Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids: A triple-blinded, randomized, placebo-controlled trial.

BACKGROUND: Patients undergoing long-term glucocorticoid therapy are administered additional glucocorticoids before minor dental procedures, although this is not supported by evidence. The authors designed this study to validate the hypothesis that routine blanket glucocorticoid supplementation is unnecessary during minor oral surgical procedures under local anesthesia. METHODS: The authors recruited 270 patients into 3 groups (1:1:1 allocation) from the dental outpatient department. Primary outcomes were changes in hemodynamic parameters and frequency of adverse events among the 3 groups. The secondary outcome was the association of preprocedural stress and procedural pain with periprocedural adverse events in the long-term glucocorticoid therapy group (groups I and II). RESULTS: No clinically relevant changes in hemodynamic parameters among the 3 groups were found. The authors also found low periprocedural adverse events in all 3 groups combined (n = 1), so they did not explore the secondary outcomes further. CONCLUSIONS: Among patients undergoing long-term glucocorticoid therapy for indications other than primary adrenal insufficiency, elective minor oral surgical procedures can be performed safely with only their daily dose of glucocorticoid when their medical conditions are optimized. Routine additional glucocorticoid supplementation appears unnecessary. The results of the study also revealed opportunities for value addition by means of integrating oral health care with medical follow-up for patients with multiple co-occurring medical conditions. PRACTICAL IMPLICATIONS: Routine blanket glucocorticoid supplementation among patients taking a long-term glucocorticoid for indications other than primary adrenal insufficiency appears unnecessary before minor oral surgical procedures under local anesthesia. This clinical trial was registered at Clinical Trial Registry-India. The registration number is CTRI/2017/02/007779.

Orientation of Dental Professionals in India towards Integrative Medicine: A Cross-Sectional Survey.

INTRODUCTION: There is a growing demand on our health care system, including Dentistry, to shift from a bio-medical approach to Integrative model of care. The attitudes of health professionals towards Integrative Medicine (IM) are an important factor that influences this transition. AIM: The aim of this study was to evaluate and compare the orientation of the dental professionals in India towards the principles and practice of Integrative Medicine. MATERIALS AND METHODS: A cross-sectional survey was conducted on 286 dental faculty and postgraduate students from three dental schools in India. The participants voluntarily and anonymously completed the "Integrative Medicine-30' questionnaire, a 30 item self-report instrument that measures the health care provider's orientation towards Integrative Medicine in five subscales. Data analysis included summary statistics and intergroup comparisons by gender and professional status with independent samples Mann-Whitney U test. RESULTS: The overall orientation of the dental professionals towards IM was almost neutral. While the use of learning resources on Complementary and Alternative Medicine was lower, they showed a more positive orientation towards patient-centred care. Compared to postgraduate students of Dentistry, the dental faculty were more oriented towards IM (median score of 82 vs. 79.5, p<0.01), especially in terms of learning from alternate paradigms (14 vs. 12, p<0.01) and safety of Complementary and Alternative Medicine (13 vs. 12, p<0.01). Females scored better than males both in terms of overall orientation (82 vs. 78, p<0.01) and towards patient-centred care (12 vs. 11, p<0.001). CONCLUSION: The results highlight the impending need to improve the orientation of dental professionals in India towards the principles and practice of IM.