Steroid Use in Dentistry – Review Flashcards

48 question-and-answer flashcards covering definitions, mechanisms, prescribing guidelines, dental applications, adverse effects, adrenal crisis management, steroid-sparing drugs, and biologic therapies relevant to steroid use in dentistry.

What three main hormones are secreted by the adrenal cortex?

Cortisol (a glucocorticoid), aldosterone (a mineralocorticoid), and dehydroepiandrosterone (DHEA, an adrenal androgen).

How much cortisol is normally produced daily, and how much can be released under severe stress?

15–30 mg per day normally; up to about 200 mg during severe stress.

Which three structures make up the HPA axis?

Hypothalamus, pituitary gland, and adrenal cortex.

At what time of day do circulating cortisol levels usually peak?

Early morning around 6–9 a.m., following the circadian rhythm.

By what basic mechanism do glucocorticoids exert their intracellular effects?

They diffuse through the cell membrane, bind cytoplasmic glucocorticoid receptors, translocate to the nucleus, bind glucocorticoid-response elements, and alter gene transcription (transactivation and transrepression).

Which key enzyme in the arachidonic-acid cascade is inhibited by corticosteroids?

Phospholipase A2.

Name four major anti-inflammatory / immunosuppressive actions of corticosteroids.

Reduced leukocyte migration, vasoconstriction, decreased vascular permeability, and induction of apoptosis in pro-inflammatory T-cells (plus suppression of B-cell antibody production).

List four common adverse effects of prolonged systemic corticosteroid therapy.

Hyperglycaemia, hypertension, decreased bone density/osteoporosis, and impaired wound healing (others: fat redistribution, myopathy, mood changes, gastric ulcer, cataract/glaucoma).

Why are topical corticosteroids generally preferred in the mouth?

They offer equal therapeutic effect with far less systemic exposure and side-effects.

Which topical vehicle is preferred for a solitary, accessible major aphthous ulcer on the tongue?

Gel or ointment applied directly to the lesion.

Which topical vehicle is preferred for diffuse desquamative gingivitis?

'Rinse-and-spit' oral suspension so medication contacts a broad area.

Which delivery form is useful for aphthous ulcers on the soft palate or oropharynx that are hard to reach?

Metered-dose corticosteroid inhalation spray directed at the lesion.

In systemic prescribing for oral lesions, what typical prednisone dose and duration are used for a short course?

0.5–1.5 mg / kg once daily in the morning for 5–7 days (no taper needed).

Match these glucocorticoids with their acting class: hydrocortisone, prednisone, dexamethasone.

Hydrocortisone – short-acting; Prednisone – intermediate-acting; Dexamethasone – long-acting.

When are intralesional steroid injections indicated in the oral cavity?

For refractory or recalcitrant lesions unresponsive to topical or systemic therapy.

What oral complication can follow frequent inhaled corticosteroid use?

Oral candidiasis (thrush).

Give one example each of steroid use in Endodontics, Orthodontics, and Oral Surgery.

Endodontics – Ledermix paste intracanal dressing; Orthodontics – antagonise bone resorption during tooth movement; Oral Surgery – postoperative 8 mg dexamethasone to limit swelling.

Which two low-risk topical steroids are commonly used for recurrent aphthous stomatitis (RAS)?

Hydrocortisone hemisuccinate 2.5 mg pellets and triamcinolone acetonide 0.1 % in adhesive paste.

What systemic prednisone schedule is recommended for severe RAS?

1 mg / kg daily as a single dose, tapered after 1–2 weeks.

What dose of prednisone is typically used during acute flares of Behçet’s disease?

40–60 mg per day, alone or with other immunosuppressants.

Name three high-potency topical steroids suitable for symptomatic oral lichen planus.

0.05 % clobetasol propionate gel, 0.05 % fluocinonide gel, 0.1 % betamethasone valerate gel.

