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frnds contact me at sukesh3567@gmail.com also inspite of facebook......

frnds contact me at sukesh3567@gmail.com also inspite of facebook......

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Sukesh surg Presentation Transcript

  • 1. TS IEN OF PAT DS T EN STER OI EM CO AG RTIM AN CO ON PRESENTED BY: SUKESH KUMAR REG NO:0798083
  • 2. INTRODUCTION Clinical application of corticosteroid Complication of corticosteroid Dental uses of corticosteroid Management of corticosteroid-use dental patients
  • 3. Introduction Adrenal gland: Cortex and Medulla Adrenal cortex: 3-layer Outer: zona glomerulosa: Middle: zona fasciculata Inner: zona reticularis
  • 4. Functions of corticosteroid Regulation of carbohydrate, fat, protein. Anti-inflammation action by inhibit lysosome, prostaglandin, cytokines release. Regulate the function of leukocyte. Increase gluconeogenic, proteolysis, lipolysis and blood sugar
  • 5. Clinical application of steriod Immunosuppressive: Rheumatoid arthritis, SLE, organ transplantation, asthma… Anti-inflammation: hepatitis, dermatoses, mucositis, post-op edema… Analgesia: reduction of pain Replacement for adrenal insufficiency
  • 6. Complication of corticosteroid
  • 7. Adverse effect of corticosteroids Receive long-term, high-dose steroid--Hypertension, heart failure.--Osteoporosis, DM, impaired wound healing, mental depression and psychosis.--Peptic ulcer, Cataract, glaucoma, growth suppression, hypocalcemia, PTH increased. Cushing syndrome Secondary adrenal insufficiency
  • 8. Dental uses of corticosteroids Topical use: non-infections, ulcerative diseases in oral cavity. Inhibit the inflammatory reaction, redness and edema. Systemic use: third molar extraction, pre-prosthetic surgery, reconstructive oral surgery, orthognatic surgery
  • 9. Condition AdministrationAphthous ulcer Topicaldentin hypersensitivity Topicaldesquamative gingivitis Topical,systemicoral lichen planus Topical,systemicpost extraction Systemicpulp capping Topicalpulpotomy Topicalsevere allergy SystemicTMJ arthritis symptoms Systemicoral pemphigus Topical,systemic
  • 10. Management of corticosteroid-use dental patients Prevent adrenal crisis
  • 11. Adrenal crisis ( acute adrenal insufficiency) Hypotension Severe weakness Progressive mental confusion Nausea and vomiting Abdominal, lower back or leg pain Hyperthermia Hypoglycemia Hyperkalemia Improve CAD Loss of consciousness Coma death
  • 12. Dental patient taking steroid supplementation not required Patient taking low dose (<20 mg of cortisol daily) Patient taking large dose: --for less than 2 weeks --for minor dental procedure with minimal stress
  • 13. Dental patient taking steroid supplementation required Patient taking large dose: for greater than 2 weeks for extensive major or stressful dental procedure # Double usual daily dose on the day before, the day of, and the day after surgery # Appointment in the morning # Good pain control # Resume normal maintenance dose post-op 2 days.
  • 14. Dental patient taking steroid supplementation required If the patient received at least 20mg of cortisol for more than 2 weeks within past year # 60mg cortisol(or equivalent) the day before and the day of surgery at morning # On first 2 post-op days, 40mg cortisol # Then take 20mg cortisol thereafter, until post-op 6 days.
  • 15. Management of adrenal crisis Place the patient in a supine position with leg elevated 200 mg hydrocortisone IV stat repeated as necessary Oxygen and CPR if necessary Transportation to a medical facility as soon as possible
  • 16. Y O UTH A NK