Steroid Medications Will Reduce Your Pain And At The Same Time Will Induce Another Pain

Steroids are organic compounds, naturally present in the human body (e.g. cholesterol, corticosteroids, estradiol, testosterone etc) and also ubiquitously present in the external environment (plants, fungi, and animals). Under normal conditions, steroids act as essential hormones and chemical messengers helping in the regular development and functioning of the human body. Corticosteroids are chemicals continuously synthesized and released in the body by the cortex region of adrenal glands and are controlled by a negative feedback mechanism.  

There are two main classes of corticosteroids: glucocorticoids and mineralocorticoids (aldosterone). Any alteration in their balance such as hormonal imbalance leads to serious health issues like impaired or abnormal body development, behavioral changes, nervous breakdown, metabolic disorders and obesity, cardiovascular complications, musculoskeletal diseases etc.

Examples of important and widely used medications containing steroids

These steroids, under several medical conditions and diseases, are recommended by the physicians to be administered as medications, which are actually artificially synthesized chemicals mimicking the function of natural steroids in the body. Not only corticosteroids, a different class called anabolic steroids also makes their entry into the human body both knowingly as supplements and unknowingly through over the counter medicines. Although the effects of the two steroid types are different, it is a common fact that over-use of both of them results in severe negative implications.

The most widely found steroidal contents present in prescription drugs are corticosteroids, taken in the following forms, with common examples:

  • Oral medications (in the form of tablet, capsule, syrups): Analgesics for pain management, anti-hypertensive drugs
  • Injectables: Examples are anti-inflammatory drugs such as those for treating arthritis, injections taken for sudden control of pain, intra-articular injections in dentistry
  • Nasal sprays and inhalers: Drugs for rhinitis, sinusitis, asthma, COPD (Chronic Obstructive Pulmonary Disease) etc available for nasal and pulmonary administration
  • Topical forms (creams, ointments, lotions etc): Treatment of dermatological infections, dermatitis, scar management, mouth ulcers

Therapeutic applications of corticosteroids in dentistry

Dentistry is the medical branch which deals with the diagnosis, management, prophylaxis and prevention of conditions and diseases of the oral cavity, mucosa and bones and tissues of the maxillofacial region such as the face, jaws, and adjoining areas. Major surgical operations, vesiculobullous diseases (fluid-filled blisters), orofacial granulomatosis (soft tissue thickening and ulceration), temporal arteritis and other oral mucosal disorders, pain management and treatment methods for minor conditions like cavities, ulcers etc require the dentist to prescribe medications containing steroids. These medicines have different therapeutic effects not only around the face and oral region but in the entire body. Examples of dental disorders for which steroid medicines are used:

  • Post-operative symptoms like allergy, pain, edema, surgical retraction: Glucocorticoids
  • Different types of oral ulcerations (caused by dentures, stomatitis, parasitic infections, gingivitis): Dexamethasone, Clobetasol, Prednisolone
  • Pulpal hypersensitivity (caused by surgeries, dentin exposure, bacterial infection): Glucocorticoids, Intracranial medications used to reduce pulpal inflammation, to prevent root resorption
  • Temporomandibular joint disorders: Dexamethasone, Prednisolone injections
  • Allergies like infections, contact dermatitis etc: Hydrocortisone, Clobetasol, Betamethasone
  • Systemic use of steroids in dentistry: For procedures like third molar extraction, pre-prosthetic surgery, orthognathic surgery (surgery of jaw and face), reconstructive oral surgery etc.
Side-effects of drugs containing corticosteroids

When taken in low doses or administration over a short period of time does not cause serious side-effects in the patients except for the regular, general conditions like mood swings, sleep disorders, weight gain etc. These conditions may return back to normal once the medication is stopped and drug remains are flushed out of the body. However when administered in large doses and over a long period of time, drastic side-effects are more likely to appear, some may be permanently present throughout the lifetime.

Another common side-effect of long-term corticosteroid usage is dental pulp calcification in which patients develop pulp stones. These can cause sudden pain, infections in the oral cavity, ulcers and abscess in the dentures, and hardening of the pulp tissue. Under severe complications, root canal may become necessary.

Side-effects of steroids administered by dental patients

The side-effects of steroid-containing medicines administered as a part of dentistry procedures can be summarized as below:

  • Neurologic effects like lack of sleep (insomnia), anxiety, mood disorders, behavioral abnormalities
  • Cardiovascular effects like hypertensions, increased risk of plaques
  • Increase in susceptibility to opportunistic infectious disease
  • Dermatological effects like atrophy
  • Musculoskeletal system may show symptoms of myopathy, muscle wasting, osteoporosis
  • Metabolic disorders including hyperlipidaemia and glucose intolerance (hormonal and enzymatic imbalance)
  • Gastrointestinal tract ulcers
  • Cataracts
  • Other general side-effects like acne, weight gain, pancreatitis, dry mouth, hirsutism (excessive body hair)

Steroidal cover for procedures in dentistry under conditions of Adrenal crisis and Addison’s disease

Corticosteroids such as hydrocortisone and fludrocortisone are used in the prophylaxis of adrenal disorders like adrenal insufficiency (Addison’s disease) characterized by decreased production of the steroids cortisol and aldosterone by the adrenal gland.  In some patients taking exogenous glucocorticoids and certain dental procedures taking more than two weeks may cause stress. This can suppress the cortisol production in the body, increasing the risk of adrenal crisis or Addisonian or Adrenal crisis.

The dentists, therefore follow the method in which patients undergoing severe stressful medical procedures, major surgeries and those who are at high risk are given additional glucocorticoid supplementation, which is also known as steroid cover. Steroid cover is not required for patients undergoing minor dental procedures of less than two-week duration or routine dental procedures such as conservative dentistry and local anesthesia.

Sudden withdrawal of corticosteroids can cause adverse effects in severe diseases like Adrenal crisis. So slow reduction of the dosage and combined dosage with non-steroidal medications having similar indications are better alternatives.

Unlike other fatal diseases requiring steroid medication, dental disorders can be prevented to a large extent. Periodic and regular dental checkups are beneficial though tedious and time-consuming. But, as prevention is better than cure, this inconvenience is better tolerable than inviting serious dental diseases making you take bigger pain and expenses. Most importantly, preventive dental check-ups help you to keep the steroid drugs at bay.