Sir, were Dexamethasone to be included in the Dental Formulary, practitioners need to be aware of common and important physical and psychiatric side effects of this potent glucocorticoid (steroid), prior to prescribing for the control of pain related to root canal treatment.
It is widely recognised that steroids can cause or worsen hyperglycaemia, and national guidelines recommend monitoring glucose levels in those with and at risk of diabetes.1 Although much of the evidence concerns long term steroid use, hyperglycaemia has been frequently reported after short courses, for example in oncology practice.2
Glucose levels can rise within hours of high dose steroids, with a disproportionate effect on afternoon and evening levels.3,4 Patients with or at risk of diabetes therefore need to be counselled to monitor their glucose levels after taking dexamethasone and may need to make short term adjustments of their diabetes therapy.
Even short courses of Dexamethasone in the peri-operative period may have an impact on wound healing,5 which would be relevant to the proposed use in endodontics.
Another established side effect of Dexamethasone is that it can cause steroid induced psychiatric reactions, including psychosis, mood changes, behavioural disturbance and cognitive dysfunction. These symptoms can develop within days of a 5 mg single dose even in those who have no psychiatric history.6,7,8,9 The incidence of a psychiatric episode to steroids has been recorded at being between 13% and 62%.8 Many of these are mild reactions such as euphoria and increased irritability and may not impact on functioning, but patients need to be warned about the severe reactions in up to 5-6% of patients,8,10 such as mania and suicidal thoughts. Severe and persistent symptoms will require treatment which is beyond the remit of the dentist.
References
JBDS-IP. Joint British Diabetes Societies for inpatient care. Management of hyperglycaemia and steroid (glucocorticoid) therapy. October 2014. Available at: https://www.diabetes.org.uk/resources-s3/2017-09/JBDS%20management%20of%20hyperglycaemia%20and%20steriod%20therapy_0.pdf (accessed 18 March 2018).
Véber O, Wilde A, Demeter J Tamás G, Mucsi I, Tabák A G. The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: a randomized crossover observational clinical study. J Endocrinol Invest 2014; 37: 345-351.
Burt M G, Roberts G W, Aguilar-Loza N R, Stranks S N. Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab 2011; 96: 1789-1796.
Lyall M J, Thethy I, Steven L et al. Diurnal profile of interstitial glucose following dexamethasone prophylaxis for chemotherapy treatment of gynaecological cancer. Diabet Med 2018; 35: 1508-1514.
Polderman J A, Farhang-Razi V, Van Dieren S et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev 2018; 11: CD011940.
Janes M, Kuster S, Goldson T M, Forjuoh S N. Steroid-induced psychosis. Proc (Bayl Univ Med Cent) 2019; 32: 614-615.
American Psychiatric Association aww. Diagnostic and statistical manual of mental disorders: DSM-5. 5th edition. Washington, DC: American Psychiatric Association, 2013.
Lewis D A, Smith R E. Steroid-induced psychiatric syndromes: A report of 14 cases and a review of the literature. J Affect Disord 1983; 5: 319-332.
Silva R G, Tolstunov L. Steroid-induced psychosis: report of case. J Oral Maxillofac Surg 1995; 53: 183-186.
Corticosteroids: easy psychiatric side-effects. September 2007. Available at: https://www.gov.uk/drug-safety-update/corticosteroids-early-psychiatric-side-effects (accessed 26 July 2020).
Nogueira B L, Silva L, Mesquita C M et al. Is the use of dexamethasone effective in controlling pain associated with symptomatic irreversible pulpitis? A systematic review. J Endod 2018; 44: 703-710.
Konagala R K, Mandava J, Pabbati R K et al. Effect of pretreatment medication on postendodontic pain: a double-blind, placebo-controlled study. J Conserv Dent 2019; 22: 54-58.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Morganstein, S., Morganstein, D. & Morganstein, L. Dexamethasone caution. Br Dent J 229, 398 (2020). https://doi.org/10.1038/s41415-020-2238-7
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41415-020-2238-7
This article is cited by
-
Immunomodulatory agents for COVID-19 treatment: possible mechanism of action and immunopathology features
Molecular and Cellular Biochemistry (2022)
