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Alhendi F. Restorative Dental Treatment and Endodontic Surgery in a Pregnant Patient Receiving Corticosteroids. Dent Clin North Am 2023; 67:711-712. [PMID: 37714631 DOI: 10.1016/j.cden.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Corticosteroid therapy (CST) can be used to treat complicated pregnancy. Second trimester of pregnancy is the preferred period to perform dental treatments. The long-term use of CST may result in hyperglycemia, hypertension, immunosuppression, and adrenal suppression, which, theoretically, may cause adrenal crisis during surgical procedures. The risk of adrenal crisis at the dental clinic caused by exogenous CST depends on the dosage, duration of treatment, route of administration, frequency, time lapse since the last dose, and type of procedure performed. Current evidence found that patients on CST undergoing general dental procedures or minor surgical procedures under local anesthesia do not require supplementary corticosteroids.
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Affiliation(s)
- Fatmah Alhendi
- Ministry of Health, AlSulaibikhat, Jamal Abdulnasser Street, PO Box 5, Zip Code 13001, Kuwait.
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2
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Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
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Guabello G, Zuffetti F, Ravidà A, Deflorian M, Carta G, Saleh MHA, Serroni M, Pommer B, Watzek G, Francetti L, Testori T. Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress. Periodontol 2000 2023; 92:329-349. [PMID: 37350348 DOI: 10.1111/prd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.
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Affiliation(s)
- Gregorio Guabello
- Endocrinology Unit, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Francesco Zuffetti
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Andrea Ravidà
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Matteo Deflorian
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
| | - Giorgio Carta
- Argo Academy International Research Bologna, Bologna, Italy
- Private Practice, Bologna, Italy
- Lake Como Institute, Como, Italy
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine & Dentistry, University 'G. D'Annunzio', Chieti-Pescara, Italy
| | - Bernhard Pommer
- Academy for Oral Implantology, Vienna, Austria
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Luca Francetti
- IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Tiziano Testori
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Galeazzi Sant'Ambrogio Hospital, Dental Clinic, Milan, Italy
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Ramasamy A, Madhan B. Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids: A triple-blinded, randomized, placebo-controlled trial. J Am Dent Assoc 2023; 154:373-383.e3. [PMID: 36966086 DOI: 10.1016/j.adaj.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Patients undergoing long-term glucocorticoid therapy are administered additional glucocorticoids before minor dental procedures, although this is not supported by evidence. The authors designed this study to validate the hypothesis that routine blanket glucocorticoid supplementation is unnecessary during minor oral surgical procedures under local anesthesia. METHODS The authors recruited 270 patients into 3 groups (1:1:1 allocation) from the dental outpatient department. Primary outcomes were changes in hemodynamic parameters and frequency of adverse events among the 3 groups. The secondary outcome was the association of preprocedural stress and procedural pain with periprocedural adverse events in the long-term glucocorticoid therapy group (groups I and II). RESULTS No clinically relevant changes in hemodynamic parameters among the 3 groups were found. The authors also found low periprocedural adverse events in all 3 groups combined (n = 1), so they did not explore the secondary outcomes further. CONCLUSIONS Among patients undergoing long-term glucocorticoid therapy for indications other than primary adrenal insufficiency, elective minor oral surgical procedures can be performed safely with only their daily dose of glucocorticoid when their medical conditions are optimized. Routine additional glucocorticoid supplementation appears unnecessary. The results of the study also revealed opportunities for value addition by means of integrating oral health care with medical follow-up for patients with multiple co-occurring medical conditions. PRACTICAL IMPLICATIONS Routine blanket glucocorticoid supplementation among patients taking a long-term glucocorticoid for indications other than primary adrenal insufficiency appears unnecessary before minor oral surgical procedures under local anesthesia. This clinical trial was registered at Clinical Trial Registry-India. The registration number is CTRI/2017/02/007779.
