Title |
Pulpal Calcifications Will Form In Patients Treated With Long-Term Systemic Steroids More Frequently Than In Patients Treated With Short-Term Systemic Steroids |
Clinical Question |
Is the use of long-term systemic steroids compared to short-term use correlated to the presence of pulp calcifications? |
Clinical Bottom Line |
For patients taking long-term systemic steroids, pulp calcifications (i.e., pulp stones and narrowing of canals) are more prevalent than in patients taking short-term systemic steroids. Evidence suggests in patients with autoimmune diseases and post-renal transplant patients, use of systemic steroids allows for more dentin formation, shrinking of the pulp chamber and calcification in the pulp. |
Best Evidence |
|
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
7871469 | Symons/1994 | 3 patients on long-term or short-term systemic steroids with radiographic evidence of pulpal calcification | Case Report | Key results | All three cases exhibited decreased pulp size in the posterior teeth with the addition of the premolars in the 3rd case. Radiographs exhibited shrinking of the pulp chamber and/or deposition of calcified tissue. Results were collected for Patient 1 from the age of 23 to 42 years old, Patient 2 from the age of 36 to 43 years old and Patient 3 from the age of 8 to 17 years old. After a diagnosis of autoimmune chronic active hepatitis, patient 1 took prednisone 10-15mg/day maintenance dose with a short period dosage of up to 40mg/day and 100mg/day of Imuran 3 months later. Patient 2 took 100mg/day Imuran and prednisone 6-16mg/day for autoimmune chronic active hepatitis for 10 years. After a kidney transplant, patient 3 took 12 mg/day of prednisone, Imuran (75mg/day) and metoprolol tartrate (400mg). | 8362197 | Nasstrom/1993 | Premolars from 5 deceased patients who were treated for renal transplantation in high doses of corticosteroids and 5 healthy subjects | Case Report | Key results | Premolars with no or few small restorations from 5 deceased patients, who received renal transplants during their lifetime, were compared with those from 5 healthy subjects. Patients 1-3, short transplantation patients, had the same pulp chamber sizes as the controls Patients 4-5 showed a greater reduction in pulp chamber sizes and radiopacity. | |
Evidence Search |
("Adrenal Cortex Hormones" [Pharmacological Action]) AND "Dental Pulp Calcification"[Mesh] |
Comments on
The Evidence |
The evidence suggested that in patients on glucocorticosteroids, not only was narrowed pulpal space indicated but also dental pulp calcification on the roof of the pulp chamber. Such evidence indicated a difference in calcification pattern than that seen in the normal aging process. However, both case reports included a very small sample size (n=3 and n-10). Therefore, more research is necessary to indicate age, sex, gender and time period after diagnosis of a chronic illness or transplant to confirm the correlation between dental pulp calcifications and long-term systemic steroid treatment. |
Applicability |
This applies to patients undergoing renal transplants or who are diagnosed with autoimmune diseases and treated with long-term systemic steroids such as Prednisone and Imuran. |
Specialty |
(Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Dental Hygiene) |
Keywords |
Dental pulp calcifications, Systemic steroids, Autoimmune disease
|
ID# |
2381 |
Date of submission |
02/25/2013 |
E-mail |
patelsg@livemail.uthscsa.edu |
Author |
Supriya Patel |
Co-author(s) |
|
Co-author(s) e-mail |
|
Faculty mentor |
Anibal Diogenes, DDS, MS, PhD |
Faculty mentor e-mail |
DIOGENES@uthscsa.edu |
|
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
None available | |