Steroid Prophylaxis: The knowledge and practices of New Zealand General Dental Practitioners.

Abstract

Objective: To describe the knowledge and practices of New Zealand (NZ) General Dental Practitioners (GDPs) concerning the use of steroid prophylaxis.

Methods: An online survey was conducted in 2013 involving a sample of 500 NZ GDPs who met inclusion criteria and had email addresses on the Dental Council register.

Results: A total of 214 dentists responded, giving a 44.5% response rate after accounting for undelivered questionnaires. Nearly two-thirds (61 .7%) did not currently recommend corticosteroid prophylaxis, although nearly three-quarters (74.8%) believed that dental treatment posed a potential risk to patients with adrenal suppression. Over half (53.4%) believed that oral corticosteroids could cause adrenocortical suppression, and a similar proportion (58.3%) believed that a specific dose of oral prednisolone of 7.5 mg per day could do so. Most practitioners (79.6%) supported the formulation of steroid prophylaxis guidelines.

Conclusion: Despite most NZ GDPs believing the dental setting to pose a risk of adrenal crisis for patients taking corticosteroids, there is some confusion among dentists identifying at-risk patients and their ability to manage if such an event was to occur in their practices. There is further confusion over whether steroid prophylaxis is warranted for perceived at-risk patients, and which regime to follow when it is. There is an associated tendency to be over-cautious when determining the need for steroid prophylaxis, and to rely on their undergraduate steroid prophylaxis guidelines when doing so. There is a need for evidence-based guidelines to be formulated by an expert panel.