CORTICOSTEROIDS IN DENTISTRY

Dr.Mehnaz1 Comment

🔷 Introduction:

Steroids are a group of hormones produced naturally in the body.

The adrenal cortex consists of 3 zones:

  1. Zona Glomerulosa synthesizes Aldosterone, the most potent Mineralocorticoid in humans.
  2. Zona Fasciculata – produces hydrocortisone (a glucocorticoid)
  3. Zona Reticularis produces Adrenal Androgens

• Glucocorticoid secretion is regulated by ACTH produced in the anterior pituitary. Cortisol has a -ve feedback on ACTH production.

• In Addison diseases, Glucocorticoid secretion impaired & ACTH is ⬆️

🔷 Corticosteroid Action & its regulation

  • Glucocorticoid – Hepatic Glycogen deposition
  • Mineralocorticoid – Sodium, electrolyte-fluid balance.
  • Glucocorticoid play critical role in body’s response to stress.

Stress

⬇️

Release of cytokines (IL-1)

⬇️

⬆️ cortisol levels

🔷 Classification:

Adrenocortical Hormones & Related Drugs

🔷 Steroid synthesis:

The substrate for steroid production is cholesterol. It is mobilized from the outer to the inner mitochondrial membrane by the steroidogenic acute regulatory (StAR) protein.

🔷 Glucocorticoids:

1) Hydrocortisone

• Action: Anti-allergy, anti-inflammatory

• Therapeutic Uses:

a) OSMF
  • intralesional injection in dose of 20-50 mg/mL
  • Topical application
  • Tablet in dose of 100mg/day can be given systemically to relieve burning sensation.
  • Tab. Cortisol(25mg) combined with dexamethasone(90mg) can be given at biweekly interval.*

Action: Fibrinolytic,Anti-allergic, anti-inflammatory*

It causes ⬇️ fibroblastic production & deposition of collagen*

b) Aphthous ulcer:
  • Topical application with orabase
  • Intralesional injection of hydrocortisone acetate (25mg/ml)
c) Desquamative Gingivitis:
  • Topical application (0.25-0.5%) to the affected area
d) Osteoarthritis
  • Intra-articular injection (25mg/ml)
e) Addisons disease
  • 20-30mg/day in divided doses
f) Lichen planus, pemphigus & eczematous skin disease
g) Shock, status asthmaticus, ulcerative colitis

• Trade Name: CORTEF, ORABASE-HCA

• Preparation:

  1. Oral: 5 – 20 mg tab.
  2. Topical – 1% eye drop solution; 0.025 nasal drops, 0.25-2.5% skin creams

• Hydrocortisone acetate 25-50 mg/mL for soft tissue suspensions

• Hydrocortisone sodium phosphate: 50mg/mL IV, IM, SC

2) Cortisone:

• Uses:

  1. OSMF
  2. Addison disease
  3. Hodgkin lymphoma

3) Prednisolone:

• Action: Anti-allergic, anti-inflammatory, immunosuppressive

• Uses:

  1. Rheumatoid arthritis: 10mg/day in divided doses
  2. Collagen disease: 1mg/kg
  3. SLE: IM/IV; Topical application 2-3 times daily
  4. Leukemia: ALL as maintenance dose
  5. Erythema multiforme, pemphigus, bullous pemphigoid, behchet’s syndrome
  6. Bronchial asthma: 40-60 mg
  7. Post-herpetic neuralgia
  8. Amyloidosis, cyclic neutropenia, purpura

• Trade name: DELTA-CORTEF, PRELONE

4) Triamcinolone:

• Uses:

  1. Lichen planus: Topical application 3-4 times daily
  2. Erythema multiforme: 40-100 mg/day or inhalation doses
  3. Recurrent aphthae: Oral (2-4 mg/day)
  4. Desquamative gingivitis, OSMF, contact chelitis – intralesional (2-3 mL/day)

• Trade name: Kenolog cream

5) Dexamethasone:

• Uses:

👉🏻Mainly used for adrenal cortical suppression

  • Allergic diseases, serum sickness, urticaria, hay fever, angioneurotic edema: IV; topically 2-4 times a day
  • Benign migratory glossitis: Topical application
  • Shock, cerebral edema, occular diseases.

• Trade name: DECADRON

6) Betamethasone:

• Action: Anti-allergy, anti-inflammatory

• Uses: Lichen planus, pemphigus, Aphthae ulcer

Dr. Mehnaz Memon🖊

References: Self Notes, Image chart source: Classification of Drugs with DOC by Vikas Seth (Third Edition)

PARATHYROID MEDICINE

muhadnoormanLeave a comment

Muhad Noorman p, Final year, Team Dentowesome

Hyperparathyroidism

Disorder of parathyroid gland characterised by excess secretion of PTH hormones resulting in clinical and biochemical hypercalcemia.

The most common cause of excess hormone production (hyperparathyroidism) is the development of a benign tumor in one of the parathyroid glands. This enlargement of one parathyroid gland is called a parathyroid adenoma which accounts for about 70 percent of all patients with primary hyperparathyroidism. The other causes comprises of parathyroid hyperplasia and PARATHYROID carcinoma (rarely).

Types

1) Primary hyperparathyroidism occurs when there is a disorder of the parathyroid glands themselves.

2) Secondary hyperparathyroidism results when a condition elsewhere in the body affects the parathyroid glands, causing them to produce too much hormone

3) Teritiary hyperparathyroidism causes when long standing secondary hyperparathyroidism become autonomous gland

CLINICAL FEATURES

Commonly found in middle aged women’s.

Hyperparathyroidism may or may not cause symptoms. When symptoms do appear, they are often mild, such as
weakness,
fatigue,
depression,( psychic moans) or
body aches and pains.
In primary hyperparathyroidism, the elevated levels of PTH cause elevated levels of blood calcium (hypercalcemia). Increased calcium and phosphorus excretion in the urine may cause kidney stones.(Nephrocalcinosis and nephrolithiasis).

Diagnosis of hyperparathyroidism relies on blood tests to measure hormone and calcium levels. Elevated Serum Calcium and phosphorus level .

Surgery is the main treatment for hyperparathyroidism. Surgical resection of adenoma and transplantation in hand muscles is most followed protocol .

Reference; Internet, SRB Textbook of surgery