Gaw A Gemma, Wemyss Callum, Bell Aileen, Goodall Christine A
Dental Core Trainee in Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Larbert, UK.
Speciality Registrar in Oral Surgery, Glasgow Dental Hospital and School, Glasgow, UK.
Br Dent J. 2022 Aug 5. doi: 10.1038/s41415-022-4515-0.
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.
患有艾迪生病或长期使用全身性糖皮质激素导致皮质类固醇反应受损的患者在接受牙科治疗时存在肾上腺危象的风险。目前缺乏确凿证据来支持牙科团队识别有风险的患者并对其进行管理以预防肾上腺危象。
回顾英国牙科教学医院在牙科环境中对有肾上腺危象风险患者的管理现状。
向英国所有18家牙科教学医院发送了一项电子调查问卷，重点关注因全身性糖皮质激素治疗可能有肾上腺危象风险的患者。询问了有关使用政策或指南的信息。对有关临床决策、患者风险评估和类固醇替代给药方案的回复进行了评估。
回复率为78%。只有29%的机构有书面政策或指南文件。在确定有肾上腺抑制风险的患者时，类固醇剂量阈值和治疗持续时间存在差异。此外，类固醇替代的给药方案也各不相同。
需要更多关于有肾上腺危象风险患者管理的证据，以为国家指南提供依据并减少患者管理的差异。