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Gaw AG, Wemyss C, Bell A, Goodall CA. Management of patients at risk of adrenal crisis in the dental setting: a review of current practice in UK dental teaching hospitals. Br Dent J 2022:10.1038/s41415-022-4515-0. [PMID: 35931749 DOI: 10.1038/s41415-022-4515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022]
Abstract
Introduction Patients with impaired corticosteroid response due to Addison's disease or systemic glucocorticoid use are at risk of adrenal crisis when undergoing dental treatment. There is a lack of conclusive evidence to support dental teams in identifying patients at risk and their management to prevent an adrenal crisis.Aim To review the current practice in UK dental teaching hospitals regarding the management of patients at risk of adrenal crisis in the dental setting.Methods An electronic survey focused on patients who may be at risk of adrenal crisis due to systemic glucocorticoid therapy was sent to all 18 UK dental teaching hospitals. Information on the use of a policy or guidance was requested. Responses were evaluated for clinical decision-making, patient risk assessment and steroid cover dosing regimens.Results A 78% response rate was achieved. Only 29% of institutions had a written policy or guidance document. Variation exists in the threshold of steroid dose and duration of treatment in identifying patients at risk of adrenal suppression. Furthermore, the dose regime for steroid cover varied.Conclusion Further evidence on the management of patients at risk of adrenal crisis is required to inform national guidance and reduce variation in patient management.
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Affiliation(s)
- A Gemma Gaw
- Dental Core Trainee in Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Larbert, UK.
| | - Callum Wemyss
- Speciality Registrar in Oral Surgery, Glasgow Dental Hospital and School, Glasgow, UK
| | - Aileen Bell
- Professor of Oral Surgery and Dental Education, Honorary Consultant in Oral Surgery and Head of Dental School, School of Medicine Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christine A Goodall
- Professor of Oral Surgery and Violence Reduction, Honorary Consultant in Oral Surgery, School of Medicine Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Affiliation(s)
- G Gaw
- By email, Forth Valley, UK
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van Dijk WEM, van Es RJJ, Correa MEP, Schutgens REG, van Galen KPM. Dentoalveolar Procedures in Immune Thrombocytopenia; Systematic Review and an Institutional Guideline. TH OPEN 2021; 5:e489-e502. [PMID: 34805736 PMCID: PMC8595053 DOI: 10.1055/a-1641-7770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background
Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding due to thrombocytopenia and infection due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients to create practical recommendations.
Methods
PubMed, Embase, Cochrane, and Cinahl were searched for original studies on dentoalveolar procedures in primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention.
Results
Seventeen articles were included, of which 12 case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of the preoperative platelet count was 2 to 412 × 10
9
/L. Two clinically relevant bleedings (2%) were reported in the same patient of which one was life-threatening. Strategies used to minimize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures, and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking.
Conclusion
Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.
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Affiliation(s)
- Wobke E M van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria E P Correa
- Oral Medicine Ambulatory, Hematology and Hemotherapy Center, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Roger E G Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin P M van Galen
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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Cortisol in Oral and Maxillofacial Surgery: A Double-Edged Sword. Int J Dent 2021; 2021:7642875. [PMID: 34545286 PMCID: PMC8448991 DOI: 10.1155/2021/7642875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Abstract
Cortisol is a hormone that is naturally produced by the zona fasciculata of the cortex in the adrenal gland. One of its main functions is to decrease inflammation, particularly in areas where an inflammatory response is not necessary. In the field of oral and maxillofacial surgery, cortisol is used to improve the outcomes of surgical procedures and to make the postoperative period more comfortable for the patient. However, cortisol is considered a double-edged sword because its use is associated with both benefits and adverse effects. It is imperative to use cortisol following an accurate diagnosis, in addition to clarity regarding the desired surgical procedure for treating the acute or chronic condition affecting the patient. When used with caution, cortisol can serve as a valuable agent for reducing the postoperative inflammatory response in patients undergoing moderate as well as moderately severe surgical procedures.
