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


CONCLUSIONS
Risk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.
Division of Oral Diagnosis, Oral Medicine and Oral and Maxillofacial Radiology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY 40536, USA.
Mohd W
MW
Khalaf
Ruba
R
Khader
Gregory
G
Cobetto
Juan Fernando
JF
Yepes
Dennis G
DG
Karounos
Craig S
CS
Miller
D015746:Abdominal Pain / Q000150:complications; D000309:Adrenal Insufficiency / Q000209:etiology* / Q000517:prevention & control; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D001424:Bacterial Infections / Q000150:complications; D001463:Barbiturates / Q000009:adverse effects; D003729:Dental Care; D006304:Health Status; D006801:Humans; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects
D018686:Anesthetics, Intravenous; D001463:Barbiturates