Medics Healthcare Professionals Addison's & Adrenal Insufficiency: Advice for Dentists Physical and emotional stress affects your cortisol levels. We don't always connect something like having a tooth out, with having surgery, but if you have Addison's disease or adrenal insufficiency, you need to consider how to manage your cortisol levels during dental procedures. We offer you guidance to follow for routine checkups and planned treatments. Preparing for a regular dentist/hygienist appointment Dental procedures Dental guidelines: managing your medication dosing Children & Young People Community Dental Services In 2013, the ADSHG carried out a UK survey of steroid-dependent patients and found that dental procedures were a trigger factor for adrenal crisis reported by 8% of those surveyed. For certain procedures, particularly those involving a local anaesthetic, you will require extra steroid cover so we have compiled some guidance, approved by our clinical advisory panel, to help you manage this. Whilst general dentists receive training about Addison’s and adrenal insufficiency, they are unlikely to have many patients with the conditions. It is therefore important that you can signpost them to accurate information such as our Dental Guidelines, so that you can receive the care you need. All Dentist & Hygienist appointments Ensure that your dentist or hygienist is aware of your diagnosis, reminding them at every appointment. Always carry your steroid card and emergency injection kit, ensuring it is accessible. Discuss with your dentist if they would be prepared to give you an emergency injection if required. Plan your dental treatment rather than have an ‘on the spot’ procedure, to ensure that you can manage your steroid medication appropriately. If you feel unwell during or after a dental or hygienist appointment, take an extra medication dose and then monitor how your body responds. Refer to the 'Sick Day Rules' for more information on adjusting your steroid replacement medication during times when you feel unwell. Sick Day Rules Regular appointments The majority of people should not need any extra glucocorticoid (steroid) medication for regular dentist checkups or hygienist appointments, however, there may be exceptions to this, including if you have a phobia of dentists and it makes you feel very nervous and stressed. You will learn to consider stressful situations on a case-by-case basis and whether you need to take a “top-up” dose based on your body. Coping with psychological stress Dental procedures: from a filling, to a tooth extraction or treatment for a tooth abscess You will require extra glucocorticoid medication. Make sure you understand and discuss the dental guidelines below with your dentist, ahead of the procedure. For planned major or invasive dental procedures, you may wish to consult with your endocrinology support team to clarify your need for extra medication. Remember that an additional dose will do no harm whereas under-medicated dental procedures are a recognised cause of adrenal crisis. 3. Ask your dentist to scan the ADSHG Surgical Guidelines and the adrenal crisis guidelines into your patient notes, along with a list of your regular steroid medications. 4. If you feel unwell during or after a dental procedure, take an extra medication dose and then monitor how your body responds. 5. Your dentist is experienced at giving injections so tell them where your emergency injection kit is, and ask them to administer an emergency injection if required. Adrenal Crisis Guidelines Dental Guidelines The below guidelines offer illustrative guidance for major and minor dental procedures Please note that dental anaesthetic containing adrenaline is suitable for use with steroid-dependent patients Reviewed Dec 2024: S.Pinkerton, Dentist, ADSHG Clinical Advisory Panel Download & print for your dentist Children / Young People Children with Addison's disease or adrenal insufficiency may be eligible to use Community Dental Services - please see the section below. Ahead of your child having dental work, please contact your child's endocrinologist, or you can read more information from Great Ormond Street Hospital (GOSH) about cortisol replacement in children having dental work. You can visit their website or download their 'Cortisol deficiency and steroid replacement therapy' document. Have your child's British Society for Paediatric Endocrinology and Diabetes (BSPED) Paediatric Steroid Treatment Card for Adrenal Insufficiency available to show the dentist team. For more information on steroid cards, visit our Steroid Emergency Card page. Community Dental Services Community Dental Services (CDS) provide specialised NHS dental care for children and adults with additional needs in the UK who are unable to be treated in general dental practice. This includes people with learning and physical disabilities, complex medical problems, severe mental health problems, elderly frail and end of life. They have specialists in Paediatric Dentistry and Special Care Dentistry. Some have other specialist too. There are Community Dental Services around the UK, hosted by NHS Trusts. NHS dental charges apply unless you are exempt. You can search online for a service near you. Some services only accept referrals via a dental or health care professional but others accept self-referral. Each service has different acceptance criteria. A person with Addison’s Disease who is stable can usually be seen in general dental practice, but may need to be referred to the CDS for specific treatment. People whose condition is unstable are often accepted for care in the CDS as are children with Addison’s Disease. Good oral hygiene is especially important for people with Addison’s Disease as treatment can be very stressful. The British Society of Paediatric Dentistry has useful advice for children: British Society of Paediatric Dentistry (BSPD) > Patients > PatientInfo There is also advice on the Oral Health Foundation website: Smile Month | Home | Oral Health Foundation With gratitude and thanks to Helen Pailthorpe, Manager of a Community Dental Service & specialist in Special Care Dentistry for sharing this information with the charity References Since they were first launched in 2005, the ADSHG surgical guidelines, approved by The Addison's Clinical Advisory Panel (CAP), have been endorsed in several clinical/endocrine publications. You can read these endorsements in the links below. NICE Guideline Adrenal insufficiency: identification and management. Published 28 August 2024 Husebye et al. 2014 Consensus statement on the diagnosis, treatment and follow up of patients with primary adrenal insufficiency. Journal of Internal Medicine 275 104-115 Allolio 2015 Adrenal crisis European Journal of Endocrinology 172 R115-R124 Puar et al. 2016 Adrenal crisis: still a deadly event in the 21st century. The American Journal of Medicine 129 339.e1-339.e9 Information for Healthcare Professionals Are you a member of our charity? Whether you're newly diagnosed or have lived with the condition for years - please join our community and support our cause! You'll receive the latest expert advice, guidance and ADSHG news, whilst being part of our inspiring and supportive community. Join the ADSHG Together we will improve the lives of those with Addison's disease and adrenal insufficiency! Say hello! Follow us on X/Twitter, Bluesky, Facebook, Instagram, LinkedIn, Threads, TikTok and YouTube. Manage Cookie Preferences