Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

Mohd W. Khalaf, Ruba Khader, Gregory Cobetto, Juan Fernando Yepes, Dennis G. Karounos, Craig S. Miller

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background: The authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients. Methods: The authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for Englishlanguage articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis. Results: Of 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as "suggestive of adrenal crisis" and two cases as "consistent with adrenal crisis." Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency. Conclusions: Adrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic. Clinical Implications: Risk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.

Original languageEnglish (US)
Pages (from-to)152-160
Number of pages9
JournalJournal of the American Dental Association
Volume144
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Keywords

  • Adrenal crisis
  • Adrenal insufficiency
  • Dental infection
  • Dental treatment

ASJC Scopus subject areas

  • Dentistry(all)

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