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Steroid treatment in dentistry

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Steroid treatment in dentistry

  1. 1. Steroid Treatment in Oral Cancer Patient Oral Maxillofacial section, VGH-Tpe Reporter: 王奕凱 Supervisor: 高壽延 主任 雷文天 醫師
  2. 2. <ul><li>Introduction </li></ul><ul><li>Clinical application of corticosteroid </li></ul><ul><li>Complication of corticosteroid </li></ul><ul><li>Dental uses of corticosteroid </li></ul><ul><li>Management of corticosteroid-use dental patients </li></ul>
  3. 3. Introduction <ul><li>Adrenal gland: Cortex and Medulla </li></ul><ul><li>Adrenal cortex: 3-layer </li></ul><ul><li>Outer: zona glomerulosa: </li></ul><ul><li>Middle: zona fasciculata </li></ul><ul><li>Inner: zona reticularis </li></ul>
  4. 6. Structure
  5. 7. Physiopharmacology of corticosteroids <ul><li>其基本構造包含 17 個碳做骨架核 , 常用之 類固醇共有 21 個碳原子。在位置 1,2 間改為雙鍵 , 即成 Prednisolone, 其抗發炎作用增強四倍 , 如C 16 再改為甲基 , C 9 改為氟離子 , 則成 Dexamethasone , 抗發炎作用 增加 30 倍而鈉滯留作用消失 </li></ul>
  6. 8. Regulation: HPA axis
  7. 9. Functions of corticosteroid <ul><li>Regulation of carbohydrate, fat, protein </li></ul><ul><li>Anti-inflammation action by inhibit lysosome, prostaglandin, cytokines release. </li></ul><ul><li>Regulate the function of lekocyte. </li></ul><ul><li>Increase gluconeogenic, proteolysis, lipolysis and blood sugar </li></ul>
  8. 10. Clinical application of steriod <ul><li>Immunosuppressive: Rheumatoid arthritis, SLE, organ transplantation, asthma… </li></ul><ul><li>Anti-inflammation: hepatitis, dermatoses, mucositis, post-op edema… </li></ul><ul><li>Analgesia: reduction of pain </li></ul><ul><li>Replacement for adrenal insufficiency </li></ul>
  9. 11. Clinical application
  10. 13. Complication of corticosteroid
  11. 14. Adverse effect of corticosteroids <ul><li>Receive long-term, high-dose steroid </li></ul><ul><li>Hypertension, heart failure </li></ul><ul><li>Osteoporosis, DM, impaired wound healing, metal depression and psychosis </li></ul><ul><li>Peptic ulcer, Cataract, glaucoma, growth suppression, hypocalcemia, PTH increased </li></ul><ul><li>Cushing syndrome </li></ul><ul><li>Secondary adrenal insufficiency </li></ul>
  12. 15. Complications of corticosteroids treatment
  13. 17. Dental uses of corticosteroids <ul><li>Topical use: non-infections, ulcerative diseases in oral cavity. Inhibit the inflammatory reaction, redness and edema </li></ul><ul><li>Systemic use: third molar extraction, pre-prosthetic surgery, reconstructive oral surgery, orthognatic surgery </li></ul>
  14. 18. condition administration 不建議使用於 herpetic infections Topical Topical Topical,systemic Topical,systemic Systemic Topical Topical Systemic Systemic Topical,systemic Aphthous ulcer dentin hypersensitivity desquamative gingivitis oral lichen planus post extraction pulp capping pulpotomy severe allergy TMJ arthritis symptoms oral pemphigus
  15. 19. Nincort ointment <ul><li>Acute and chronic oral lesions </li></ul><ul><li>成分 : 0.1% triamcinolone acetonide </li></ul><ul><li>3.5 g/ tube (17.5 mg cortisol/tube) </li></ul><ul><li>用法: apply a small dab (about ¼ inch ) </li></ul><ul><li>to the lesion at bed time, or 2- </li></ul><ul><li>3times a day after meals </li></ul>
  16. 20. Dexaltin ointment <ul><li>Indication: inflammation manifestation of corticosteroid-responsive dermatoses in oral cavity </li></ul><ul><li>成分 : 0.1% dexamethasone 5g / tube </li></ul><ul><li>( 133 mg cortisol/ tube ) </li></ul>
  17. 21. PBK solution <ul><li>Indication: oral ulcer </li></ul><ul><li>成分: susp 100ml/ bot </li></ul><ul><li>prednisolone 100mg(400mg cortisol) </li></ul><ul><li>benadryl 8.33 mg </li></ul><ul><li>kaopectin 33.33 mg </li></ul><ul><li>用法: gargling in mouth for 5 min. </li></ul><ul><li>5-10 ml Bid </li></ul>
  18. 22. Management of corticosteroid-use dental patients Prevent adrenal crisis
  19. 24. Adrenal crisis ( acute adrenal insufficiency) <ul><li>Hypotension </li></ul><ul><li>Severe weakness </li></ul><ul><li>Progressive mental confusion </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Abdominal, lower back or leg pain </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Improve CAD </li></ul><ul><li>Loss of consciousness </li></ul><ul><li>Coma </li></ul><ul><li>death </li></ul>
  20. 25. Dental patient taking steroid supplementation not required <ul><li>Patient taking low dose (<20 mg of cortisol daily) </li></ul><ul><li>Patient taking large dose: </li></ul><ul><li>for less than 2 weeks </li></ul><ul><li>for minor dental procedure with minimal stress </li></ul>
  21. 26. Dental patient taking steroid supplementation required <ul><li>Patient taking large dose: </li></ul><ul><li>for greater than 2 weeks </li></ul><ul><li>for extensive major or stressful dental procedure </li></ul><ul><li># Double usual daily dose on the day before, the day </li></ul><ul><li>of, and the day after surgery </li></ul><ul><li># Appt in the morning </li></ul><ul><li># Good pain control </li></ul><ul><li># Resume normal maintenance dose post-op 2 days. </li></ul>
  22. 27. Dental patient taking steroid supplementation required <ul><li>If the patient received at least 20mg of cortisol for more than 2 weeks within past year </li></ul><ul><li># 60mg cortisol(or equivalent) the day before </li></ul><ul><li>and the day of surgery at morning </li></ul><ul><li># On first 2 post-op days, 40mg cortisol </li></ul><ul><li># Then take 20mg cortisol thereafter, until </li></ul><ul><li>post-op 6 days. </li></ul>
  23. 28. Management of adrenal crisis <ul><li>Place the patient in a supine position with leg elevated </li></ul><ul><li>200 mg hydrocortisone IV stat repeated as necessary </li></ul><ul><li>Oxygen and CPR if necessary </li></ul><ul><li>Transportation to a medical facility as soon as possible </li></ul>
  24. 29. Thanks for your attention

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