The role of corticosteroids in dermatology and rheumatology

Dentists should identify patients taking corticosteroids when taking a pre-operative medical history. The patient may also be taking other drugs e.g. non-steroidal anti-inflammatory drugs (NSAIDs) to help control arthritic pain. Some of these drugs affect oral tissues.

The stress of routine dental procedures is insufficient to cause an adrenal crisis. If prolonged treatment is anticipated, e.g. surgical procedures, advice should be sought from the physician who is supervising the patient's steroid therapy.

Drug treatment of breast cancer
With chemotherapy, there is always the possibility of changes to the haematopoietic and immune systems. During the period of immuno suppression, the patient's susceptibility to infection is increased.

Routine dental examinations should continue, but elective invasive treatment should be postponed until it can be established that any period of immuno suppression has passed. This can be planned with the advice of the physician or oncologist managing the case.

In patients needing urgent invasive dental treatment, such as the endodontic treatment of acute infection or the removal of a tooth, possibly also involving bone removal, antibiotics may be necessary.

Oral mucosal ulcerations occur regularly in association with anticancer drugs. This ulceration may be treated with topical medication. Triamcinolone preparations suitable for oral use will improve the patient's comfort. (See also Dental implications 'Complications of cytotoxic therapy' Aust Prescr 1995;18:68.)

R.G. Woods

Australian Dental Association