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An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery: A double-blind, split-mouth, cross-over study

Lookup NU author(s): Professor Mark Thomason, Professor Nick Girdler, Professor Pat Kendall-Taylor, Dr Hilary Wastell, Emeritus Professor Robin Seymour


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Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined/Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5-10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure. Copyright © Munksgaard 1999.

Publication metadata

Author(s): Seymour RA; Thomason JM; Girdler NM; Kendall-Taylor P; Wastell H; Weddel A

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Periodontology

Year: 1999

Volume: 26

Issue: 9

Pages: 577-582

Print publication date: 01/09/1999

ISSN (print): 0303-6979

ISSN (electronic): 1600-051X

Publisher: Wiley-Blackwell Publishing, Inc.


DOI: 10.1034/j.1600-051X.1999.260903.x

PubMed id: 10487307


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