steroid treatment in dentistry

Steroid Steroid Treatment in Treatment in Oral Cancer Oral Cancer

PatientPatientOral Maxillofacial section, VGH-TpeOral Maxillofacial section, VGH-Tpe

Reporter: Reporter: 王奕凱王奕凱Supervisor: Supervisor: 高壽延主任高壽延主任雷文天醫師雷文天醫師

IntroductionIntroduction Clinical application of corticosteroidClinical application of corticosteroid Complication of corticosteroidComplication of corticosteroid Dental uses of corticosteroidDental uses of corticosteroid Management of corticosteroid-use Management of corticosteroid-use

dental patientsdental patients

IntroductionIntroduction

Adrenal gland: Cortex and MedullaAdrenal gland: Cortex and Medulla Adrenal cortex: 3-layerAdrenal cortex: 3-layer

Outer: zona glomerulosa: Outer: zona glomerulosa:

Middle: zona fasciculataMiddle: zona fasciculata

Inner: zona reticularisInner: zona reticularis

StructureStructure

Physiopharmacology of Physiopharmacology of corticosteroidscorticosteroids

1.1. 其基本構造包含其基本構造包含 1717 個碳做骨架核個碳做骨架核 ,, 常用之類固醇常用之類固醇共有共有 21 21 個碳原子。在位置個碳原子。在位置 1,2 1,2 間改為雙鍵間改為雙鍵 , , 即即成成 Prednisolone, Prednisolone, 其抗發炎作用增強四倍其抗發炎作用增強四倍 , , 如如ＣＣ 1616 再改為甲基再改為甲基 ,, ＣＣ 9 9 改為氟離子改為氟離子 ,, 則成則成 Dexamethasone , Dexamethasone , 抗發炎作用增加抗發炎作用增加 3030 倍而鈉滯倍而鈉滯留作用消失留作用消失

Regulation: HPA axisRegulation: HPA axis

Functions of Functions of corticosteroidcorticosteroid

Regulation of carbohydrate, fat, Regulation of carbohydrate, fat, proteinprotein

Anti-inflammation action by inhibit Anti-inflammation action by inhibit lysosome, prostaglandin, cytokines lysosome, prostaglandin, cytokines release.release.

Regulate the function of lekocyte. Regulate the function of lekocyte. Increase gluconeogenic, proteolysis, Increase gluconeogenic, proteolysis,

lipolysis and blood sugarlipolysis and blood sugar

Clinical application of Clinical application of steriodsteriod

Immunosuppressive: Rheumatoid Immunosuppressive: Rheumatoid arthritis, SLE, organ transplantation, arthritis, SLE, organ transplantation, asthma…asthma…

Anti-inflammation: hepatitis, Anti-inflammation: hepatitis, dermatoses, mucositis, post-op dermatoses, mucositis, post-op edema…edema…

Analgesia: reduction of painAnalgesia: reduction of pain Replacement for adrenal insufficiencyReplacement for adrenal insufficiency

Clinical applicationClinical application

Complication of Complication of corticosteroidcorticosteroid

Adverse effect of Adverse effect of corticosteroidscorticosteroids

Receive long-term, high-dose steroidReceive long-term, high-dose steroid Hypertension, heart failureHypertension, heart failure Osteoporosis, DM, impaired wound Osteoporosis, DM, impaired wound

healing, metal depression and psychosishealing, metal depression and psychosis Peptic ulcer, Cataract, glaucoma, Peptic ulcer, Cataract, glaucoma,

growth suppression, hypocalcemia, PTH growth suppression, hypocalcemia, PTH increasedincreased

Cushing syndromeCushing syndrome Secondary adrenal insufficiencySecondary adrenal insufficiency

Complications of corticosteroids Complications of corticosteroids treatmenttreatment

Dental uses of Dental uses of corticosteroidscorticosteroids

Topical use: non-infections, Topical use: non-infections, ulcerative diseases in oral cavity. ulcerative diseases in oral cavity. Inhibit the inflammatory reaction, Inhibit the inflammatory reaction, redness and edemaredness and edema

Systemic use: third molar extraction, Systemic use: third molar extraction, pre-prosthetic surgery, pre-prosthetic surgery, reconstructive oral surgery, reconstructive oral surgery, orthognatic surgery orthognatic surgery

Aphthous ulcerAphthous ulcerdentin dentin hypersensitivityhypersensitivitydesquamative desquamative gingivitisgingivitisoral lichen planusoral lichen planuspost extractionpost extractionpulp cappingpulp cappingpulpotomypulpotomysevere allergysevere allergyTMJ arthritis TMJ arthritis symptoms symptoms oral pemphigusoral pemphigus

