By Renee Prajer, RDH, MS, and Gwen Grosso, RDH, MS
The adrenal glands produce hormones that are involved with every body function. They are located bilaterally above the kidneys. The functions of the adrenal glands include anti-inflammatory and immunosuppressive properties, as well as providing homeostasis during periods of physical or emotional stress.
The adrenal glands are responsible for cortisol (cortisone) production. Cortisol (cortisone) regulates the metabolism of carbohydrates, fat, and protein. Cortisol is vital in helping the body react to stressful situations. Individuals with decreased cortisol production cannot respond to stress and therefore are at risk of cardiovascular collapse (adrenal crisis) and possible death.
The adrenal glands also produce aldosterone. Aldosterone regulates sodium and potassium, which are critical in the maintenance of blood pressure. Hypofunction of the adrenal glands results in decreased cortisol production (Addison's disease). Adrenal crisis can occur when a patient with adrenal insufficiency (Addison's Disease) is challenged by stress.
The treatment for Addison's Disease is steroidal medication. Patients taking exogenous steroids may have adrenal suppression with decreased cortisol production resulting in the body's inability to produce cortisol when stress is encountered. Patients who are taking steroids for asthma or arthritis may also be at risk for adrenal insufficiency. If a patient has taken 10 to 20 milligrams of steroids within the last year for a seven- to 10-day period, the patient may need additional steroid supplementation for invasive surgical procedures. It is prudent to consult the patient's physician regarding the need for steroid supplementation.
Current research indicates the majority of patients with adrenal insufficiency can receive routine dental treatment without the need for supplemental steroids. Individuals at risk for adrenal crisis during dental procedures are those patients with little to no adrenal function who are scheduled for surgical procedures that may cause stress.
When assessing the risk of adrenal crisis, the oral health-care provider should consider the following:
• Patient's medical history
• The procedure that is being performed (surgery, prophylaxis, etc.)
• Administration of drugs
& • The level of pain control
Darby, Walsh: Dental Hygiene Theory and Practice, 2003 Saunders, Supplemental Corticosteroids for Dental Patients with Adrenal Insufficiency, JADA, Vol. 132, November 2001, Little J. et al: Dental Management of the Medically Compromised Patient, 2002, Mosby.
Renee G. Prajer, RDH, MS, is an assistant professor and Junior Clinic Coordinator in the Department of Dental Hygiene at the University of New Haven in West Haven, Conn.