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The Effect of Mouthrinse with 0.05% Dexamethasone Solution on the Oral Bacterial Community of Oral Lichen Planus Patients: Prospective Pilot Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11146286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Few studies have already been performed to assess oral bacteria during steroid therapy for oral lichen planus (OLP). Thus, the aim of our study was to analyze the effect of dexamethasone mouthrinse treatment on the oral bacteria of OLP patients. This prospective study was conducted on patients who were diagnosed with OLP and treated with 0.05% dexamethasone mouthrinse twice per day for 4 weeks. Using unstimulated saliva of the patients before and after treatment, the qualitative and quantitative changes in oral bacteria were analyzed using quantitative real-time polymerase chain reaction (qPCR). The qPCR results were analyzed using Wilcoxon signed-rank test to the quantitative changes with dexamethasone mouthrinse. The statistical significance was considered at a level of 0.05. In total, 20 patients were enrolled in this study, wherein all were noted to show improved symptoms of OLP. Fifteen patients (75%) had a qualitative change in the oral microbial species and an improved relative periodontitis risk score (from 26.1 ± 10.7 to 20.9 ± 9.2; p = 0.008). However, quantitative changes in all species were determined to be not statistically different before and after the treatment. Most OLP patients had a changed microbial community composition after 0.05% dexamethasone mouthrinse for 4 weeks. In particular, the composition of the periodontopathic bacteria was improved after the treatment.
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10
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The Effects of Prednisone/Ketoprofen Administration in Association with Amoxicillin Clavulanate Following Periodontal Surgical Therapy in Patients with Severe Chronic Periodontitis. ACTA ACUST UNITED AC 2021; 57:medicina57050447. [PMID: 34064493 PMCID: PMC8147920 DOI: 10.3390/medicina57050447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate and compare the effects of two different anti-inflammatory drugs (ketoprofen and prednisone) combined with an antibiotic (amoxicillin + clavulanic acid) and periodontal surgery on dental and periodontal parameters in patients with severe chronic periodontitis. In addition, salivary stress expressed by cortisol levels was assessed. Materials and Methods: An interventional study was performed on 22 periodontal subjects and 19 clinical healthy controls. The patients were divided in four groups, depending on treatment planning, as follows: eight patients received prednisone and antibiotherapy, associated with surgical periodontal therapy; seven patients received ketoprofen and antibiotherapy, associated with surgical periodontal therapy (group II); seven patients received only prednisone. Periodontal healthy patients underwent routine scaling and polishing. Bleeding on probing (BOP), dental mobility and salivary cortisol (ng/mL) were assessed before and after treatment. The means and standard deviations for the salivary cortisol levels (SCLs), dental and periodontal parameters were calculated for all groups using each patient as a unit of analysis. Results: Data analyses showed that the two different anti-inflammatory drugs associated with or without surgical therapy were efficient on inflammation periodontal parameters (BOP, dental mobility). Prednisone treatment alone was associated with a significant decrease of SCLs between pretreatment and post-treatment. Conclusions: In the present study, the effects of either of the anti-inflammatory drugs on inflammation evolution and salivary stress were comparable in patients undergoing antibiotherapy and surgical periodontal therapy.
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Alawsi F, Sawbridge D, Fitzgerald R. Orthodontics in patients with significant medical co-morbidities. J Orthod 2020; 47:4-24. [PMID: 32985344 DOI: 10.1177/1465312520949881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A wide variety of patients with medical co-morbidities may present to general orthodontic practice. It is important for the treating clinician to have a general understanding of key medical conditions that may impact upon the treatment and management options. This clinical supplement provides a treatment-focused summative update for the orthodontist regarding significant medical co-morbidities, their general prevalence and an exploration of potential impacts upon orthodontic treatment. This review also discusses the significance of key medications and provides suggestions for the safe provision of orthodontic treatment.
