Steroid Cover Evidence — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementSteroid Cover EvidenceORE Part 1

A patient takes long-term therapeutic oral prednisolone for an inflammatory condition and has no diagnosis of primary adrenal insufficiency. They require a routine uncomplicated dental extraction under local anaesthesia. What is the most appropriate management of their corticosteroid therapy?

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Correct answer: C — Continue the usual corticosteroid dose without supplementary cover

**A is correct.** For a patient taking long-term therapeutic corticosteroids who undergoes routine dentistry or minor oral surgery under local anaesthesia, supplementary “steroid cover” is not routinely required. They should continue their regular corticosteroid regimen. The decisive features are the uncomplicated extraction, local anaesthesia and absence of primary adrenal insufficiency. Doubling the dose or administering parenteral hydrocortisone/methylprednisolone is unnecessary for this low-stress procedure and is not evidence-based. Withholding steroids is unsafe because interruption can precipitate adrenal insufficiency and worsen the underlying disease. This advice must not be extrapolated to patients on physiological replacement therapy for established adrenal insufficiency, or to more extensive surgery/anaesthesia, where individual medical advice and perioperative supplementation may be required.

Reference: Gibson N, Ferguson JW. Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature. British Dental Journal, 2004. https://pubmed.ncbi.nlm.nih.gov/15592544/