Pharmacology for Dentists — Chapter 7: Steroid Use in Dentistry
“Steroids heal. But they can also harm. Dentistry needs to walk that fine line.”
💡 Why Dentists Must Understand Steroid Use in Dentistry
Steroid use in dentistry is becoming increasingly relevant as more patients take systemic corticosteroids for chronic conditions such as asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and post-transplant immunosuppression. These medications alter stress responses, immune function, and tissue healing — all of which are directly relevant to dental procedures.
When such patients sit in your chair, the stakes are different. Without appropriate planning, a simple extraction or implant could result in delayed healing, infection, or even adrenal crisis. That’s why every dentist should understand both the pharmacologic principles and clinical applications of steroid use in dentistry.
🔬 Mechanism: How Steroids Work and Why It Matters
Corticosteroids, such as prednisone and dexamethasone, mimic endogenous cortisol. Their actions include:
- Anti-inflammatory: Suppress prostaglandin and cytokine release
- Immunosuppressive: Suppress T-cell activity and reduce leukocyte infiltration
- Metabolic: Influence glucose regulation, fat distribution, protein breakdown
Long-term corticosteroid use suppresses the hypothalamic-pituitary-adrenal (HPA) axis. This makes patients reliant on external steroids and impairs their ability to mount a physiologic response to stress, including surgical trauma.
🩺 Adrenal Suppression and Dental Stress
Under normal conditions, the adrenal glands release cortisol in response to stress (e.g., surgery, infection). This helps maintain blood pressure, vascular tone, and glucose stability.
In steroid-dependent patients, this cortisol surge may not occur, increasing the risk for:
- Hypotension
- Hypoglycemia
- Nausea, weakness, or collapse
- Full-blown adrenal crisis
Who’s at Risk?
- Patients taking systemic steroids for more than 2–3 weeks
- Those recently tapered off corticosteroids
- Patients on alternate-day dosing or high-dose bursts
- Individuals with Cushingoid appearance (moon face, truncal obesity)
Note: Inhaled or topical steroids generally do not suppress the HPA axis significantly, but it is always best to ask detailed history.
🧪 Corticosteroids and Wound Healing
Steroids influence all four phases of wound healing:
- Inflammation Suppression: While this can reduce post-op pain and swelling, it also slows down immune recruitment and wound debridement.
- Fibroblast Inhibition: Decreases granulation tissue formation and slows tissue repair.
- Reduced Collagen Synthesis: Weakens tensile strength and slows epithelial regeneration.
- Impaired Angiogenesis: Decreases new blood vessel formation via VEGF suppression, reducing oxygen delivery to healing sites.
These effects mean steroid use in oral surgery must be managed with careful post-op monitoring, especially for:
- Socket healing
- Implant osseointegration
- Periodontal regeneration
- Flap stability
🦷 Clinical Implications of Steroid Use in Dentistry
| Dental Procedure | Impact of Steroids | Considerations |
|---|---|---|
| Simple Extraction | Delayed clot formation, slower epithelialization | Monitor for infection or dry socket |
| Multiple Extractions | Impaired tissue regeneration | Consider supplemental steroid if high-risk |
| Periodontal Flap Surgery | Soft tissue delay, suturing complications | Use resorbable sutures, close monitoring |
| Dental Implants | Delayed osseointegration | Avoid immediate loading; close follow-up |
Remember: not all steroid use is dangerous — context is everything.
💊 Steroid Supplementation: When and How
The need for “steroid cover” depends on the procedure’s stress level and the patient’s adrenal suppression status.
General Rule:
| Procedure Type | Risk Level | Steroid Supplement Needed? |
|---|---|---|
| Scaling, fillings | Low | No |
| Simple extraction | Low-Mod | Usually no |
| Flap surgery | Moderate | Yes – double usual morning dose |
| Implants, grafting | High | Yes – medical consult advised |
| GA procedures | Very High | IV hydrocortisone with MD consult |
Common Protocol:
- Minor procedures: maintain regular dose
- Moderate stress: double the usual oral dose morning of procedure
- Major surgery: IV hydrocortisone 100 mg pre-op, then 50 mg q6h x 24 hr
Never stop corticosteroids abruptly. Tapering should always be under physician guidance.
📋 Physician Communication and Coordination
When in doubt, coordinate with the prescribing physician (rheumatologist, endocrinologist, transplant specialist). Include:
- Procedure type and date
- Estimated surgical stress
- Current steroid regimen
- Request for guidance on steroid supplementation
Having a pre-written EMR communication template can streamline this process.
📊 Summary Table — Risk Stratification
| Factor | Low Risk | Moderate Risk | High Risk |
|---|---|---|---|
| Duration | <2 weeks | 2–4 weeks | >4 weeks or chronic use |
| Route | Topical/inhaled | Oral low-dose | Oral high-dose or IV |
| Procedure | Cleaning, fillings | Extraction, flap surgery | Implants, bone grafting, GA |
| Action | No change | Double daily dose | IV steroids or MD consult |
🧠 Dentist’s Takeaway — EEAT Perspective
Steroids are double-edged tools. For patients, they reduce inflammation and improve quality of life. For dentists, they change the rules of surgery, healing, and stress response.
Steroid use in dentistry demands:
- Experience: to detect subtle signs of adrenal suppression and anticipate delayed wound healing.
- Expertise: to differentiate between low-risk and high-risk scenarios based on dosage, duration, and route.
- Authoritativeness: through confident communication with prescribing physicians and clear documentation.
- Trustworthiness: when treatment plans are based not on routine, but on risk-aware, evidence-based decisions.
Next time a patient reports long-term corticosteroid use:
- Don’t assume it’s safe.
- Ask detailed questions about the regimen.
- Consult their physician when in doubt.
- Adjust your surgical plan accordingly.
💡 Dental surgery is stress. Adrenal physiology is delicate. But with insight and planning, you can protect both your procedure and your patient.
🔗 Learn more in the ADA clinical overview on steroid therapy and dental stress management
Next : Pharmacology for Dentists — Chapter 8: Bleeding Risks and Dental Surgery Strategy
