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Pregnancy can be a nervous time for many parents especially when an illness or medical emergency arises for the mother. Most moms tend to be are extremely cautious about

Pregnancy Marielaina Perrone DDS

Be Educated On What Drugs Are Safe During Pregnancy

taking any drugs during pregnancy. They are fearful of harming their baby and rightfully so.  In some instances, taking medications can be helpful to both mother and baby. The medications can relieve pain, infection, and stress.

Drug and chemical exposure  during pregnancy are believed to account for approximately 1% of all birth defects. Birth defects are most commonly associated with poor nutrition, smoking and alcohol, previous diseases, genetics, pharmaceutical effects, and maternal age.

Pregnancy Risk Categories For Drugs

Category A – These drugs have been well studied over the years and have not demonstrated any risk to the fetus in any trimester of pregnancy.

Category B – No evidence of risk in humans. This category has shown adverse effects in animal trials but in controlled human trials have been deemed to be safe with no increased risk of fetal abnormalities.

Category C – Potential risk during pregnancy is present here. Not enough studies have proven the safety of these drugs but in some cases they are deemed necessary to use as the benefits outweigh the potential risks during pregnancy.

Category D – These have shown positive evidence of risk to the fetus. However, these drugs may be used in life threatening or in care of a serious disease for which safer drugs cannot be used or are ineffective.

Category X – Contraindicated in pregnancy. The risk of these drugs clearly outweighs any potential benefits. These drugs include Accutane, thalidomide, and Xanax

Drugs Used In Dentistry

Local Anesthetics – Most local anesthetics as used in dentistry have been shown to be relatively safe. Any local anesthesia can cross the placenta and cause fetal depression, therefore dosage should be limited to the minimum required for effective pain control. Luckily, most dentistry can be completed with very small amounts of local anesthetic, thus causing no danger to mom or baby. A major study was completed spanning about 35 years and tracking 55,000 children. The study showed no evidence of any adverse reactions from local anesthetic use in pregnant women. Different types of local anesthesia include:

- Epinephrine (adrenalin) –  used in local anesthesia to improve local anesthetic efficiency. It is longer lasting and allows for less bleeding during surgical procedures. Normal dental doses do not pose any significant risk to fetus. Epinephrine has been shown to cause constriction of the umbilical artery but has only been seen to cause issue when paired with an already compromised fetus.

Pregnancy Marielaina Perrone DDS-Levonordefrin - used in local anesthesia, and similar to epinephrine in its action.  It is less potent than epinephrine, but it is used in higher concentrations, dosage is about 5x more than the usual epinephrine dose. For this reason levonordefrin is NOT recommended during pregnancy.

-Lidocaine - Deemed completely safe in normal dentistry dosing levels.

-NSAIDS -  non steroidal anti inflammatory drugs which include, aspirin, ibuprofen(Advil, Motrin), and naproxen sodium(Alleve). These drugs all block formation of prostaglandin. Prostaglandin is one of the hormones involved in the induction of labor.  By blocking prostaglandin production, these drugs may prolong labor.  Aspirin decreases the ability to form a blood clot, and can cause increased bleeding  if taken within 5 days of delivery. Aspirin and other NSAIDS should be avoided especially during the third trimester of pregnancy. The alternative here for pregnant women would be to take acetominophen(Tylenol). Acetominophen causes less tummy irritation and does not cause a tendency to bleed.

-Opiates – such as codeine should be used with caution and only when indicated. The use of codeine during pregnancy has been studied extensively. The studies have shown that codeine is associated with multiple congenital defects, including heart defects and cleft palate or cleft lip. The association with these defects may also be due to the medical condition associated with their use.

-Antibiotics – The penicillin and cephalosporin antibiotics most commonly used in dentistry (penicillin V, amoxicillin, and caphalexin) are generally considered safe for use during pregnancy. Clindamycin, metronidazole, and erythromycin are also believed to have minimal risk. Tetracyclines, including doxycycline, have shown to cause tooth discoloration and impaired bone metabolism. As a side note, taking antibiotics while using birth control medications will generally cause the birth control to be ineffective.

-Sedative Agents – are used to relax and calm you, such as valium. These agents decrease action of the nervous system, and can cross the placental barrier. One of the most commonly prescribed drugs in this category is valium. It has been shown to cause  cleft lip and cleft palate when taking during pregnancy. So, caution should be taken when using valium over a prolonged period of time during pregnancy.

-Nitrous Oxide and General Anesthesia – The various side effects of inhaling nitrous oxide during pregnancy include behavioral and skeletal deformations, Cosmetic Dentist Marielaina Perrone DDSspontaneous abortions and reduced fertility. Nitrous oxide can inactivate vitamin B12. This in turn will affect DNA synthesis. DNA is crucial, as it is the genetic building blocks for your baby’s formation. For this reason, it is recommended to minimize exposure to nitrous oxide during the first trimester.

