this seminar provides information about the corticosteroids ,history,uses, functional anatomy of adrenal glands, it's drawbacks, cushing's habitus, dental implications, mineralocorticoids, glucocorticoids

1. PRESENTEDBY:
RituGupta
PGIYear
Dept.OfConservativeDentistryAndEndodontics
People’sDentalAcademy,Bhopal.
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38. PRE-OPERATIVE ANTI INFLAMMATORY
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40. STEROIDS IN
ENDODONTICS
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41. • Glucocorticoids have been used as an intracanal
medication either alone or in combination with
antibiotics/antihistamines and systemically as a means to
decrease pain and inflammation in endodontic patients.
• They reduce acute inflammatory response by:
1. Suppressing vasodilation
2. Migration of PMN’s
3. Phagocytosis
4. Inhibiting formation of arachidonic acid from neutrophil and
macrophage cell membrane phospholipids, thus blocking
the COX and lipoxygenase pathways and respective
synthesis of PGs and leukotrienes
Marshall G: Consideration of steroids for endodontic pain, Endod Topics 3:41, 2002.
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42. • Wolfson and Blitzer stated that hydrocortisone as an intracanal medication
resulted in reduction and elimination of inflammatory reactions in
periapical tissues
• Ehrmann reported that ledermix (triamcinolone dimethyl chlorotetracycline
in a water soluble cream) stopped the pain associated with pericementitis.
• Langeland et al demonstrated that ledermix as an intracanal medication
eliminated post-endodontic treatment pain within minutes to a few hours
after placement.
• Chance et al compared the effect of intracanal meticortelone
(prednisolone acetate 2.5%) vs. saline on post treatment pain in a double-
blind study – RESULT: corticosteroid was found effective in significantly
reducing the incidence of pain in vital teeth when compared to saline.
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43. LEDERMIX
• Ledermix is a paste that combines 1% triamcinolone acetonide
(a corticosteroid) and demethylchlorotetracycline
(demeclocycline, a tetracycline analog)
• Used as a pulp capping agent, and as a root canal
medicament for both vital and necrotic cases because of it’s
anti inflammatory and anti- microbial properties.
• Both components of ledermix can diffuse into dentin and
through the apical foramen.
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44. • It may be combined with calcium hydroxide at a 50:50 ratio
to enhance it’s anti-microbial efficacy, but this tends to
reduce the diffusion of it’s main ingredients.
• Efficacious against pulpal pain in some earlier studies,
possibly because of it’s corticosteroid content; however,
pulp capping for painful cases with pulp exposures is not
currently recommended because of it’s low term prognosis.
• In a randomized clinical trial compare Ledermix with
formocresol and calcium hydroxide used as
interappointment medicaments on post-instrumentation
flare-ups, no differences were detected among the three
medicaments.
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45. Intracanal Administration
• In 50 consecutive patients requiring nonsurgical root canal treatment
of vital teeth, one investigator alternately placed a dexamethasone
solution or saline placebo as intracanal medicaments after the root
canals had been cleaned and shaped
• Pretreatment pain ratings were collected and at 24, 48 and 72 hours
after treatment
• Results indicated a significant reduction in pain of 24hours but no,
significant difference at 48 and 72 hours
• Intracanal steroids appear to have significant effects for reducing
postoperative pain
• Moskow A,et al: intracanal use of a corticosteroid solution as an endodontic anodyne. Oral Surgery Oral
Med Oral Pathol 58:600, 1984
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46. Systemic Administration
• In one double-blind, randomized, placebo-controlled study, dexamethasone (4mg/ml)
or saline was injected intramuscularly at the conclusion of a single visit endodontic
appointment or at the first visit of a multi-visit procedure.
• Results indicated that the steroid significantly reduced the incidence and severity of
pain at 4 hours when compared with the placebo.
• Pain was reduced at 24hours but not significant at 48hours.
Marshall J, Walton R: The effect of intramuscular injection of steroid on posttreatment endodontic pain, J Endod 10:584, 1984
• 106 patients with irreversible pulpitis and acute periradicular periodontitis were given
an intraoral intramuscular injection of dexamethasone at different doses, either on
completion of a single visit endodontic treatment or after the first visit of multi-visit
procedure.
• Systemic administration of dexamethasone was shown to significantly reduce the
severity of pain at 4 and 8 hours, with an optimum dose between 0.07 and 0.09
mg/kg
• No significant reduction at 24,48,72 hours.
