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Sukesh surg

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Sukesh surg

  2. 2. INTRODUCTION Clinical application of corticosteroid Complication of corticosteroid Dental uses of corticosteroid Management of corticosteroid-use dental patients
  3. 3. Introduction Adrenal gland: Cortex and Medulla Adrenal cortex: 3-layer Outer: zona glomerulosa: Middle: zona fasciculata Inner: zona reticularis
  4. 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. 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. 6. Complication of corticosteroid
  7. 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. 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. 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. 10. Management of corticosteroid-use dental patients Prevent adrenal crisis
  11. 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. 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. 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. 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. 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. 16. Y O UTH A NK