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Affiliation(s)
- Fahad Alawsi
- Orthodontic Department, Royal Preston Hospital, Preston, UK
| | - David Sawbridge
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rhian Fitzgerald
- Orthodontic Department, Royal Preston Hospital, Preston, UK.,Alder Hey Children's Hospital, Liverpool, UK
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12
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Monaghan L, Jadun S, Darcey J. Endodontic microsurgery. Part one: diagnosis, patient selection and prognoses. Br Dent J 2019; 226:940-948. [PMID: 31253911 DOI: 10.1038/s41415-019-0415-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Historically, surgical endodontics has been viewed as a treatment of last resort, mainly due to poor outcomes as a result of limitations in materials and techniques. Contemporary techniques, modern materials and better visualisation have all led to an improvement in success rates, making endodontic microsurgery a valuable treatment option to certain patients. Such advances, however, are no substitute for skill in endodontic diagnosis and treatment planning, which can often prove challenging. A variety of tools are available to test for fractures and assess both periodontal and pulpal health. More advanced techniques such as cone beam computed tomography are often invaluable in pre-surgical assessment and diagnosis. Once an accurate diagnosis has been established, a favourable prognosis is explicitly linked to careful patient selection. Orthograde treatment, or retreatment, remains the gold standard for the majority of endodontic problems. However, there are a number of indications for surgery where orthograde treatment is either impossible, or less likely to be successful. It is paramount for any clinician undertaking endodontic surgery to have a detailed understanding of the local and systemic factors associated with successful treatment. Whilst there are few absolute medical contraindications, there are a number of conditions which may influence patient management and make treatment more challenging.
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Affiliation(s)
- Liam Monaghan
- University Dental Hospital of Manchester, Orthodontic Department, Higher Cambridge Street, Manchester, UK
| | - Sarah Jadun
- University Dental Hospital of Manchester, Oral Surgery, Higher Cambridge Street, Manchester, UK
| | - James Darcey
- University Dental Hospital of Manchester, Restorative Department, Higher Cambridge Street, Manchester, UK.
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Farag AM. Head and Neck Manifestations of Endocrine Disorders. Atlas Oral Maxillofac Surg Clin North Am 2018; 25:197-207. [PMID: 28778308 DOI: 10.1016/j.cxom.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Arwa M Farag
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, DHS #638, Boston, MA 02111, USA; Department of Oral Medicine, Faculty of Dentistry, King AbdulAziz University, 1 Umm Al Muminin Road, Jeddah 21589, Kingdom of Saudi Arabia.
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Abstract
Tuberculosis (TB) is a preventable and curable infection, but remains a significant cause of death. The dental team is likely to encounter patients with a history of TB, however, at present there is limited guidance available to inform the provision of oral healthcare for this patient group. This may lead to confusion with delays in care. There is a potential health risk posed to patients and co-workers by a member of the dental team who becomes infected. TB has the potential to be a major issue for oral healthcare in the United Kingdom (UK). This paper discusses the implications for both patient care and management of the dental team.
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15
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Jovanović M, Stojanović S. Application of corticosteroids in dentistry. ACTA STOMATOLOGICA NAISSI 2018. [DOI: 10.5937/asn1878888j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Kiran MS, Vidya S, Aswal GS, Kumar V, Rai V. Systemic and Topical Steroids in the Management of Oral Mucosal Lesions. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2017; 9:S1-S3. [PMID: 29284925 PMCID: PMC5730992 DOI: 10.4103/jpbs.jpbs_91_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
From the time of its introduction in the 1040s, glucocorticoids have provided a panacea for many diseases. The therapeutic benefit of corticosteroids lies in their anti-inflammatory and immunosuppressive properties which makes them highly effective in the management of oral mucosal lesions. This article aims to present to the clinician, the plethora of options available as steroid therapy and enables one to choose based on the underlying disease and the properties of the drug.
