Endocrine

Dental Management of Patients with Chronic steroids / adrenal insufficiency

Confirm daily steroid dose & procedure size

Steroid supplementation (stress dose) depends on the maintenance dose and the magnitude of the procedure. Includes central causes (e.g. pituitary adenoma / hypopituitarism) and long-term exogenous steroids. Watch for adrenal crisis: hypotension, collapse — this is a medical emergency.

Emergency vs routine management

If EMERGENCY — what to do

• Ensure the usual steroid dose was taken; for invasive treatment of acute infection follow sick-day rules (double oral dose for 24–48 h) in liaison with the physician.Ref: Woodcock T et al. Guidelines for the management of glucocorticoids during the peri-operative period (AAGBI/SfE). Anaesthesia 2020;75:654–663
• Adrenal crisis (collapse, hypotension, confusion): lay flat with legs raised, oxygen, hydrocortisone 100 mg IM/IV, call emergency services.Ref: Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)

If ROUTINE — what to do

• Routine care under LA: continue the usual dose, morning appointment, stress reduction.Ref: Woodcock T et al. Guidelines for the management of glucocorticoids during the peri-operative period (AAGBI/SfE). Anaesthesia 2020;75:654–663
• Major surgery / GA: physician-planned hydrocortisone cover.Ref: Woodcock T et al. Guidelines for the management of glucocorticoids during the peri-operative period (AAGBI/SfE). Anaesthesia 2020;75:654–663

Clinical precautions

• Morning appointments
• Effective pain and anxiety control
• Ensure usual steroid taken before appointment
• Establish current daily prednisolone-equivalent dose

Information & tests to request

• Daily prednisolone-equivalent dose (mg)

At a glance by procedure

Initial assessment before lab results or timing details are entered.

Procedure	Initial assessment
Examination / radiographs	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Supragingival scaling / polish	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Root canal treatment	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Simple extraction (1–3 teeth)	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Surgical / bony extraction	MODIFY / CAUTION Confirm daily steroid dose & procedure size
Implant placement	MODIFY / CAUTION Confirm daily steroid dose & procedure size

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

Adrenal insufficiency — perioperative steroid cover consensus
Woodcock T et al. Guidelines for the management of glucocorticoids during the peri-operative period (AAGBI/SfE). Anaesthesia 2020;75:654–663
Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.