• Nadimpalli Harshita Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka - 575 001, India.
  • Deepa G Kamath Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka - 575 001, India.
  • Swati Swati Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka - 575 001, India.


Corticosteroids are chemically similar to endogenous cortisol and are used fundamentally as replacement therapy in patients with adrenal insufficiency, and used as anti-inflammatory agents. They are widely used in systemic diseases such as rheumatoid arthritis, asthma, and connective tissue disorders. In dentistry primarily these are used to decrease post-operative pain and edema in inflammatory diseases such as oral lichen planus, pemphigus, and recurrent aphthous stomatitis. This action is predominantly due to eicosanoid formation that inhibits phospholipase A2 activity. Corticosteroids can be supplemented either topically systemically or as inhalational therapy. Research suggests that local application of corticosteroids shows favorable effect on the periodontal ligament and possesses antiresorptive effect, but long-term systemic therapy is a risk for periodontal diseases which may provoke attachment loss and disruption of transseptal fibers. Oral manifestations are common with the use of inhaled steroids and are dependent on dose, frequency, duration, and inhaler use. It is commonly associated with ulceration of tongue, buccal mucosa, and occasionally on the gingiva due to xerostomia and immune suppression. It also causes a decrease in bone mineral density. This review explains about various effects of different types of corticosteroids on periodontium used in dentistry.

Keywords: Corticosteroids, Topical, Systemic, Inhalational, Bone mineral density, Periodontium.


1. Sweetman SC. Martindale: The Complete Drug Reference. 37th ed. London: Pharmaceutical Press; 2011.
2. Bruton LL, Lazo JS, Parker KL. Goodman and Gilman’S the Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw- Hill; 2006.
3. Loose DS, Stancel GM. Estrogens and progestins. In: Brunton LL, Lazo JS, Parker KL editors. Goodman and Gilmans the Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006. p. 1541-72.
4. Ganong WF. Review of Medical Physiology. 24th ed. China: LANGE Basic Science; 2012.
5. Bennett PN, Brown MJ. Clinical Pharmacology. 9th ed. New Delhi: Reed Elsevier; 2003. p. 664.
6. Ata-Ali J, Ata-Ali F, Peñarrocha-Oltra D, Peñarrocha M. Corticosteroids use in controlling pain, swelling and trismus after lower third molar surgery. J Clin Exp Dent 2011;3:469-75.
7. Lozada-Nur F, Miranda C, Maliksi R. Double-bind clinical trial of 0.05% clobetasol proprionate ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatment of patients with oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol 1994;77:598-604.
8. Lozada F, Silverman S Jr. Topically applied fluocinonide in an adhesive base in the treatment of oral vesiculoerosive diseases. Arch Dermatol 1980;116:898-900.
9. Tanya Syngle, Sudeep Kaur, Nidhi Garg. Osteoporotic fracture risk in rheumatoid arthritis Int J Pharm Pharm Sci 2018;10:106-9.
10. McGraw-Hill. Concise Encyclopedia of Bioscience. 1st ed. New York: McGraw-Hill Publishing; 2004.
11. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993;48:961-4.
12. Glick MS, Greenberg M, Ship JA. Burket’s Oral Medicine. 11th ed. Hamilton, BC: Decker Inc; 2008.
13. Grover VK, Babu R, Bedi SP. Steroid therapy current indications in practice. Int Jugglers’ Assoc 2007;51:339-89.
14. Voûte AB, Schulten EA, Langendijk PN, Kostense PJ, van der Waal I. Fluocinonide in an adhesive base for treatment of oral lichen planus. A double-blind, placebo-controlled clinical study. Oral Surg Oral Med Oral Pathol 1993;75:181-5.
15. Lozada-Nur F, Huang MZ. Open preliminary clinical trial of clobetasol propionate in adhesive paste for treatment of chronic oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol 1991;71:283-7.
16. Altenburg A, Zouboulis CC. Current concepts in the treatment of recurrent aphthous stomatitis. Skin Therapy Lett 2008;13:13-4.
17. Sai Keerthana PC, Anila KN, Reshma Reji. Naproxen-induced erythema multiforme-a rare case report. Int J Pharm Pharm Sci 2017;9:294-5.
