Low Dose Steroid No Supplementation — ORE Part 1 MCQ

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EasyHuman Disease & Dental ManagementLow Dose Steroid No SupplementationORE Part 1

A patient with asthma takes prednisolone 5 mg orally each morning. They need a simple extraction under local anaesthesia and have no diagnosis of primary adrenal insufficiency. What is the most appropriate management of their corticosteroid treatment?

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Correct answer: A — Continue the usual prednisolone dose without additional steroid cover

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

A is correct. For patients taking long-term glucocorticoids for conditions other than primary adrenal insufficiency, a randomised controlled trial found that minor oral surgery under local anaesthesia could be undertaken safely using the usual daily steroid dose, without routine supplementary glucocorticoids. Thus, the patient should take their normal prednisolone. B is unnecessary routine escalation. C and D are parenteral rescue or perioperative measures for substantially greater physiological stress or suspected adrenal crisis, not a simple extraction under local anaesthesia. E is unsafe: abruptly withholding prescribed prednisolone may worsen asthma control and is not a method of preventing adrenal suppression. This answer does not apply automatically to patients with diagnosed adrenal insufficiency, who require individual sick-day/peri-procedural advice.

Reference: Ramasamy A, Madhan B. Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids: A triple-blinded, randomized, placebo-controlled trial. Journal of the American Dental Association. 2023. https://pubmed.ncbi.nlm.nih.gov/36966086/