Management of patients at risk of adrenal crisis in the dental setting: a review of current practice in UK dental teaching hospitals

Gaw, A. G., Wemyss, C. , Bell, A. and Goodall, C. A. (2022) Management of patients at risk of adrenal crisis in the dental setting: a review of current practice in UK dental teaching hospitals. British Dental Journal, (doi: 10.1038/s41415-022-4515-0) (PMID:35931749) (Early Online Publication)

Abstract

Introduction: Patients with impaired corticosteroid response due to Addison's disease or systemic glucocorticoid use are at risk of adrenal crisis when undergoing dental treatment. There is a lack of conclusive evidence to support dental teams in identifying patients at risk and their management to prevent an adrenal crisis. Aim: To review the current practice in UK dental teaching hospitals regarding the management of patients at risk of adrenal crisis in the dental setting. Methods: An electronic survey focused on patients who may be at risk of adrenal crisis due to systemic glucocorticoid therapy was sent to all 18 UK dental teaching hospitals. Information on the use of a policy or guidance was requested. Responses were evaluated for clinical decision-making, patient risk assessment and steroid cover dosing regimens. Results: A 78% response rate was achieved. Only 29% of institutions had a written policy or guidance document. Variation exists in the threshold of steroid dose and duration of treatment in identifying patients at risk of adrenal suppression. Furthermore, the dose regime for steroid cover varied. Conclusion: Further evidence on the management of patients at risk of adrenal crisis is required to inform national guidance and reduce variation in patient management.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bell, Professor Aileen and Goodall, Professor Christine and Wemyss, Mr Callum
• Authors: Gaw, A. G., Wemyss, C., Bell, A., and Goodall, C. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: British Dental Journal
• Publisher: Nature Publishing Group for the British Dental Association
• ISSN: 0007-0610
• ISSN (Online): 1476-5373
• Published Online: 05 August 2022
• Copyright Holders: Copyright © 2022 The Author(s) under exclusive licence to the British Dental Association
• First Published: First published in British Dental Journal 2022
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher