A med consult will make this decision about tapering)
• Pts who are immunosuppressed because of chronic use of steroids or because of medical conditions may also require antibiotic prophylaxis because of risk of infection.
• Low risk pts: these are pts taking steroids intermittently; no recommendations as to steroid supplementation. However, best to do dental procedures on the day pt has taken their steroid, not on the steroid-free day.

Category: Pharmacology Notes