Liesinger A, Marshall F: Effect of variable doses of dexamethasone on posttreatment endodontic pain, J Endod 19:35, 1993.
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47. • In a double-blind placebo-controlled study, patients with irreversible
pulpitis were given 4 mg of dexamethasone or placebo by means of a
supra-periosteal injection at the apex of the treated tooth after
pulpectomy.
• This is an injection technique that most clinicians would be familiar with
(as opposed to intramuscular injection).
• Posttreatment pain was significantly reduced in the steroid group during
the first 24 hours.
• There was no difference at 48 hours.
Kaufman E, et al: Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic
treatment, Oral Surg Oral Med Oral Pathol 77:651, 1994.
• Another study compared the effect an IL injection of methylprednisolone,
mepivacaine, or placebo in preventing posttreatment endodontic pain.
• The results showed that methylprednisolone significantly reduced
postoperative pain within a 24-hour follow-up period.
Liesinger A, Marshall F, Marshall J: Effect of variable doses of dexamethasone on posttreatment endodontic pain, J Endod
19:35, 1993.
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48. Collectively, these studies on systemic steroid administration
indicate that corticosteroids reduce the severity of posttreatment
endodontic pain compared with placebo treatment.
However, given the relative safety/efficacy relationship between
steroids and NSAIDs, most investigators choose an NSAID as
the drug of first choice for postoperative pain control.
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49. A clinical trial aimed to evaluate and compare the effect of a single pretreatment
dose of ketorolac (20 mg), prednisolone (30 mg), and placebo on post-
endodontic pain in patients undergoing endodontic therapy for irreversible
pulpitis or pulpal necrosis using a visual analog scale.
Conclusion: From this study, it could be concluded that a single pretreatment
dose of prednisolone has a more sustained effect in reducing post-endodontic
pain compared with placebo or ketorolac
Praveen, R., Thakur, S., & Kirthiga, M. (2017). Comparative Evaluation of Premedication with Ketorolac and Prednisolone
on Postendodontic Pain: A Double-blind Randomized Controlled Trial. Journal of Endodontics, 43(5), 667–673.
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50. Which is the Best of all??
A review aimed to find the most effective oral premedication in reducing pain in adults
after nonsurgical root canal therapy (NSRCT) using network meta-analysis.
Results : Eleven studies comparing pharmacologic groups of medications were
included in the primary analysis. Compared with placebo, corticosteroids (prednisolone
30–40 mg) was ranked best for reducing postoperative pain.
NSAIDs were ranked least among the medications, and the quality of this evidence was
very low.
Additional analysis based on the chemical name showed that sulindac, ketorolac, and
ibuprofen significantly reduced pain at 6 hours, whereas piroxicam and prednisolone
significantly reduced the pain at 12 and 24 hours. Etodolac was found to be least
effective in reducing pain. Overall, the evidence was of moderate to very low quality.
Conclusions: Based on the limited and low-quality evidence, oral premedication with
piroxicam or prednisolone could be recommended for controlling postoperative pain
after NSRCT.
Nagendrababu et al .Efficacy and Safety of Oral Premedication on Pain after Nonsurgical Root Canal Treatment: A Systematic
Review and Network Meta-analysis of Randomized Controlled Trials. Journal of Endodontics. 2019 Vol 10 (8).
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51. STEROIDS IN ORAL
MEDICINE
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54. TOPICAL
CORTICOSTEROIDS
FOR ULCERATIVE
VESICULOEROSIVE
LESIONS
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58. Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M.
Interventions for treating oral lichen planus: corticosteroid therapies.
Cochrane Database of Systematic Reviews 2020, Issue 2.
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60. STEROIDS IN
SALIVARY GLAND
DISORDERS
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62. STEROIDS IN
NEURALGIA
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64. STEROIDS FOR
TMJ
DISORDERS
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73. • Tripathi KD. Essentials of Medical Pharmacology. 8/e. New Delhi (India) :
Jaypee Brothers Medical Publishers (P) Ltd; 2019
• Dhikav V et al. Pharmacology for Dental Students. 1st edition. Delhi :
AITBS Publishers and Distributors (Regd) ; 2003
• Berman. Cohen’s Pathways of the Pulp. 7th edition. St.Louis, Mo: Mosby
Elsevier; 2011
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75. THANK YOU!!!
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The power of corticosteroid should not be
feared but must be respected……