What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure?

This Medicines Q&A gives 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 management of patients with secondary adrenal insufficiency, e.g. caused by long-term use of high doses of steroids.

Summary

  • Patients with primary adrenal insufficiency (e.g. Addison’s disease) lack endogenous steroid hormones cortisol and aldosterone and require daily steroid therapy (usually hydrocortisone and fludrocortisone) to replace them. These patients are unable to physiologically adapt to stress and usually need supplemental steroid therapy when having dental procedures, to prevent adrenal crisis.
  • Patients having minor dental procedures (e.g. scale and polish, filling replacement) should be advised to take an additional oral dose of glucocorticoid one hour prior to their appointment.
  • Patients having minor oral surgery e.g. root canal work under local anaesthetic, require steroid supplementation prior to the procedure, and for a full 24 hours afterwards.
  • Those requiring dental extractions should be referred to secondary care.
  • Patients with primary adrenal insufficiency are invariably well informed about their medical condition and additional steroid requirements. Discussion with the patient in advance of the dental procedure is vital for planning required steroid therapy in relation to the type and timing of the procedure. They should be advised to bring their emergency hydrocortisone injection kit to all appointments.
Endocrine system disordersFludrocortisoneHydrocortisoneQ&A

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