18. Gonzalez-Moles MA, Morales P, Rodriguez-Archilla A, Isabel IR, Gonzalez-Moles S. Treatment of severe chronic oral erosive lesions with clobetasol propionate in aqueous solution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:264-70.
19. Seymour RA, Heasman PA. Drugs and the periodontium. J Clin Periodontol 1988;15:1-6.
20. McMaster A, Ray DW. Drug insight: Selective agonists and antagonists of the glucocorticoid receptor. Nat Clin Pract Endocrinol Metab 2008;4:91-101.
21. Schimmer BP, Funder WH. ACTH, adrenal steroids, and pharmacology of the adrenal cortex. In: Brunton LL, editor. Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill; 2011. p. 1209-36.
22. Hirata F, Schiffmann E, Venkatasubramanian K. A phospholipase A2 inhibitory protein in rabbit neutrophils induced by glucocorticoids. Proc Natl Acad Sci U S A 1980;77:2533-6.
23. Burkholder B. Topical corticosteroids: An update. Curr Probl Dermatol 2000;12:222-5.
24. Mori M, Pimpinelli N, Giannotti B. Topical corticosteroids and unwanted local effects. Improving the benefit/risk ratio. Drug Saf 1994;10:406-12.
25. Leung DY, Bloom JW. Update on glucocorticoid action and resistance. J Allergy Clin Immunology 2003;111:3-22.
26. Hein R, Krieg T. Effects of corticosteroids on human fibroblasts in-vitro. In: Chrostophers E, Schopf E, Kligman AM, Schopf E, Stoughton RB, editors. Topical Corticosteroid Therapy: A Novel Approach to Safer Drugs. New York, NY: Raven Press; 1988. p. 57-65.
27. Katz M, Gans EH. Topical corticosteroids, structure-activity and the glucocorticoid receptor: Discovery and development-a process of planned serendipity”. J Pharm Sci 2008;97:2936-47.
28. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for the use of topical glucocorticosteroids. American academy of dermatology. J Am Acad Dermatol 1996;35:615-9.
29. WHO model prescribing information: drugs used in skin diseases: Annex: Classification of topical corticosteroids. [Internet] [Cited 2017 Jan 13].
30. Community Drug Utilization Program: Topical Corticosteroids. Saskatchewan Health, Saskatoon; 1998.
31. Zegarelli EV, Kutscher AH, Mehrhof A. Long-lasting loz-enges with triamcinolone acetonide. Treatment of erosive li-chen planus of oral mucosa. N Y State J Med 1969;69:2463-4.
32. Hegarty AM, Hodgson TA, Lewsey JD, Porter SR. Fluti-casone propionate spray and betamethasone sodium phos-phate mouthrinse: A randomized crossover study for the treatment of symptomatic oral lichen planus. J Am Acad Dermatol 2002;47:271-9.
33. Yohn JJ, Weston WL. Topical glucocorticosteroids. Curr Probl Dermatol 1990;2:31-63.
34. Buttgereit F, Saag KG, Cutolo M, da Silva JA, Bijlsma JW. The molecular basis for the effectiveness, toxicity, and resistance to glucocorticoids: Focus on the treatment of rheumatoid arthritis. Scand J Rheumatol 2005;34:14-21.
35. Lee NP, Arriola ER. Topical corticosteroids: Back to basics. West J Med 1999;171:351-3.
36. Berliner DL, Nabors CJ Jr. Effects of corticosteroids on fibroblast functions. J Reticuloendothel Soc 1967;4:284-313.
37. Bauer EA, Kronberger A, Valle KJ, Jeffrey JJ, Eisen AZ. Glucocorticoid modulation of collagenase expression in human skin fibroblast cultures. Evidence for pre-translational inhibition. Biochim Biophys Acta 1985;825:227-35.
38. Priestley GC, Brown JC. Effects of corticosteroids on the proliferation of normal and abnormal human connective tissue cells. Br J Dermatol 1980;102:35-41.
39. Kirakozova A, Texeira F, Curran A, Gu, F, Tawil P, Trope M. Effect of intracanal corticosteroids on healing of replanted dog teeth after extended dry times. J Appl End 2009;35:663-7.
