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The Use of Systemic Corticosteroids for the Relief 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.

Further Information

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.

 

Online Induction

Ensuring our entire team have a thorough understanding of the organisation, what drives us and what makes us a world-class team is very important.  By sharing the same vision and the way we do things, we can continue to provide the innovative solutions and high standards for which we have become renowned both in Australia and overseas.  

Even our “old hands”, meaning those who have been with us for many months or years, must complete the new program.  We have taken a modular approach to the program and in all, there are six modules.   It is structured so your Induction runs over a six week period; however, we would ask that current staff move through the program as soon as you can.  I need your support to ensure that all staff to complete the full program by 31 January 2014.   We estimate that the program should take around 2 hours to complete.   In anticipation, thank you for your support for this important activity.

As an overview, the induction includes:

Introduction and HR

This module includes topics covering the Aspen Medical organisation, our values and important company policies and procedures.

HSE

In this module we will cover areas such as work, health and safety, manual handling, risk management and incident reporting.

Quality

This module provides an overview of our quality management system including the standards under which it is delivered and instruction on how to access this system.

Clinical Governance

This module includes a brief overview of clinical governance that will provide you with an understanding of the importance of safety, quality in health care and our world class credentialing process.

Infection Control

In this module you will gain an understanding of the basic principles of infection prevention and control as well as understanding the importance of good hand hygiene practices.

Workplace Confidentiality

Within this module we provide you with an understanding of accepted codes of conduct, steps on following confidentiality and privacy procedures.

 

How to access the Induction Program:

Step 1: Logon to the MyAspen staff portal (see below for details of the location of the login on the ne website)

Step 2: Click on Training & Online Programs

Step 3: Click on Corporate Training

Step 4: Click on Aspen Medical Induction 2013 – 2014 ALL NEW INDUCTION

Step 5: Enter the AMCI Enrolment Key: AMci13%$

If you do not have logon details to the MyAspen staff portal, please contact [email protected]

After you have finished all modules you will be required to complete the Employee Feedback questionnaire for the program.

As this is a new program we ask you to be patient with the system and know that your constructive feedback is valuable.  Feedback will be given due consideration as it supports Aspen Medical corporate quality improvement initiatives.  Please provide any feedback to your Manager or send an email to [email protected]

 

Staff Portal

No it hasn't disappeared!  The MyAspen Staff Portal log-in has been re-located on the new website to the bottom of the web pages.