Summary
Medications Summary - Dental Surgery BDS
- Module
- Dentistry
- Institution
- Cardiff University (CF)
A complete set of notes on all medicines teaching from the Dental Surgery BDS course at Cardiff University. All 5 years are covered.
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Steroids➔ Long term corticosteroids for primary adrenal insufficiency (Addison’s) OR for other
conditions (RA)
Prednisolone 10mg is equal to
● Betamethasone 1.5mg
● Dexamethasone 1.5mg
● Hydrocortisone 40mg
● Methylprednisolone 8mg
● Triamcinolone 8mg
➔ These patients will have suppressed HPA axis (reduced stress response efficacy)
➔ Do not stop long term corticosteroids - will cause insufficient cortisol concentration -
increased risk of Addisonian crisis
➔ Signs of adrenal crisis = sweating, nausea, dizziness, collapse, hypotension
➔ Tx of adrenal crisis = IV steroids
Supplementation for dental procedures
● Minor procedure (filling): continue usual doses on day. Additional oral dose of next dose
due to be taken one hour before appointment. Resume as normal afterwards
● Minor OS (root canal under LA): continue usual doses on day. Extra double dose (up to
20mg hydrocortisone or equivalent) of the next due dose one hour prior to surgery.
Continue to double all due doses for 24 hours post-procedure
● Major dental surg (multiple XLA under GA): refer to secondary care
Antiplatelets
● Take as normal
● Consider staging treatment over multiple visits
Warfarin
● Take as normal, ensure INR less than 4 maximum 72 hours prior to procedure (ideally
24 hours)
● Consider staging treatment over multiple visits
● Can use absorbable sutures or oxidised cellulose (Surgicel)
Direct Oral Anticoagulants
● Simple extractions ok if normal renal function
● For procedures with higher risk of bleeding:
- DOACs administered twice a day (apixaban, dabigatran): skip morning dose
- DOACs administered once a day (rivaroxaban): if pt usually takes in morning, delay
dose until 4 hours after haemostasis. If pt usually takes in evening, no need for alteration
MRONJ
● Try to avoid extractions
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