Sir, the paper by Drs Gibson and Ferguson (BDJ 2004, 197: 681–685) reviews this controversial field well. In their introduction, they refer to a previous edition of Medical Problems in Dentistry (1998). This was written about 5 years ago, based on the evidence then available. The current (2004) edition states “Although the evidence for the need for steroid cover may be questionable, medico-legal and other considerations suggest that one should act on the side of caution and fully inform and discuss with the patient, take medical advice in any case of doubt and give a steroid cover unless quite confident that collapse is unlikely”

Although Gibson and Ferguson make no reference to our initial recent recommendations, our last conclusion is not too dissimilar to their conclusions – though perhaps a little more cautious.

It may also be relevant that the UK MHRA (Medicines and Healthcare Products Regulatory Agency) and CSM (Committee of Safety of Medicines) together published recommendations which appear not yet to have been superseded, that include “Patients who encounter stresses such as trauma, surgery or infection and who are at risk of adrenal insufficiency should receive systemic corticosteroid cover during these periods. This includes patients who have finished a course of systemic corticosteroids of less than three weeks duration in the week prior to the stress. Patients on systemic corticosteroid therapy who are at risk of adrenal suppression and are unable to take tablets by mouth should receive parenteral corticosteroid cover during these periods.”

(http://www.mca.gov.uk/ourwork/monitorsafequalmed/currentproblems/ volume24may.htm)