|History of systemic use of more than 7.5 mg/day of prednisone for more than 3 weeks.||Presently using more than 7.5 mg/day of systemic prednisone.||Glucocorticosteroid use on alternating days.|
|Minimally stressful procedures||If within 2 weeks after cessation of glucocorticosteroid therapy: Give previous maintenance dose on morning of appointment.||No supplementation of glucocorticosteroids needed.||No supplementation of glucocorticosteroids needed. Provide dental care on same day patient is taking glucocorticosteroids.|
|Stressful procedures||If within 3 weeks after cessation of glucocorticosteroid therapy: Give previous maintenance dose on morning of appointment.||Double daily dose on day of procedure and give an additional single dose on first postoperative day if pain is anticipated.||Double daily dose and provide dental care on same day patient is taking glucocorticoteroids.|
Always monitor blood pressure during the procedure.
Always prevent any intraoperative pain.
Always provide postoperative analgesia.
UK Medicines Information Pharmacists, have put forth modifications to these recommendations.#Different organizations, such as
- Glick M. Glucocorticosteroid replacement therapy: a literature review and suggested replacement therapy. Oral Surg Oral Med Oral Pathol. 1989;67(5):614-20
- Miller CS, et al. Supplemental corticosteroids for dental patients with adrenal insufficiency: reconsiderations of the problem. J Am Dent Assoc 2001;132:1570-1579.