ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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 (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 7871469Symons/19943 patients on long-term or short-term systemic steroids with radiographic evidence of pulpal calcificationCase Report
Key resultsAll 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).
#2) 8362197Nasstrom/1993Premolars from 5 deceased patients who were treated for renal transplantation in high doses of corticosteroids and 5 healthy subjectsCase Report
Key resultsPremolars 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/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry)
Keywords Dental pulp calcifications, Systemic steroids, Autoimmune disease
ID# 2381
Date of submission: 02/25/2013spacer
E-mail patelsg@livemail.uthscsa.edu
Author Supriya Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, PhD
Faculty mentor/Co-author e-mail DIOGENES@uthscsa.edu
Basic Science Rationale
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