--- title: "Addison's Disease and Orthodontics UK | Steroid Cover Guide" url: https://virtualconsultant.online/guides/addisons-disease-orthodontics-uk description: "Addison's disease affects orthodontic treatment in the UK — steroid cover for extractions, gingival hyperpigmentation, electrolyte risks." updated: 2026-08-17T00:00:00Z publisher: Virtual Consultant Online --- Addison's Disease Steroid Cover Adrenal Insufficiency Extractions # Addison's Disease and Orthodontics UK Addison's disease (primary adrenal insufficiency) affects the body's ability to produce cortisol and aldosterone. In the context of orthodontic treatment, the most important considerations are steroid cover for extractions, electrolyte balance for sedation, and the risk of prolonged healing. This guide covers what patients with Addison's disease and their dental teams need to know. This page is for information only and does not replace advice from your medical or dental team. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Compare Costs](https://virtualconsultant.online/costs) ## What is Addison's disease and why does it matter for dental treatment? Addison's disease (primary adrenal insufficiency) is a rare condition in which the adrenal glands — located above the kidneys — fail to produce sufficient cortisol and, in most cases, aldosterone. In the UK it affects approximately 1 in 10,000 people and is most commonly caused by autoimmune destruction of the adrenal cortex. The deficit of cortisol means the body cannot mount an adequate stress response to physiological challenges — including surgical procedures and sedation. This is the central concern for dentists and orthodontists: procedures that the normal cortisol-producing body manages without difficulty can precipitate an adrenal crisis in unmanaged Addison's disease. Patients with Addison's disease must therefore carry a steroid replacement medication and a steroid emergency injection kit (hydrocortisone for injection), and their dental team must know about their diagnosis and current medication regimen. ## What is steroid cover and when is it needed in orthodontic treatment? Steroid cover refers to the additional oral or injectable hydrocortisone given to a patient with adrenal insufficiency before a stressful dental procedure to supplement their baseline cortisol replacement. In routine orthodontic appointments — wire changes, aligner fittings, impressions, bonding of brackets — the stress level is relatively low and many patients on stable replacement therapy do not require additional steroid cover beyond their normal daily dose. However, for dental extractions (including those planned as part of orthodontic treatment to create space), minor oral surgery, and procedures under sedation or general anaesthesia, steroid cover is standard practice. The specific protocol — whether to double the morning hydrocortisone dose, take an additional dose before the procedure, or require injectable cover — should be agreed with the patient's endocrinologist or GP before any extraction or invasive procedure is scheduled. ## How does Addison's disease affect wound healing after extractions? Cortisol plays an important role in the inflammatory response and tissue repair. Patients with adrenal insufficiency on replacement therapy generally heal normally from routine extractions, provided their steroid replacement is adequate and the procedure-specific cover protocol has been followed. However, if steroid replacement is subtherapeutic — due to missed doses, intercurrent illness, or inadequate cover for the procedure — wound healing may be impaired and the risk of post-operative infection may be increased. Patients should be reminded to take their normal morning hydrocortisone before any dental appointment, and to carry their emergency hydrocortisone injection kit. Prolonged bleeding, excessive pain, failure of the socket to begin closing normally, or signs of infection in the days following extraction should prompt earlier dental review and consideration of whether the stress of the procedure caused a relative cortisol deficiency. ## What is hyperpigmentation of the gingiva in Addison's disease? One of the oral signs of Addison's disease is hyperpigmentation — a darkening of the skin and mucous membranes caused by elevated levels of adrenocorticotropic hormone (ACTH) and related peptides, which stimulate melanin production. In the mouth, this presents as brown or bluish-brown discolouration of the gingiva (gums), buccal mucosa (inner cheeks), lips, and palate. Gingival hyperpigmentation due to Addison's disease may be the first clinical sign that leads to diagnosis in some patients. For orthodontists, awareness of this sign is important: if a patient presents with unexplained gingival pigmentation not explained by racial or medication-related causes, Addison's disease should be considered and the patient referred to their GP. In patients with known Addison's disease, the hyperpigmentation does not usually require treatment and does not affect orthodontic appliance placement. ## What