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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 (2022)Cite this article

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.

Key points

  • The majority of UK dental teaching hospitals do not have a local policy or guidance document to support clinical decision-making in the management of patients at risk of adrenal crisis in the dental setting.

  • Across the UK, there is variation in the management of patients at risk of adrenal crisis in the dental setting and sources of reference used by institutions provide differing recommendations.

  • This survey supports the need for evidence review, further studies and the development of pragmatic national guidance to reduce variation in practice, support the dental team with clinical decision-making and improve the safety of patients who may be at risk of adrenal crisis.

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Acknowledgements

We would like to thank all of the responding institutions for providing us with the information within this study and their supporting comments. Thank you also to Callum Weir.

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Authors and Affiliations

  1. Dental Core Trainee in Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Larbert, UK

    A. Gemma Gaw

  2. Speciality Registrar in Oral Surgery, Glasgow Dental Hospital and School, Glasgow, UK

    Callum Wemyss

  3. Professor of Oral Surgery and Dental Education, Honorary Consultant in Oral Surgery and Head of Dental School, School of Medicine Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK

    Aileen Bell

  4. Professor of Oral Surgery and Violence Reduction, Honorary Consultant in Oral Surgery, School of Medicine Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK

    Christine A. Goodall

Authors
  1. A. Gemma Gaw
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  2. Callum Wemyss
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  3. Aileen Bell
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  4. Christine A. Goodall
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Contributions

A. Gemma Gaw and Callum Wemyss designed the survey, analysed the data and prepared the manuscript. Aileen Bell facilitated distribution of the survey. A. Gemma Gaw, Callum Wemyss, Aileen Bell and Christine Goodall reviewed and edited the manuscript and approved the final version.

Corresponding author

Correspondence to A. Gemma Gaw.

Ethics declarations

The authors declare no conflicts of interest.

This study is a service evaluation and therefore ethical approval was not required. All survey respondents consented to participate in this study and to the use of their data being shared for research purposes and publication.

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Gaw, A., Wemyss, C., Bell, A. et al. Management of patients at risk of adrenal crisis in the dental setting: a review of current practice in UK dental teaching hospitals. Br Dent J (2022). https://doi.org/10.1038/s41415-022-4515-0

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  • DOI: https://doi.org/10.1038/s41415-022-4515-0

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