TopicalTopical

TopicalTopical

Topical,systemicTopical,systemic


SystemicSystemic

Topical Topical

Topical Topical

SystemicSystemic

SystemicSystemic


condition administration

不建議使用於 herpetic infections

Nincort ointment Nincort ointment

Acute and chronic oral lesionsAcute and chronic oral lesions 成分成分：： 0.1% 0.1% triamcinolone acetonide triamcinolone acetonide

3.5 g/ tube (17.5 mg 3.5 g/ tube (17.5 mg cortisol/tube)cortisol/tube)

用法：用法： apply a small dab (about ¼ apply a small dab (about ¼ inch )inch )

to the lesion at bed time, or 2-to the lesion at bed time, or 2-

3times a day after meals3times a day after meals

Dexaltin ointmentDexaltin ointment

Indication: inflammation Indication: inflammation manifestation of corticosteroid-manifestation of corticosteroid-responsive dermatoses in oral cavityresponsive dermatoses in oral cavity

成分成分：： 0.1% 0.1% dexamethasone 5g / tube dexamethasone 5g / tube

( 133 mg cortisol/ tube )( 133 mg cortisol/ tube )

PBK solutionPBK solution Indication: oral ulcerIndication: oral ulcer 成分：成分： susp 100ml/ botsusp 100ml/ bot prednisolone 100mg(400mg prednisolone 100mg(400mg

cortisol)cortisol) benadryl 8.33 mgbenadryl 8.33 mg kaopectin 33.33 mgkaopectin 33.33 mg 用法：用法： gargling in mouth for 5 min.gargling in mouth for 5 min. 5-10 ml Bid5-10 ml Bid

Management of Management of corticosteroid-use corticosteroid-use

dental patientsdental patients

Prevent adrenal Prevent adrenal crisiscrisis

Adrenal crisisAdrenal crisis( acute adrenal ( acute adrenal insufficiency)insufficiency)

HypotensionHypotension Severe weaknessSevere weakness Progressive mental confusionProgressive mental confusion Nausea and vomitingNausea and vomiting Abdominal, lower back or leg painAbdominal, lower back or leg pain HyperthermiaHyperthermia HypoglycemiaHypoglycemia HyperkalemiaHyperkalemia Improve CADImprove CAD Loss of consciousnessLoss of consciousness ComaComa deathdeath

Dental patient taking Dental patient taking steroid supplementation steroid supplementation

not requirednot required Patient taking low dose (<20 mg of Patient taking low dose (<20 mg of

cortisol daily)cortisol daily) Patient taking large dose:Patient taking large dose:

for less than 2 weeksfor less than 2 weeks

for minor dental procedure with for minor dental procedure with minimal stressminimal stress


requiredrequired Patient taking large dose:Patient taking large dose:

for greater than 2 weeksfor greater than 2 weeks

for extensive major or stressful dental for extensive major or stressful dental procedureprocedure

＃＃ Double usual daily dose on the day before, Double usual daily dose on the day before, the day the day

of, and the day after surgeryof, and the day after surgery

＃＃ Appt in the morning Appt in the morning

＃＃ Good pain controlGood pain control

＃＃ Resume normal maintenance dose post-op 2 Resume normal maintenance dose post-op 2 days.days.


requiredrequired If the patient received at least 20mg of If the patient received at least 20mg of

cortisol for more than 2 weeks within past cortisol for more than 2 weeks within past yearyear

＃＃ 60mg cortisol(or equivalent) the day 60mg cortisol(or equivalent) the day before before

and the day of surgery at morningand the day of surgery at morning

＃＃ On first 2 post-op days, 40mg cortisolOn first 2 post-op days, 40mg cortisol

＃＃ Then take 20mg cortisol thereafter, Then take 20mg cortisol thereafter, until until

post-op 6 days. post-op 6 days.

Management of adrenal Management of adrenal crisiscrisis

Place the patient in a supine position Place the patient in a supine position with leg elevatedwith leg elevated

200 mg hydrocortisone IV stat 200 mg hydrocortisone IV stat repeated as necessaryrepeated as necessary

Oxygen and CPR if necessaryOxygen and CPR if necessary Transportation to a medical facility Transportation to a medical facility

as soon as possibleas soon as possible

Thanks for your Thanks for your attentionattention

steroid treatment in dentistry

Documents

corticosteroid