40. Hamidouche Z, Haÿ E, Vaudin P, Charbord P, Schüle R, Marie PJ, et al. FHL2 mediates dexamethasone-induced mesenchymal cell differentiation into osteoblasts by activating wnt/beta-catenin signaling-dependent runx2 expression. FASEB J 2008;22:3813-22.
41. Langenbach F, Handschel J. Effects of dexamethasone, ascorbic acid and b-glycerophosphate on the osteogenic differentiation of stem cells in vitro. Stem Cell Res Ther 2013;4:117-23.
42. Hirayama T, Sabokbar A, Athanasou AN. Effect of corticosteroids on human osteoclast formation and activity. J Endoc 2002;175:155-63.
43. Cury PR, Araújo VC, Canavez F, Furuse C, Araújo NS. Hydrocortisone affects the expression of matrix metalloproteinases (MMP-1, -2, -3, -7, and -11) and tissue inhibitor of matrix metalloproteinases (TIMP-1) in human gingival fibroblasts. J Periodontol 2007;78:1309-15.
44. Aufdemorte TB, De Villez RL, Parel SM. Modified topical steroid therapy for the treatment of oral mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol 1985;59:256-60.
45. Gonzalez-Moles MA, Ruiz-Avila I, Rodriguez-Archilla A, Morales- Garcia P, Mesa-Aguado F, Bascones-Martinez A, et al. Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:688-92.
46. Seymour AR. Effects of medications on the periodontal tissues in health and disease. Periodontol 2000 2006;40:120-9.
47. Labelle RE, Schaffer EM. The effects of cortisone and induced local factors on the periodontium of the albino rat. J Periodontol 1966;37:483-90.
48. Garsia GV, Fernandes AL, Almeida MJ, Bosco FA, Hitomi JM. Comparison between laser therapy and non-surgical therapy for periodontitis in rats treated with dexamethasone. Las Med Sci 2010;25:197-206.
49. Drozdzowska B, Pluskiewicz W, Michno M. Tooth count in elderly women in relation to their skeletal status. Maturitas 2006;55:126-31.
50. Nicopoulou-Karayianni K, Tzoutzoukos P, Mitsea A, Karayiannis A, Tsiklakis K, Jacobs R, et al. Tooth loss and osteoporosis: The OSTEODENT Study. J Clin Periodontol 2009;36:190-7.
51. Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent 1990;63:218-22.
52. Krall EA, Garcia RI, Dawson-Hughes B. Increased risk of tooth loss is related to bone loss at the whole body, hip, and spine. Calcif Tissue Int 1996;59:433-7.
53. Lukert BP, Adams JS. Calcium and phosphorus homeostasis in man. Effect of corticosteroids. Arch Intern Med 1976;136:1249-53.
54. Olgaard K, Storm T, van Wowern N, Daugaard H, Egfjord M, Lewin E, et al. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: A double-blind study on the high-dose, long-term effects of prednisone versus deflazacort. Calcif Tissue Int 1992;50:490-7.
55. Gray RE, Doherty SM, Galloway J, Coulton L, de Broe M, Kanis JA, et al. A double-blind study of deflazacort and prednisone in patients with chronic inflammatory disorders. Arthritis Rheum 1991;34:287-95.
56. Krishnan V, Bryant HU, Macdougald OA. Regulation of bone mass by wnt signaling. J Clin Invest 2006;116:1202-9.
57. Choi SS, Park EK, Kwack MH, Sung YK. Effects of dexamethasone, a synthetic glucocorticoid, on human periodontal ligament stem cells Naunyn Schmiedebergs Arch Pharmacol 2015;388:991-95.
58. Safkan B, Knuuttila M. Corticosteroid therapy and periodontal disease. J Clin Periodontol 1984;11:515-22.
59. Bonadonna S, Burattin A, Nuzzo M, Bugari G, Rosei EA, Valle D, et al. Chronic glucocorticoid treatment alters spontaneous pulsatile parathyroid hormone secretory dynamics in human subjects. Eur J Endocrinol 2005;152:199-205.
60. Ohnaka K, Taniguchi H, Kawate H, Nawata H, Takayanagi R. Glucocorticoid enhances the expression of dickkopf-1 in human osteoblasts: Novel mechanism of glucocorticoid- induced osteoporosis. Biochem Biophys Res Commun 2004;318:259-64.