are the risks of sedation and electrolyte imbalance in Addison's disease? Aldosterone deficiency in Addison's disease (primary adrenal insufficiency) leads to reduced sodium retention and increased potassium levels in the blood (hyponatraemia and hyperkalaemia). Under normal replacement conditions these are corrected by fludrocortisone supplementation, but electrolyte levels can fluctuate — particularly during illness, dehydration, or physiological stress. Electrolyte disturbances of clinical significance can cause arrhythmias, hypotension, and cardiovascular instability during sedation or general anaesthesia. For any orthodontic procedure planned under conscious sedation or general anaesthesia (for example, surgical exposure of impacted teeth), pre-procedure electrolyte checking is appropriate, the endocrinologist or GP should be consulted regarding medication management, and the anaesthetic team must be informed of the Addison's diagnosis and current medications including fludrocortisone and hydrocortisone. Patients with Addison's disease should not be sedated in primary care without appropriate medical assessment. ## How do medication interactions affect orthodontic care for Addison's disease patients? The primary medications used in Addison's disease are hydrocortisone (for cortisol replacement), fludrocortisone (for aldosterone replacement), and in some cases dehydroepiandrosterone (DHEA). Hydrocortisone is a corticosteroid with known interactions relevant to dental practice: it can affect wound healing at very high doses, interact with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen by potentially increasing the risk of peptic ulceration, and in very high doses may affect bone metabolism. For the doses used in Addison's replacement therapy, these interactions are of minimal clinical significance in routine orthodontic care. However, when NSAIDs are prescribed for orthodontic pain management — for example after extractions — patients with Addison's disease should be advised to take them with food and for the shortest necessary duration. Paracetamol is a safer first-line analgesic choice for pain management following dental procedures in this patient group. ## What should patients with Addison's disease tell their orthodontist? Patients with Addison's disease should disclose their diagnosis at the initial consultation and provide their full medications list including current hydrocortisone and fludrocortisone doses. They should inform the team of the name and contact details of their endocrinologist or supervising GP. They should bring their emergency hydrocortisone injection kit to every appointment and confirm that it is in date. They should advise the orthodontic team of any recent changes to their replacement therapy, any recent adrenal crises, and any planned or recent illness that may have affected their steroid balance. If extractions are planned as part of orthodontic treatment, the patient should request guidance from their endocrinologist on the appropriate steroid cover protocol before the procedure is booked, and provide this information to the dental team in advance. ## Useful related pages [Down Syndrome and Orthodontics UK](https://virtualconsultant.online/guides/down-syndrome-orthodontics-uk) [Autoimmune Disease and Orthodontics UK](https://virtualconsultant.online/guides/autoimmune-disease-orthodontics-uk) [Bisphosphonates and Orthodontics UK](https://virtualconsultant.online/guides/bisphosphonates-orthodontics-uk) [Extraction for Braces UK](https://virtualconsultant.online/guides/tooth-extraction-for-braces-uk) [Get a Quote from Virtual Consultant Online](https://virtualconsultant.online/evaluations/quote) This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist. ### Compare next steps [Orthodontist Near Me](https://virtualconsultant.online/locations/orthodontic-treatment-near-me) [Clear Aligners Near Me](https://virtualconsultant.online/treatments/clear-aligners-near-me) [Invisalign Near Me](https://virtualconsultant.online/locations/invisalign-provider-near-me) [Browse Locations](https://virtualconsultant.online/locations) ### Ready for a clearer starting point? Upload guided photos and receive an indication of likely treatment options and pricing before booking appointments. [Get an Online Quote](https://virtualconsultant.online/evaluations/quote) ### Frequently Asked Questions Can patients with Addison's disease have orthodontic braces? Yes. Addison's disease is not a contraindication to orthodontic treatment including fixed braces or clear aligners. Routine orthodontic appointments — wire changes, aligner fitting, impression-taking, and bracket bonding — generally do not require any modification to the patient's usual steroid replacement regimen. The key considerations arise when extractions are planned as part of the orthodontic treatment plan, as these require appropriate steroid cover to be agreed in advance with the patient's endocrinologist or GP. Does Addison's disease require steroid cover for tooth extractions? Yes. Dental extractions are