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Article: Corticosteroids can increase patient's risk at the dental office DR. JERRY GORDON
Any dental procedure that causes an elevated level of physical stress (dental fillings, root canal, oral surgery, etc.) or emotional stress (fear) can be expected to challenge the adrenal gland to produce increased amounts of cortisol to combat that stress.

The present or past use of drugs classified as corticosteroids can put patients at increased risk of serious health consequences during dental treatment. The reason that corticosteroids present this risk is that their use suppresses our own body's production of cortisol from the adrenal cortex (the outer aspect of a small gland located near or upon the kidney). Cortisol is a vital to our survival because it helps the body adapt to both physical and emotional stress.

The use of corticosteroids is widespread in today's society, partly due to the longer life expectancies of the general population, and the associated development of chronic diseases. Corticosteroids are used for a wide variety of ailments, both acute (sudden onset) and chronic (slow onset, long duration). Some diseases that are often managed by corticosteroids include, allergic reactions, shock, colitis, meningitis, arthritis, emphysema, and many, many others. Some common corticosteroids are hydrocortisone (Cortef, Solu-Cortef), cortisone (Cortone), prednisone (Apo-Prednisone, Orasone), dexamethasone (Decadron), and others. All corticosteroids are not, however, created equally. For example, a 5 mg dose of prednisone is equivalent to 20 mg of hydrocortisone, or is 4 times more potent.

A person who takes corticosteroids, or has taken the equivalent dose of 20 mg or more of cortisone daily for two or more weeks within the past two years may have negatively affected the function of their adrenal gland. Any dental procedure that causes an elevated level of physical stress (dental fillings, root canal, oral surgery, etc.) or emotional stress (fear) can be expected to challenge the adrenal gland to produce increased amounts of cortisol to combat that stress. If the adrenal gland cannot produce the required cortisol, the patient can succumb to a rare, but often fatal condition called acute adrenal insufficiency.

To prevent this potentially life-threatening occurrence, the dentist, the family doctor, and patient must cooperate to the fullest extent. The process begins with the patient informing the dentist (both verbally and in the medical history) that he or she is taking or has taken corticosteroids within the past two years. The dentist can then contact the family doctor to help determine what dosage the patient should take prior, during or after a dental procedure. Although a twofold to fourfold increase in the corticosteroids is a common recommendation the day of dental treatment, much higher doses may be required for a fearful patient who requires extensive dental treatment.

It is important to note that some physicians greatly underestimate the amount of physical and emotional stress generated by both routine and advanced dental treatment for some dental patients. This places a greater responsibility on the dentist to clearly communicate with the physician the emotional state of the patient, and the amount of stress that may be caused by the dental procedure. This brings us to the last, and possibly most important point, namely that the dentist must do everything in his or her power to reduce the physical and emotion stress of dental treatment. This includes clear communication from the dentist to the patient, and vise-versa, appropriate use of anxiety reducing agents such as nitrous oxide gas or anti-anxiety medications, and very effective use of local anesthetic drugs to eliminate (if possible) the potential discomfort associated with some dental procedures.

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. Dr. Gordon was recently asked to provide commentary about mid-level providers for the influential dental journal Dental Abstracts.

Dr. Gordon responds to an article in Dental Abstracts challenging his views.

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