61. Ebeling PR, Erbas B, Hopper JL, Wark JD, Rubinfeld AR. Bone mineral density and bone turnover in asthmatics treated with long-term inhaled or oral glucocorticoids. J Bone Miner Res 1998;13:1283-9.
62. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006;77:1465-82.
63. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: Current understanding and review of the literature. Chest 2004;126:213-9.
64. Shashikiran ND, Reddy VV, Raju PK. Effect of antiasthmatic medication on dental disease: Dental caries and periodontal disease. J Indian Soc Pedod Prev Dent 2007;25:65-8.
65. Dyer MJ, Halpin DM, Stein K. Inhaled ciclesonide versus inhaled budesonide or inhaled beclomethasone or inhaled fluticasone for chronic asthma in adults: A systematic review. BMC Fam Pract 2006;7:34.
66. Pauwels R, Newman S, Borgstrom L. Airway deposition and airway effects of antiasthma drugs delivered from metereddose inhalers. Eur Respir J 1997;10:2127-38.
67. Anderson PJ. Delivery options and devices for aerosolized therapeutics. Chest 2001;120:89S-93S.
68. Bernstein DI, Berkowitz RB, Chervinsky P, Dvorin DJ, Finn AF, Gross GN, et al. Dose-ranging study of a new steroid for asthma: Mometasone furoate dry powder inhaler. Respir Med 1999;93:603-12.
69. Toogood JH, White FA, Baskerville JC, Fraher LJ, Jennings B. Comparison of the antiasthmatic, oropharyngeal, and systemic glucocorticoid effects of budesonide administered through a pressurized aerosol plus spacer or the turbuhaler dry powder inhaler. J Allergy Clin Immunol 1997;99:186-93.
70. Jones A, Fay JK, Burr M. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease (Cochrane Review) Update Software. Issue 3. Oxford, UK: The Cochrane Library; 2003.
71. Leone FT, Fish JE, Szefler SJ, West SL. Systematic review of the evidence regarding potential complications of inhaled corticosteroid use in asthma: Collaboration of American college of chest physicians, American academy of allergy, asthma, and immunology, and American college of allergy, asthma, and immunology. Chest 2003;124:2329-40.
72. Richy F, Bousquet J, Ehrlich GE, Meunier PJ, Israel E, Morii H, et al. Inhaled corticosteroids effects on bone in asthmatic and COPD patients: A quantitative systematic review. Osteoporos Int 2003;14:179-90.
73. Hubbard RB, Smith CJ, Smeeth L, Harrison TW, Tattersfield AE. Inhaled corticosteroids and hip fracture: A population-based case-control study. Am J Respir Crit Care Med 2002;166:1563-6.
74. Van Staa TP, Leufkens HG, Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 2001;16:581-8.
75. Martin RJ, Szefler SJ, Chinchilli VM. Systemic effect comparisons of six inhaled corticosteroid preparations. Am J Respir Crit Care Med 2002;165:1377-83.
76. Derendorf H. Pharmacokinetic and pharmacodynamic properties of inhaled corticosteroids in relation to efficacy and safety. Respir Med 1997;91:22-8.
77. Selroos O, Halme M. Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from a metered dose inhaler and dry powder inhaler. Thorax 1991;46:891-4.
78. El O, Gulbahar S, Ceylan E. Bone mineral density in asthmaticpatients using low dose inhaled glucocorticosteroids. J Investig Allergol Clin Immunol 2005;15:57-62.
79. Jones A, Fay JK, Burr M. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002;1:CD003537.
80. Boskabady M, Nematollahi H, Boskabady MH. Effect of inhaled medication and inhalation technique on dental caries in asthmatic patients. Iran Red Crescent Med J 2012;14:816-21.
81. Daudt DL, Cavagni J, Gaio JE, Souza A. Torres SL, Ferreira AP, et al. Effect of inhaled corticosteroid on TNF-α production and alveolar bone loss in Wistar rats. Arch Oral Biol 2011;56:1398-403.
252 Views | 691 Downloads
How to Cite
Harshita, N., D. G. Kamath, and S. Swati. “CORTICOSTEROIDS - ASSETS AND LIABILITIES ON PERIODONTIUM”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 8, Aug. 2018, pp. 56-60, doi:10.22159/ajpcr.2018.v11i8.25442.
Review Article(s)