Pharmacology Notes

Corticosteroids are useful drugs for the management of many dental and oral inflammatory conditions. Their use must be based on a complete medical and medication history plus an accurate diagnosis of the dental or oral condition, as they should not be used when an infection is present or is likely to occur. Corticosteroids can be used intradentally (within a tooth), topically or systemically. The most effective route of administration should be chosen; this usually means using a locally delivered form of the drug rather than a systemically delivered form wherever possible. Thus, intradental or topical corticosteroids are preferred as they place the drug at the site of required action, which results in more rapid onset of action and less chance of systemic effects.

Anaphylactic (IgE-mediated) and anaphylactoid (pseudoallergic) reactions have overlapping clinical features. Anaphylactic and anaphylactoid reactions usually appear within minutes of parenteral or mucosal exposure to a drug, and around 30 minutes to hours after drug ingestion.

Anaphylactic urticaria and angioedema begin soon after drug exposure. Other features of anaphylaxis include bronchospasm, laryngeal oedema, abdominal cramps, diarrhoea and hypotension.

Anaphylactoid urticaria and angioedema with or without hypotension and bronchospasm similarly present soon after drug administration. Itch and/or urticaria alone can occur in milder presentations, and are more often seen after oral administration; they are occasionally seen following subcutaneous or intramuscular administration.

See Box 13.29 and Appendix 4.1 for management of patients with anaphylactoid or anaphylactic reactions.