Endocrine
Dental Considerations for Patients Taking Long-term corticosteroids
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
- • ≥ 5 mg prednisolone/day for > 4 weeks: risk of adrenal suppression — follow sick-day rules for surgery with infection.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)
- • Expect delayed healing and higher infection risk.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
If ROUTINE — what to do
- • Routine care: continue the usual dose; no extra cover for routine LA dentistry.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: physician-planned stress-dose 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 |
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)
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.