Steroids and Dental Procedures: Important Precautions

How Steroids Affect the Body

Corticosteroids (such as prednisolone, dexamethasone, methylprednisolone, and hydrocortisone) are prescribed for a wide range of conditions including rheumatoid arthritis, asthma, inflammatory bowel disease, autoimmune diseases, and organ transplant maintenance. They are potent anti-inflammatory and immunosuppressive medications.

Long-term use of systemic steroids — typically defined as more than 5 mg of prednisolone (or equivalent) daily for more than one month — has several effects that are directly relevant to dental treatment.

Adrenal Suppression and the Risk of Adrenal Crisis

The most important consideration for dental treatment is adrenal suppression. The adrenal glands normally produce cortisol in response to physical stress, pain, and anxiety. Prolonged steroid use suppresses the adrenal glands — they become unable to produce their own cortisol when needed.

In a stressful situation — such as a dental procedure involving pain, anxiety, or surgery — the body's demand for cortisol increases sharply. If the adrenal glands are suppressed, they cannot meet this demand. The result can be a potentially life-threatening adrenal crisis, characterised by sudden severe weakness, nausea, vomiting, low blood pressure, and collapse.

Steroid Cover for Dental Procedures

For major dental procedures (surgical extractions, implant surgery, multiple extractions under local anaesthesia), patients on significant long-term steroids may need supplemental steroid cover — an additional dose of hydrocortisone given before the procedure to meet the body's increased cortisol demand.

The need for steroid cover depends on the current dose, duration of steroid use, and the nature of the procedure. For minor procedures such as scaling or simple restorations, steroid cover is usually not required. Dr. P Meghana may liaise with your prescribing physician to determine the appropriate protocol.

Impaired Healing and Infection Risk

Steroids impair wound healing by suppressing the inflammatory phase of healing, reducing collagen synthesis, and blunting the immune response. For dental patients, this means:

• •Extraction sockets may take longer to heal and are more prone to dry socket
• •Surgical wounds heal more slowly and may require longer suture retention
• •The risk of post-procedure infection is higher — antibiotics may be prescribed prophylactically
• •Oral candidiasis (thrush) is more common, especially in patients using inhaled steroids without rinsing after use

Steroid-Related Bone Changes and Implants

Long-term systemic steroid use can cause osteoporosis (bone thinning), which affects the jawbone. This has implications for dental implants — reduced bone density can impair osseointegration (the fusion of the implant with bone). Patients on long-term steroids who are considering implants should have a bone density assessment and a candid discussion with Dr. P Meghana about realistic outcomes.

Inhaled Steroids and Oral Health

Patients who use inhaled corticosteroids (like Fluticasone, Budesonide, or Beclometasone) for asthma or COPD are at risk for oral candidiasis (a fungal infection causing white patches or soreness in the mouth) and dental erosion from dry mouth. To minimise this risk, always rinse your mouth with water and gargle immediately after using a steroid inhaler. Using a spacer device with your inhaler also reduces oral deposition.