What systemic prednisolone regimen is used for recalcitrant erosive lichen planus?

40–80 mg daily for 5–7 days at the lowest effective dose/duration.

State a typical prednisone course for moderate-to-severe oral erythema multiforme.

40–80 mg per day for 1–2 weeks followed by rapid taper.

What is the initial systemic prednisone range for severe pemphigus vulgaris?

100–200 mg daily until lesions subside, then gradual taper to 40–50 mg maintenance.

For mucous-membrane pemphigoid unresponsive to topical therapy, what systemic prednisolone dose is used?

1–2 mg / kg / day.

Recommended initial prednisolone doses for bullous pemphigoid according to severity?

Mild: 20 mg / day (≈0.3 mg / kg); Moderate: 40 mg / day (≈0.6 mg / kg); Severe: 50–70 mg / day (≈0.75–1 mg / kg).

How are symptomatic oral ulcers in systemic lupus erythematosus usually treated?

High-potency topical or intralesional steroids; systemic low-dose prednisone 10–20 mg / day may be required for flares.

List four key laboratory abnormalities in an acute adrenal crisis (Addisonian crisis).

Hyponatraemia, hyperkalaemia, hypoglycaemia, metabolic acidosis (plus possible uraemia).

What immediate medical management is required for adrenal crisis?

IV 5 % dextrose in normal saline plus IV hydrocortisone 20–25 mg/24 h (primary) or 15–20 mg/24 h (secondary) adjusting as the patient stabilises.

Do routine dental procedures under local anaesthesia usually need steroid supplementation in patients on chronic steroids?

No; maintain the patient’s usual glucocorticoid dose without supplementation.

What peri-operative hydrocortisone regimen is advised for patients on steroids undergoing minor surgery under general anaesthesia?

100 mg hydrocortisone IM pre-operatively, continue normal glucocorticoid medications.

Define ‘steroid-sparing drug’.

A non-steroidal immunosuppressive agent that allows partial or total withdrawal of corticosteroids.

Name three mechanistic classes of steroid-sparing immunosuppressants and give one example of each.

Alkylating agents – cyclophosphamide; Antimetabolites – methotrexate; Calcineurin inhibitors – cyclosporine.

What is the major oral adverse effect associated with cyclosporine therapy?

Gingival hyperplasia.

Which laboratory test must be checked before starting a patient on dapsone?

Glucose-6-phosphate dehydrogenase (G6PD) level to avoid haemolysis.

State two serious adverse effects of weekly low-dose methotrexate.

Marrow suppression and hepatotoxicity (others: mucositis, alopecia).

What constitutes ‘success’ of corticosteroid-sparing therapy?

Reducing prednisone to ≤10 mg/day, clinical reduction of inflammation, symptom stabilisation/improvement, and acceptable drug-related side-effect profile.

What is a biologic agent in the context of immunotherapy?

A therapeutic product derived from or engineered in biological sources that targets specific immune cells or mediators (e.g., monoclonal antibodies, fusion proteins).

Name three TNF-α inhibitors used in oral-medicine conditions.

Infliximab, etanercept, and adalimumab.

What surface molecule on B-cells is targeted by rituximab?

CD20.

How does denosumab help in osteoporosis management?

It blocks RANK-L, inhibiting osteoclast formation and activity, thereby reducing bone resorption and increasing bone density.

Give two oral-health–related indications for biologic therapy.

Refractory Behçet’s disease or vesiculobullous diseases (e.g., pemphigus/pemphigoid) unresponsive to conventional therapy.

List four potential systemic side-effects common to many biologic agents.

Infusion reactions/cytokine storm, serious infections, autoimmune phenomena, and increased risk of malignancy (others: fatigue, MRONJ, impaired wound healing).

What overarching principle must accompany the use of steroids, steroid-sparing drugs, or biologics in dentistry?

Close patient monitoring to balance therapeutic benefit against potential systemic and oral adverse effects.