What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure?

UNLABELLED: Patients with primary adrenal insufficiency (Addison's disease) lack the endogenous steroid hormones cortisol and aldosterone and require daily steroid therapy (usually hydrocortisone and fludrocortisone) to replace them. These patients are unable to adapt physiologically to stress and may need supplemental steroid therapy when having dental procedures, to prevent adrenal crisis. This paper provides guidance on dental procedures for which steroid supplementation may be required in patients with primary adrenal insufficiency and gives advice on doses and timing of supplementation. It does not address the management of patients with secondary adrenal insufficiency caused by long-term use of high doses of steroids. This document is for guidance only. Patients with primary adrenal insufficiency should be assessed individually as steroid requirements will vary. CLINICAL RELEVANCE: Although patients with primary adrenal insufficiency (Addison's disease) are invariably very well informed about their steroid requirements prior to a dental procedure, dental staff should have an understanding of the steroid supplementation that may be required.

Allergy to local anaesthetic agents used in dentistry--what are the signs, symptoms, alternative diagnoses and management options?

UNLABELLED: This paper addresses the signs and symptoms of local anaesthetic hypersensitivity, differential diagnoses and the management of a patient with suspected allergy to local anaesthetics. CLINICAL RELEVANCE: While allergy to anaesthetic is rare, knowledge of other causes of similar symptoms is important.

Utility and value of a medicines information service provided by pharmacists: a survey of health professionals.

OBJECTIVES: many health professionals lack the time and skills to search for and appraise information on medicines. A solution might be to use others skilled in evidence appraisal, who make recommendations or provide information tailored to patients' needs. The objectives of this study were to assess how advice provided to health professionals by the northwest of England regional medicines information centre is used, whether it is useful for patient care and to measure satisfaction with the service. METHODS: a questionnaire was designed and sent to health professionals who contacted the centre between September 2008 and March 2009. Enquirers contacting the centre more than once were sent a questionnaire only in response to their first enquiry during the study period. Non-responders were sent a reminder. KEY FINDINGS: questionnaires were sent to 672 enquirers; 68% were returned. Nearly all respondents used the advice provided. Of the 430 respondents who provided data on how they used the information, 81% used it to manage a current patient and 29% to plan the care of future patients; nearly all considered it useful. Where data were given (n = 366), half used it to check if current or proposed management was appropriate, 45% to make changes to therapy and 35% to advise another health professional. In addition to patient care, one-quarter (n = 105/430) of respondents used the information for continuing professional development and 16% (n = 69/430) for training or teaching. CONCLUSIONS: health professionals value the enquiry-answering service and use the advice provided for patient care, continuing professional development and educating patients and other health professionals. The service is responsive, supporting the care of patients needing immediate and future management.

Drug interactions with local anaesthetic preparations used by primary care dental practitioners.

UNLABELLED: A number of drug interactions that may potentially occur with local anaesthetic preparations are listed in the British National Formulary (BNF) and Summaries of Product Characteristics (SmPC). Many are theoretical or are associated with higher doses of local anaesthetic preparations than those used for dental procedures in primary care. Reports of serious interactions between medicines and local anaesthetic preparations occurring in dental practice are exceedingly rare. Practitioners can minimize the risk of interactions by using an aspirating syringe, which reduces the likelihood of the local anaesthetic being administered directly into a blood vessel. Adhering to the dosage recommendations in the product literature will also minimize the risk. This paper will explore the clinical significance of potential interactions between dental local anaesthetic preparations used in primary care and other medicines as listed in the BNF and SmPCs.These are summarized in Tables 1 and 2. CLINICAL RELEVANCE: A knowledge of potential drug interactions with local anaesthetic preparations is essential for clinicians.