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Affiliation(s)
- M Shashi Kiran
- Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | - S Vidya
- Department of Oral Pathology, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India
| | | | - Vinod Kumar
- Department of Dentistry, Jimma University, Jimma, Ethiopia
| | - Vineet Rai
- Department of Dentistry, Jimma University, Jimma, Ethiopia
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Hassona Y, Kasabreh N, Hammoudeh H, Scully C. Oral healthcare management in Bardet Biedl syndrome. SPECIAL CARE IN DENTISTRY 2016; 37:47-50. [PMID: 27571505 DOI: 10.1111/scd.12198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bardet Biedl syndrome is a rare autosomal recessive disorder with variable clinical presentation and challenging diagnosis. Recognition of orofacial features might help in the diagnosis. Dental management of affected patients might be complicated by renal, cardiac, metabolic, neurosensory, and cognitive defects.
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Affiliation(s)
- Yazan Hassona
- Assistant Professor, Department of Oral Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman
| | - Najla Kasabreh
- Teaching Assistant, School of Dentistry, The University of Jordan, Amman
| | - Hanin Hammoudeh
- Teaching Assistant, School of Dentistry, The University of Jordan, Amman
| | - Crispian Scully
- Codirector WHO Collaborating Centre for Oral Health-General Health and Professor Emeritus, University College London, UK
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18
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Yoshida M, Yamamoto T, Shiiba S, Harano N, Sago T, Nunomaki M, Watanabe S. Anesthetic Management of a Patient With Takayasu Arteritis. Anesth Prog 2016; 63:31-3. [PMID: 26866409 DOI: 10.2344/14-00006r1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Takayasu arteritis is a rare chronic progressive panendarteritis involving the aorta and its main branches. Anesthesia in patients with this disease can be complicated by severe uncontrolled hypertension, end-organ dysfunction, and stenosis of major blood vessels. In this case, general anesthesia was induced with sevoflurane and remifentanil without complications. To prevent intraoperative complications, we conducted intubation with a rigid video laryngoscope with careful consideration of the concentrations of analgesics and sedatives used. This case demonstrates the importance of anesthetic techniques for maintaining adequate tissue perfusion without hemodynamic changes in the anesthetic management of patients with Takayasu arteritis.
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Affiliation(s)
- Mitsuhiro Yoshida
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
| | - Toru Yamamoto
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, Yokohama, Kanagawa, Japan
| | - Shunji Shiiba
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
| | - Nozomu Harano
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
| | - Teppei Sago
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
| | - Masahito Nunomaki
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
| | - Seiji Watanabe
- Division of Dental Anesthesiology, Department of Control of Physical Function, Kyushu Dental University, Kitakyushu, Fukuoka, Japan, and
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Napeñas JJ, Kujan O, Arduino PG, Sukumar S, Galvin S, Baričević M, Costella J, Czerninski R, Peterson DE, Lockhart PB. World Workshop on Oral Medicine VI: Controversies regarding dental management of medically complex patients: assessment of current recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:207-26. [DOI: 10.1016/j.oooo.2015.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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20
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Pre- and postoperative management techniques. Before and after. Part 1: medical morbidities. Br Dent J 2015; 218:273-8. [PMID: 25766163 DOI: 10.1038/sj.bdj.2015.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/08/2022]
Abstract
This article provides readers with an overview of available evidence in relation to providing care to patients in different medical circumstances within oral surgery. There is evidence available to support discussions with patients taking particular medications (such as bisphosphonates, anticoagulants and corticosteroids) and also to try to prevent certain complications (such as 'dry socket'). In order to reduce the risks of potential morbidities, either perioperatively or postoperatively, operators must use high-quality, reliable and informed protocols, management techniques, advice and interventions to provide patients with the best care. These are used both preoperatively and postoperatively and patients should be consented appropriately, in a manner tailored to their own individual circumstances, but also using available evidence to explain the benefits and harms of any given procedure. In this short series we will outline and discuss common pre- and postoperative management techniques, protocols and instructions, and the evidence available to support these.
