Table 3.40.

Key considerations for dental management in Cushing's syndrome (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Adrenal crisis; hypertension, cardiovascular disease, diabetes; poor wound healing
Appropriate dental care	1	Avoid elective dental care until disease is controlled; preoperative hydrocortisone
Pain and anxiety control
– Local anaesthesia	0
– Conscious sedation	1	Avoid drugs compromising ventilation
– General anaesthesia	3/4	Consider associated medical complications
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	0
Treatment modification
– Oral surgery	1	Infections; poor wound healing
– Implantology	1
– Conservative/Endodontics	0
– Fixed prosthetics	0
– Removable prosthetics	0
– Non-surgical periodontology	0
– Surgical periodontology	1	Infections; poor wound healing
Hazardous and contraindicated drugs	0

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.