I have been taking steroids for a long time: can I have implants?

Steroids are the medicine form of cortisol, the stress hormone the body produces by itself. The NHS writes that these medicines reduce redness and swelling, that is, inflammation, and stop the immune system attacking the body's own tissue. As far as implants are concerned, the problem arises from this very power: a medicine that suppresses inflammation can also slow some of the steps of wound healing and of fighting infection.

Among the side effects the NHS lists for long-term steroid use, there are three that directly concern implants: weakening of the bones (osteoporosis), more frequent infections and high blood sugar. For prednisolone the NHS also lists slow wound healing among the possible signs of Cushing's syndrome and a wound that does not close among those of infection, and asks you to tell a doctor if this happens. Each of these is a separate matter; when they are found together, the area needing attention widens.

On the evidence side the picture is more encouraging than people think. In a retrospective study, 105 implants were placed, without bone grafting and by the conventional two-stage method, in 31 patients taking steroids for a systemic disease. 104 of them fused with the bone, and at a mean follow-up of 71 months after loading, 99% of the implants were in the mouth. The authors concluded that steroids should not be regarded as a contraindication for implants. The study is small and retrospective; on its own it is not enough to generalise from.

A 2025 scoping review examining implants in autoimmune diseases gathered 87 studies and recorded that the immunosuppressant most often used in these patients was steroids. The rate at which implants stayed in the mouth varied from study to study, from 85.3% up to no losses at all, and a substantial share of the losses occurred early, before the prosthesis was fitted. The authors write plainly that the evidence consists largely of case reports and retrospective studies, that is, that it is of a low level.

There is also a more cautious finding on bone loss. In a prospective study, 75 patients who had taken steroids for 12 months or longer were compared with 79 people who had not, and bone loss around the implants at one year was found to be strongly associated with steroid use. The authors report that the loss increased as the dose increased. However, the distribution of bone types differed between the two groups and the study measured bone level, not implant loss; for that reason the finding should be read as 'monitor the bone more closely'.

The third matter is the adrenal glands. When steroids are taken from outside for a long time, these glands can reduce their own cortisol production. At a moment of stress such as surgery, infection or injury, the body's need increases, and if enough hormone cannot be produced, an emergency known as an adrenal crisis, which involves a drop in blood pressure and fainting, can develop. The 2020 guideline from the anaesthesia, endocrinology and physicians' associations in the UK writes that this suppression can occur in those who have taken 5 mg or more of prednisolone a day, or its equivalent, for a month or longer; alongside tablets, steroids taken by inhaler, nasal spray, joint injection and skin cream are included too.

At this point the sources do not say exactly the same thing, and it is important that you know this. A review published in the British dental journal in 2004 concluded that patients on long-term steroids did not need extra steroids for routine dental treatment and minor surgical procedures carried out under local anaesthetic, whereas under general anaesthetic they might, depending on dose and duration. The summary of the 2020 guideline, however, emphasises that recommending the same prescription for everyone is not right and that the extra dose in a period of stress is given not in place of the usual steroid treatment but on top of it. For this reason the 2004 review should not be read as a general rule that an extra dose is never needed for a minor procedure. The upshot: whether an extra dose is needed is determined together with the prescribing doctor according to your dose, your duration and the extent of the procedure to be carried out.

The NHS's clearest rule for people taking steroids is not to stop the medicine suddenly. If you have been taking steroids for more than 3 weeks or at a high dose, the dose is usually reduced gradually; stopping suddenly can lead to symptoms such as extreme tiredness, feeling sick, dizziness and joint pain, and the symptoms of the condition being treated can also come back. That is why the thought 'I am having an operation, so I will stop the steroids' is dangerous.

The distinction below is the framework for the assessment made at examination. The final decision is made after the steroid dose, its duration, the state of the condition it is taken for and the picture in your mouth have been read together.

In this group of patients, most of the safety is achieved by the right information reaching the right person in time.

1. 1

   Know the signs of an adrenal crisis

   The signs the NHS lists: a fast heartbeat, marked dizziness on standing up, severe pain in the abdomen or side, muscle weakness, a headache that does not go away, feeling or being sick, extreme drowsiness or confusion, seizures, loss of consciousness. If you take steroids long term and these appear before or after the procedure, call 112.

2. 2

   The name, dose, route and duration of the medicine

   Is it a tablet, an inhaler, a nasal spray, a joint injection or a cream? What is the daily dose, how long have you been taking it, and have you had a break or a course in the past year? The guideline writes that routes other than tablets can also suppress the adrenal glands.

3. 3

   Show your steroid card

   The NHS asks patients who carry a steroid emergency card to show it to their doctor or dentist at any medical or dental treatment, surgery or invasive procedure; the aim is that extra steroids can be given if needed. If you do not have a card but have been taking steroids for a long time, ask your doctor about this.

4. 4

   A discussion with the prescribing doctor

   Whether an extra dose is needed and, if so, how it will be given is decided by the prescribing doctor according to the type of procedure (local anaesthetic, sedation or general anaesthetic) and its extent. Your dentist informs them of the procedure to be carried out and its estimated duration.

5. 5

   Bone, blood sugar and a mouth check

   The amount and quality of bone with a CBCT scan and, if necessary, a check of blood sugar and for thrush or inflammation in the mouth. All of these relate to the known effects of steroids and are dealt with before surgery.

6. 6

   Choice of painkiller

   The NHS asks for it to be checked in advance whether anti-inflammatory painkillers such as ibuprofen and aspirin are safe together with prednisolone. Settle in advance which painkiller you will use after surgery.

7. 7

   Sharing the plan and the documents

   If you send your medicine list, a photograph of your steroid card and any images you have through the assessment form in advance, the dentist establishes before the procedure whether correspondence with your prescribing doctor is needed.

The options are the same as for other patients; the difference is how each one suits this group in terms of surgical burden and care needs.

None of the following is inevitable; all are matters that can be planned for when they are known in advance.

In a patient taking steroids, healing follows the same path; it is simply monitored more closely and the medicine routine is never interrupted.

1. The day of the procedure

   Take your steroids in the routine your doctor has told you; if an extra dose has been recommended, follow that. Have your steroid card with you. If you feel extremely weak, dizzy or sick, say so at once.

2. The first days and the first week

   Swelling and tenderness should go down. A fever, increasing swelling, a bad taste in the mouth or white patches should be reported without waiting in this group. If you cannot take your medicines because of being sick, call the prescribing doctor straight away.

3. The first months

   Checking the wound and monitoring the bone around the implant with X-rays. Because bone loss in the first year was found to be greater in people taking steroids in one study, the check-ups in this period should not be skipped.

4. The long term

   Regular professional maintenance and daily interdental cleaning. If your steroid dose changes, a new course starts or osteoporosis medication is added, let your dentist know.

Taking steroids does not directly change the fee for treatment. What it affects is the preparation, the coordination and the follow-up routine:

Coordination with the doctor and additional tests

The opinion of the prescribing doctor and, if necessary, blood sugar or other tests are part of the preparation in this group.

Treatment of infection and thrush in the mouth

Treating infected roots, gum disease or thrush before surgery can be a separate item.

Whether an additional procedure is needed

If bone quality is low, the extent of the plan can change; when anchorage can be achieved without bone grafting, this item and the additional healing time drop out.

Type of anaesthesia

If sedation or a general anaesthetic is planned, the decision on an extra dose and the monitoring needed can change; this too affects the extent of the preparation.

Frequency of follow-up

Check-up intervals are kept more frequent; the long-term maintenance item grows a little, and in return problems are caught early.