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Henderson S. What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure? ACTA ACUST UNITED AC 2014; 41:342-4. [PMID: 24930256 DOI: 10.12968/denu.2014.41.4.342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Patients with primary adrenal insufficiency (Addison's disease) lack the endogenous steroid hormones cortisol and aldosterone and require daily steroid therapy (usually hydrocortisone and fludrocortisone) to replace them. These patients are unable to adapt physiologically to stress and may need supplemental steroid therapy when having dental procedures, to prevent adrenal crisis. This paper provides guidance on dental procedures for which steroid supplementation may be required in patients with primary adrenal insufficiency and gives advice on doses and timing of supplementation. It does not address the management of patients with secondary adrenal insufficiency caused by long-term use of high doses of steroids. This document is for guidance only. Patients with primary adrenal insufficiency should be assessed individually as steroid requirements will vary. CLINICAL RELEVANCE Although patients with primary adrenal insufficiency (Addison's disease) are invariably very well informed about their steroid requirements prior to a dental procedure, dental staff should have an understanding of the steroid supplementation that may be required.
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Herlich A. Anesthetic emergencies in oral surgery: malignant hyperthermia, endocrinopathy, and neurologic events. Oral Maxillofac Surg Clin North Am 2013; 25:507-14, vii. [PMID: 23664228 DOI: 10.1016/j.coms.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the impressive safety of office-based anesthesia, serious emergencies still occur. Early and appropriate treatment is likely to improve outcomes. This article discusses selected emergencies with backgrounds and rationale for emergent treatment.
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Affiliation(s)
- Andrew Herlich
- Department of Anesthesiology, University of Pittsburgh School of Medicine, 1400 Locust Street, Suite 2192, Pittsburgh, PA 15219, USA.
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Adrenal crisis provoked by dental infection: case report and review of the literature. ACTA ACUST UNITED AC 2010; 110:325-9. [DOI: 10.1016/j.tripleo.2010.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 04/08/2010] [Accepted: 04/11/2010] [Indexed: 11/20/2022]
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Gonzalez-Moles MA, Scully C. HPA-suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus. J Eur Acad Dermatol Venereol 2010; 24:1055-9. [PMID: 20158585 DOI: 10.1111/j.1468-3083.2010.03591.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral topical corticosteroids have potential to produce inhibition of the hypothalamus-pituitary-adrenal (HPA) axis. OBJECTIVE To assess whether clobetasol propionate (CP) in aqueous solution causes HPA inhibition. PATIENTS AND METHODS Sixty-two patients with oral lichen planus or oral lichenoid lesions presenting with severe lesions were treated with topical oral 0.05% CP plus 100,000 IU/cm(3) nystatin in aqueous solution. Initial treatment of three 5-min mouthwashes (10 mL) daily was reduced, when the response was deemed complete or excellent, to a maintenance treatment of one 5-min mouthwash on alternate days for 6 months; treatment was then withdrawn and patients were followed up for 1 year. HPA function was assessed by plasma cortisol measurement and adrenocorticotropin (ACTH) stimulation at the end of the initial and maintenance treatment regimens. RESULTS The HPA axis was more frequently inhibited during initial (53/62; 85.5%) vs. maintenance (2/49; 4%) regimens of aqueous CP. LIMITATIONS In patients with morning plasma cortisol levels between 3 and 18 microg/dL, a normal result for the ACTH stimulation test only moderately reduces the possibility that a patient has secondary adrenal insufficiency. This can be considered a minor limitation in our study, as only three patients required additional assessment with the ACTH stimulation test. CONCLUSIONS Hypothalamus-pituitary-adrenal inhibition is substantial during initial treatment with aqueous CP three times daily.
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Affiliation(s)
- M A Gonzalez-Moles
- Oral Medicine Department, School of Dentistry, Granada University, Granada, Spain.
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Abstract
This article is divided into three time periods according to the different phases of cancer treatment: pre, inter, and postcancer therapy. The purpose of dental protocols prior to cancer therapy and the incidence and management of acute and long term oral complications from cancer therapy in the pediatric population are discussed.
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Affiliation(s)
- Catherine H Hong
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28232-2861, USA.
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