Diş hekimliği uygulamalarında topikal steroidler: Yan etkileri ve kullanım önerileri

Topikal, sistemik, inhalasyonel, rektal ve intraartiküler ajanlar olarak kullanılabilen glikokortikoidler genellikle enflamatuvar, alerjik, otoimmün ve neoplastik hastalıkların tedavisinde tercih edilirler. Özellikle bu ajanlardan topikal formda olanlar oral mukozal hastalıklarla ilişkili ağız lezyonlarının tedavisinde kullanılmaktadırlar. Bu nedenle oral mukozal hastalıklarda etkili bir tedavi sağlamak ve aynı zamanda hastaları potansiyel yan etkilerden korumak için diş hekimleri topikal steroidlerin (TS) endikasyonlarını, yan etkilerini ve klinik uygulama şekillerini bilmelidirler. Doğru şekilde kullanıldığında birçok oral mukozal hastalıkta tatmin edici klinik sonuçlar sağlayan TS’nin, hatalı uygulamalar sonucunda iyatrojenik Cushing sendromu, adrenal yetmezlik gibi ciddi komplikasyonlara neden olabileceğine dair birçok çalışma bulunmaktadır. Literatürde, TS’nin hangi dozdan ve uygulama sıklığından sonra sistemik kan dolaşımına katıldığına ilişkin bir görüş birliğine varılamamıştır. Sunulan bu derlemede, son yıllarda diş hekimleri tarafından sıklıkla reçete edilmeye başlayan TS’nin endikasyon ve kontrendikasyonları ile avantaj ve dezavantajlarının yanı sıra, güncel literatür bilgileri ışığında doğru kullanım önerilerinin paylaşılması amaçlanmıştır.

Topical steroids in dentistry: Adverse effects and proposal for application

Glucocorticoids, which are used as topical, systemic, inhalational, rectal and intraarticular agents, are often preferred for treatment of inflammatory, allergic, autoimmune and neoplastic diseases. Especially, topical forms of these agents are used to treat oral lesions associated with oral mucosal diseases. Therefore, dentists must know indications, side effects and application forms of topical steroids (TS) in order to treat oral mucosal diseases effectively, and to protect the patients from potential side effects. There are many studies, suggesting that when TS are used properly, they provide satisfactory clinical results in many oral mucosal diseases; whereas it may lead to serious complications, such as iatrogenic Cushing syndrome and adrenal insufficiency, as a result of inaccurate applications. In the literature, there is no consensus about the posology of TS, which results in the absorption of the TS into systemic circulation. The aims of this review are to offer indications, contraindications, advantages, and disadvantages of TS, which have been frequently prescribed by dentists in recent years, as well as to share suggestions for proper usage of these drugs in accordance with the current information in the literature.

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