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Risk of adrenal crisis in dental patients: Results of a systematic search of the literature.
MedLine Citation:
PMID:  23372131     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: /st> 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: /st> The authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language 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: /st> 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: /st> 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: /st> Risk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.
Authors:
Mohd W Khalaf; Ruba Khader; Gregory Cobetto; Juan Fernando Yepes; Dennis G Karounos; Craig S Miller
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Dental Association (1939)     Volume:  144     ISSN:  1943-4723     ISO Abbreviation:  J Am Dent Assoc     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503060     Medline TA:  J Am Dent Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  152-60     Citation Subset:  D; IM    
Affiliation:
Dr. Khalaf is an assistant professor, Division of Oral Diagnosis, Oral Medicine and Oral and Maxillofacial Radiology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington.
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