The Use of Systemic Corticosteroids for the Reilef of Dental Pain
The aim of this bulletin is to provide advice for all prescribing Aspen Medical clinicians regarding the use of systemic Corticosteroids such as Dexamethasone for the relief of dental pain.
The Therapeutic Guidelines, Oral and Dental, 2012 at page 40, include the following guidance:-
“Systemic corticosteroids are usually inappropriate for general dental practice. They represent a highly potent class of medication and while adverse events are uncommon and of short duration, they are significant...Some oral inflammatory conditions, however, do require systemic corticosteroids. Systemic corticosteroids should only be used in patients who have been assessed as suitable for treatment (e.g. there are no contra-indications to their use) and in whom they are the treatment of choice. Systemic corticosteroids may be useful in the management of severe postoperative swelling, severe trauma and periapical nerve sprouting and acute apical periodontitis following removal of an acutely inflamed pulp. All of these conditions usually require specialist management.”
- Clinical staff may be presented with patients with persistent and severe dental pain which cannot be resolved with the use of conventional analgesics and is non-responsive to remedial dental treatments. In most cases referral to a specialist is indicated, however there may be time delays before definitive treatment can be provided and the patient’s symptoms may need to be managed in the interim.
- Small, short term doses of systemic corticosteroids may be prescribed to assist with the relief of persistent and severe dental pain which is non-responsive to dental treatment and prescription of conventional analgesics (eg Paracetamol and Codeine, Oxycodone etc.) Alternatively, small short term does of systemic corticosteriods may be used where regular analgesics are contra-indicated.
- Systemic corticosteroids should not be prescribed for dental pain for a period in excess of five (5) days with dental clinical review to occur immediately upon completion of the prescribed dosage.
Appropriate dosage/ prescription is as follows: “Dexamethasone 4mg tab.” Instructions: Take 2 tabs (8mg) immediately, then 1 tab (4mg) twice daily for a maximum of five (5) days. Issue total: 12 tabs. Nil Repeats.
Patients must be given clear and comprehensive information regarding these medications and their potential side effects. Patients must be informed that this medication is only being used as a short term option and if unsuccessful in resolving the pain, specialist treatment must be sought immediately.
- All efforts to investigate and resolve the cause of the pain should be made within the first week of this initial prescription. Specialist treatment or surgical intervention under general anaesthesia is frequently indicated to resolve the cause of the pain so priority for this treatment should be increased and appropriate timeframes assigned. If necessary, alternative treatment times or alternative providers may need to be sourced.
Aspen Dentists who are members of the ADA are reminded that they can access the 'ADA Therapeutics Advice Line' through the ADA Members Services portal or via the following link:- http://www.ada.org.au/members/PharmaAdvice/pharmaadvice.aspx
Further advice may be sought via the Aspen Medical Clinical Team Clinical at [email protected] or (02) 6203 9500
National Prescribing Service (NPS) has a free Medication safety course that is recommended for all clinical – especially Medical Practitioners, Nurses, Pharmacists and Dentists. The course is on-line and free. The course also attracts Continuous Professional Development (CPD) points.
Please keep your credentialing information up-to-date. All DOHS CHPs are reminded of the following:
- maintain currency of AHPRA registration by the due date
- maintain a program of continuous professional development, and be able to provide evidence of such when requested
- notify DOHS management if additional relevant professional qualifications have been attained
- notify DOHS management if a complaint has been made about clinical performance, or an investigation commenced into professional behaviour.
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