Diþ hekimliði uygulamalarýnda topikal steroidler: Yan etkileri ve kullaným önerileri

Topikal, sistemik, inhalasyonel, rektal ve intraartiküler ajanlar olarak kullanýlabilen glikokortikoidler genellikle enflamatuvar, alerjik, otoimmün ve neoplastik hastalýklarýn tedavisinde tercih edilirler. Özellikle bu ajanlardan topikal formda olanlar oral mukozal hastalýklarla iliþkili aðýz lezyonlarýnýn tedavisinde kullanýlmaktadýrlar. Bu nedenle oral mukozal hastalýklarda etkili bir tedavi saðlamak ve ayný zamanda hastalarý potansiyel yan etkilerden korumak için diþ hekimleri topikal steroidlerin (TS) endikasyonlarýný, yan etkilerini ve klinik uygulama þekillerini bilmelidirler. Doðru þekilde kullanýldýðýnda birçok oral mukozal hastalýkta tatmin edici klinik sonuçlar saðlayan TS’nin, hatalý uygulamalar sonucunda iyatrojenik Cushing sendromu, adrenal yetmezlik gibi ciddi komplikasyonlara neden olabileceðine dair birçok çalýþma bulunmaktadýr. Literatürde, TS’nin hangi dozdan ve uygulama sýklýðýndan sonra sistemik kan dolaþýmýna katýldýðýna iliþkin bir görüþ birliðine varýlamamýþtýr. Sunulan bu derlemede, son yýllarda diþ hekimleri tarafýndan sýklýkla reçete edilmeye baþlayan TS’nin endikasyon ve kontrendikasyonlarý ile avantaj ve dezavantajlarýnýn yaný sýra, güncel literatür bilgileri ýþýðýnda doðru kullaným önerilerinin paylaþýlmasý amaçlanmýþtýr.

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.