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1. TS
IEN
OF PAT DS
T
EN STER OI
EM CO
AG RTI
M AN CO
ON
PRESENTED BY:
SUKESH KUMAR
REG NO:0798083

2. INTRODUCTION
 Clinical application of corticosteroid
 Complication of corticosteroid
 Dental uses of corticosteroid
 Management of corticosteroid-use dental patients

3. Introduction
 Adrenal gland: Cortex and Medulla
 Adrenal cortex: 3-layer
Outer: zona glomerulosa:
Middle: zona fasciculata
Inner: zona reticularis

5. Functions of corticosteroid
 Regulation of carbohydrate, fat, protein.
 Anti-inflammation action by inhibit lysosome,
prostaglandin, cytokines release.
 Regulate the function of leukocyte.
 Increase gluconeogenic, proteolysis, lipolysis and
blood sugar

7. Clinical application of steriod
 Immunosuppressive: Rheumatoid arthritis, SLE,
organ transplantation, asthma…
 Anti-inflammation: hepatitis, dermatoses, mucositis,
post-op edema…
 Analgesia: reduction of pain
 Replacement for adrenal insufficiency

9. Complication of corticosteroid

10. Adverse effect of corticosteroids
 Receive long-term, high-dose steroid
--Hypertension, heart failure.
--Osteoporosis, DM, impaired wound healing, mental
depression and psychosis.
--Peptic ulcer, Cataract, glaucoma, growth suppression,
hypocalcemia, PTH increased.
 Cushing syndrome
 Secondary adrenal insufficiency

11. Dental uses of corticosteroids
 Topical use: non-infections, ulcerative diseases in
oral cavity. Inhibit the inflammatory reaction, redness
and edema.
 Systemic use: third molar extraction, pre-prosthetic
surgery, reconstructive oral surgery, orthognatic
surgery

12. Condition Administration
Aphthous ulcer Topical
dentin hypersensitivity Topical
desquamative gingivitis Topical,systemic
oral lichen planus Topical,systemic
post extraction Systemic
pulp capping Topical
pulpotomy Topical
severe allergy Systemic
TMJ arthritis symptoms Systemic
oral pemphigus Topical,systemic

13. Management of corticosteroid-use
dental patients
Prevent adrenal crisis

15. Adrenal crisis
( acute adrenal insufficiency)
 Hypotension
 Severe weakness
 Progressive mental confusion
 Nausea and vomiting
 Abdominal, lower back or leg pain
 Hyperthermia
 Hypoglycemia
 Hyperkalemia
 Improve CAD
 Loss of consciousness
 Coma
 death

16. Dental patient taking steroid
supplementation not required
 Patient taking low dose (<20 mg of cortisol daily)
 Patient taking large dose:
--for less than 2 weeks
--for minor dental procedure with minimal stress

17. Dental patient taking steroid
supplementation required
 Patient taking large dose:
for greater than 2 weeks
for extensive major or stressful dental procedure
＃ Double usual daily dose on the day before, the
day
of, and the day after surgery
＃ Appointment in the morning
＃ Good pain control
＃ Resume normal maintenance dose post-op 2
days.

18. Dental patient taking steroid
supplementation required
 If the patient received at least 20mg of cortisol
for more than 2 weeks within past year
＃ 60mg cortisol(or equivalent) the day
before
and the day of surgery at morning
＃ On first 2 post-op days, 40mg cortisol
＃ Then take 20mg cortisol thereafter, until
post-op 6 days.

19. Management of adrenal crisis
 Place the patient in a supine position with leg
elevated
 200 mg hydrocortisone IV stat repeated as
necessary
 Oxygen and CPR if necessary
 Transportation to a medical facility as soon as
possible

20. Y O U
TH A NK