a physiological stressor that requires additional cortisol cover in patients with adrenal insufficiency. The typical protocol involves doubling the morning hydrocortisone dose on the day of extraction, or following a specific protocol agreed with the patient's endocrinologist. The patient should also carry their emergency hydrocortisone injection kit to the appointment. The precise cover protocol should be agreed before the extraction is scheduled, and the dental team should be aware of the signs of an adrenal crisis in case of emergency. What are the signs of an adrenal crisis during a dental appointment? An adrenal crisis is a medical emergency that can present during or after a dental procedure in an under-replaced patient with Addison's disease. Signs include sudden severe weakness or fatigue, nausea, vomiting, severe abdominal pain, hypotension (low blood pressure with dizziness or fainting), confusion, and in severe cases loss of consciousness. If an adrenal crisis is suspected during a dental appointment, the emergency protocol is: lay the patient flat with legs elevated, call 999 immediately, and administer an intramuscular hydrocortisone injection (100 mg) from the patient's emergency kit if trained to do so and the kit is available. Do not delay calling emergency services. Does Addison's disease cause changes in the gums or mouth? Yes. One of the characteristic oral signs of Addison's disease is hyperpigmentation — a darkening of the gums (gingiva), inner cheeks, lips, and palate — caused by elevated ACTH levels stimulating melanin production. This brownish or bluish-grey discolouration may be the first visible sign of Addison's disease in some patients. In patients with known Addison's disease on replacement therapy, gingival hyperpigmentation does not affect orthodontic treatment and does not require any specific intervention beyond awareness. Orthodontists who notice unexplained gingival pigmentation should consider this sign and refer the patient to their GP. Is healing slower after dental extractions in Addison's disease? In patients on adequate steroid replacement therapy who follow the recommended cover protocol for their extraction, wound healing is generally normal. If the replacement therapy is subtherapeutic or the cover protocol is not followed, the physiological stress of extraction can precipitate relative cortisol deficiency, which may impair the inflammatory phase of healing and increase infection risk. Patients should take their morning hydrocortisone on the day of extraction as advised, keep the socket clean, and contact their dental team promptly if healing appears to be taking longer than expected or if signs of infection develop. Can patients with Addison's disease have sedation for dental treatment? Sedation for dental treatment in patients with Addison's disease carries specific risks due to electrolyte disturbances (hyponatraemia and hyperkalaemia) and the impaired stress response. Conscious sedation in primary dental care should only be carried out with full knowledge of the Addison's diagnosis, after consultation with the patient's endocrinologist or GP, and with appropriate electrolyte monitoring and emergency protocols in place. General anaesthesia should always involve the anaesthetic team being informed about the Addison's diagnosis and the patient's medication regimen, and appropriate intraoperative steroid supplementation will typically be given. Where can patients with Addison's disease in the UK get support? The Addison's Disease Self-Help Group UK (ADSHG) provides information, peer support, and an emergency protocol card that patients can carry to medical and dental appointments. The card summarises the patient's condition and the emergency hydrocortisone protocol for clinicians. The NHS provides an information page on Addison's disease at nhs.uk/conditions/addisons-disease. Patients should also discuss their dental care needs with their endocrinologist at their next specialist review, to ensure that an agreed steroid cover protocol for dental procedures is documented in their medical records. Explore your options Quick links Not sure where to start? Use these quick links to explore orthodontic treatments, typical costs, and helpful guides that explain what different options involve. Whether you're researching braces or clear aligners, comparing pricing, or just getting a feel for what comes next, you can browse at your own pace and come back when you're ready to request a quote. 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Upload guided photos and get a tailored recommendation for your teeth and bite. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Find an Orthodontist](https://virtualconsultant.online/locations) Citation details Title Addison's Disease and Orthodontics UK | Steroid Cover Guide Publisher Virtual Consultant Online Published 2026-06-28 Updated 2026-08-17 URL [https://staging.virtualconsultant.online/guides/addisons-disease-orthodontics-uk](https://staging.virtualconsultant.online/guides/addisons-disease-orthodontics-uk)