Oral pathology induced by excess or deficiency of glucocorticoids in adults

Abstract

Oral manifestations are present both in Cushing's syndrome and in adrenal insufficiency. Possible oro-dental pathology in patients with Cushing's syndrome include jawbone loss, tooth loss, and periodontal diseases. Professional societies did not include Cushing's syndrome as being part of systemic diseases associated with loss of periodontal supporting tissues. The comorbidities of Cushing's syndrome such as obesity, osteoporosis, and diabetes are conditions that influence periodontal attachment apparatus. In patients with adrenal primary insufficiency, the most specific sign is the melanic pigmentation of the skin and mucosal surfaces due to increments of corticotropin and pro-opiomelanocortin peptide levels that occur as a result of decreased cortisol feedback. The oral mucosa develops black plaques that can also be present on the gums, palate, tongue, and lips. The pallor may occur in patients with adrenocortical insufficiency secondary to corticotropin deficiency. Patients with primary adrenal insufficiency need to increase their glucocorticoid doses during physical activity, intercurrent illnesses, surgery, and medical procedures. Current evidence indicates that routine, nonsurgical, or minor surgical procedures do not need supplemental glucocorticoids in diagnosed patients who are in a stable condition. However, for major oral surgery, glucocorticoid supplementation is necessary for the surgery day and for at least one postoperative day.