Key Topics

• • Introduction
• • Topical corticosteroids
• • Systemic corticosteroids
• • Implications for dental practice

Learning Objectives

• • To be familiar with the use of topical steroids in maintaining oral health
• • To be aware of the potential adverse effects of corticosteroids and how they may affect the role of the dentist.

Introduction

Corticosteroid medications are synthetic agents used either systemically (oral or parenteral route) or topically. They are used to treat inflammation and allergy as well as being used for their immunosuppressive properties.

Examples of conditions requiring steroid treatment include asthma, cerebral oedema, anaphylaxis, inflammatory bowel disease, pemphigus and as part of chemotherapy regimens among many others.

This chapter summarizes the use of topical corticosteroids including those that are licensed for use in and around the oral cavity, systemic corticosteroids and their side effects and the implications for dental practice in terms of steroid cover.

Topical corticosteroids

There are a number of topical corticosteroid preparations available in various different forms including creams, ointments, nasal sprays and eye drops. They act locally to suppress the inflammatory response. They are classified according to the potency of the steroid and the range includes mild, moderate, potent and very potent preparations. Examples include hydrocortisone 0.1% (mild) at one end of the spectrum through to clobetasol (very potent) at the other end. To minimize potential side-effects, the least potent efficacious preparation should be considered.

Compound preparations are also available whereby a corticosteroid is combined with an antimicrobial agent.

Uses in dentistry

Topical corticosteroids have many uses in dentistry from treating oral mucosal ulcerative lesions through to the use of compound preparations to manage, for example angular cheilitis and pulp capping.

Oral mucosal lesions can include oral ulcers (aphthae), lichen planus and mucous membrane pemphigoid among others. Hydrocortisone muco-adhesive buccal tablets can be applied directly to the lesion. Betamethasone 500 microgram tablets can be dissolved in water to make a mouthwash and can be used up to four times daily when lesions are present. The patient must be instructed not to swallow the preparation.

Ledermix® is a dental cement that is a compound preparation containing both an antibiotic and triamcinolone. It can be used to treat reversible pulpitis or for deep caries close to the pulp for both direct and indirect pulp capping.

A compound preparation of miconazole nitrate 2% with hydrocortisone 1% (Daktacort™) can be used to treat angular cheilitis. This preparation may be selected instead of an antimicrobial on its own if there is a significant amount of inflammation at the angle of the mouth.