From the Guidelines
Taking prednisone before periodontal surgery is not recommended unless absolutely necessary and under the guidance of a physician, as it may increase the risk of postoperative complications, especially when high doses are administered for prolonged periods. When considering the use of prednisone before periodontal surgery, it's crucial to weigh the potential benefits against the risks, particularly the risk of infectious complications and impaired wound healing 1.
Key Considerations
- Patients who have been taking prednisone for more than 6 weeks at doses above 20 mg daily are at a higher risk of short-term surgical complications, including a five-fold risk of infectious complications 1.
- Steroid withdrawal is strongly recommended prior to surgical interventions whenever possible, and if complete withdrawal is not achievable, progressive tapering to the lowest dose is advised 1.
- For patients on long-term corticosteroid therapy, supplemental steroids may be necessary before surgery to prevent adrenal crisis, but the decision should be made on an individual basis, considering the dose and duration of steroids preceding surgery 1.
Recommendations for Practice
- Consultation with both the dentist and physician is essential to determine the best course of action regarding prednisone use before periodontal surgery.
- Patients should continue their prescribed prednisone regimen unless advised otherwise by their healthcare provider, as sudden discontinuation can lead to serious health consequences.
- The use of short-term corticosteroids to reduce post-operative swelling should be determined on a case-by-case basis, considering the potential risks and benefits 1.
Conclusion is not needed as per the guidelines, the above text is the final answer.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Safety of Prednisone Before Periodontal Surgery
- The use of prednisone before periodontal surgery has been evaluated in several studies, with a focus on its effects on inflammation, pain, and surgical outcomes 2, 3, 4, 5.
- A study published in 2021 found that prednisone treatment alone was associated with a significant decrease in salivary cortisol levels, indicating a reduction in stress and inflammation 2.
- Another study published in 2024 found that preemptive oral analgesia with steroidal and non-steroidal anti-inflammatory drugs, including prednisone, was effective in controlling post-operative pain in periodontal surgeries 3.
- A review of corticosteroid administration in oral and orthognathic surgery found that corticosteroids, including prednisone, decreased oedema and pain significantly, with no higher risk of infection and a minimum risk of other side effects 4.
- A clinical trial published in 2021 found that preoperative oral administration of prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment 5.
Considerations for Patients on Long-Term Steroid Medication
- Patients on long-term steroid medication may require supplementary "steroid cover" for certain types of stressful treatment, including dentistry, to prevent acute adrenal crisis 6.
- However, a review of the literature found that the risk of significant adrenal insufficiency is low, even following major surgical procedures, and that patients on long-term steroid medication do not require supplementary "steroid cover" for routine dentistry, including minor surgical procedures, under local anaesthesia 6.
- Patients undergoing general anaesthesia for surgical procedures may require supplementary steroids dependent upon the dose of steroid and duration of treatment 6.
Key Findings
- Prednisone can be effective in reducing inflammation and pain in periodontal surgery 2, 3, 4, 5.
- Patients on long-term steroid medication may require supplementary "steroid cover" for certain types of stressful treatment, including dentistry 6.
- The risk of significant adrenal insufficiency is low, even following major surgical procedures, and patients on long-term steroid medication do not require supplementary "steroid cover" for routine dentistry, including minor surgical procedures, under local anaesthesia 6.