04 April 2023

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Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids

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Background

Patients undergoing long-term glucocorticoid therapy are administered additional glucocorticoids before minor dental procedures, although this is not supported by evidence. The authors designed this study to validate the hypothesis that routine blanket glucocorticoid supplementation is unnecessary during minor oral surgical procedures under local anesthesia.

Methods

The authors recruited 270 patients into three groups from the dental outpatient department. Primary outcomes were changes in hemodynamic parameters and frequency of adverse events among the three groups. The secondary outcome was the association of preprocedural stress and procedural pain with periprocedural adverse events in the long-term glucocorticoid therapy group (groups I and II).

Results

The researchers found no clinically relevant changes in hemodynamic parameters among the three groups. The team also found low periprocedural adverse events in all three groups combined (n = 1), so they did not explore the secondary outcomes further.

Conclusions

Among patients undergoing long-term glucocorticoid therapy for indications other than primary adrenal insufficiency, elective minor oral surgical procedures can be performed safely with only their daily dose of glucocorticoid when their medical conditions are optimized. Routine additional glucocorticoid supplementation appears unnecessary.

The results of the study also revealed opportunities for value addition by means of integrating oral health care with medical follow-up for patients with multiple co-occurring medical conditions.

Practical implications

Routine blanket glucocorticoid supplementation among patients taking a long-term glucocorticoid for indications other than primary adrenal insufficiency appears unnecessary before minor oral surgical procedures under local anesthesia. This clinical trial was registered at Clinical Trial Registry-India. The registration number is CTRI/2017/02/007779.

Akilesh Ramasamy and Balasubramanian Madhan. "Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids: A triple-blinded, randomized, placebo-controlled trial." JADA. March 23, 2023. DOI:https://doi.org/10.1016/j.adaj.2023.01.001