Conclusion

It is important to understand what we put into our bodies, and how they effect us, especially during pregnancy. When pregnant, the importance of being aware can not be stressed enough. Most often we can avoid medications during pregnancy, but it is not always the case. We can still have health issues during pregnancy, and knowing which drugs are safer, and those to stay away from may be critical. Your dental health is important before, during , and after pregnancy for both you and your baby. Dental care should be embraced before and during pregnancy to maintain a healthy oral environment to limit any potential issues that may develop. Choose your dentist wisely and ensure they are well versed in handling a patient thinking about becoming or are already pregnant to ensure a safe delivery.

Did you know that a redheads genetic makeup may lead to a need for increased local anesthetic and have higher dental anxiety? A recent study by the Journal of the American Dental Association (JADA) shows that people with a specific gene tend to experience increased dental anxiety during routine dental treatment. This gene occurs more often in redheads than the general population. A second study showed that redheads need 20% more anesthesia, and it wears off faster than in blondes or dark haired people. Perhaps, the need for increased anesthesia has caused many of these redheads to fear dental treatment?

The Dental Anxiety and Dental Pain Study

The dental anxiety study included 144 people (67 with red hair and 77 with dark hair) who answered various questions about dental fears and dental anxieties. Following survey questions, blood samples were taken to test for the presence of specific gene variations. People with one specific gene, melanocortin 1 receptor (MC1R), were more than twice as likely to report dental fear and dental anxiety than those without the gene. 85 patients had the gene in the study and 65 of them were redheads. This same gene is also thought to be responsible for increased sensitivity to thermal pain and increased resistance to the effects of local anesthesia.

The research teams believes variations of the MC1R gene play a role. This MC1R gene produces melanin, which gives skin, hair and eyes their distinctive color.

While blond, brown and black-haired people produce melanin, those with red hair have a mutation of this receptor. It produces a different coloring called pheomelanin, which results in freckles, fairer skin and red hair. Approximately 5% of whites are believed to have these characteristics.

While the relationship between MC1R and pain sensitivity is not known completely, researchers have discovered MC1R receptors in the brain and some of them are known to influence pain sensitivity. As stated above, non redheads can also carry the gene.

Tips to Deal With Dental Anxiety and Dental Pain

-Communication. Keeping open lines of communication is always important to ensure proper numbing is being obtained to make the patient comfortable. Discussing all aspects of dental anxiety ahead of time will ensure the best possible outcomes for the patient.

-Medication. Many patients do very well taking a pre visit valium to relax themselves and remove excess dental anxiety. It will also allow the anesthesia to work more effectively during the visit because you are so relaxed.

-Distraction. Use of an ipod, to listen to music during your dental visits places your mind in a relaxed state. It helps to drown out unwanted noise.

What Does It All Mean?

Many redheads will present with increased dental anxiety as well as be more resistant to local anesthesia. So, both dentist and patient need to be aware of these situations. A dentist armed with this knowledge will approach these patients differently and ask specific questions about past anesthesia issues, as well as past dental anxiety and experiences. You do not have to have red hair to experience dental anxiety or have difficulty getting numb. There are many ways to address both problems  and overcome them with proper techniques and good communication.

Scaling and root planing is one of the most conservative and effective procedures to treat periodontal disease before it progresses. Scaling is the removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces. Scaling and root planing cleans between the gums and the teeth along the roots. Scaling and root planing specifically targets the areas below the gum line (along the root).

Scaling and root planing are sometimes referred to as a deep dental cleaning. Scaling involves removal of built up plaque at the gum line using either manual hand instruments or an ultrasonic cleaning tool (the vibrations break up the tartar and plaque). During root planing, your dentist or hygienist will be gently cleaning the roots of your teeth, and removing any rough spots along the roots and teeth. These rough spots tend to be a trap for bacteria and plaque. Plaque is far more likely to stick to rough surfaces. As the bacteria builds up in the form of plaque it creates a sticky surface for even more bacteria to accumulate. The root surface is made smooth in a process called root planing. Root planing removes any remaining tartar and smooths

Root Planing and scaling

Scaling and Root Planing

irregular areas of the root surface. This procedure is usually performed using local anesthesia, because the roots of teeth are unprotected by enamel and are very sensitive. Your dentist will use a local anesthetic to numb your mouth before starting the procedure. Local anesthetic should prevent you from feeling discomfort during the root planing and scaling. Instead, you’ll just feel the pressure of the instruments in your mouth.

It usually takes more than one visit to complete scaling and root planing. Since all of that deep cleaning can leave your teeth pretty sensitive, the dentist or hygienist will only do one part your mouth at a time. The number of treatments can depend on how severe your periodontal disease is and your personal oral hygiene habits. It generally takes 2 visits to complete the scaling and root planing procedure. You will schedule your follow up appointments about 1 week apart from each other. It will also be recommended that you schedule more frequent cleanings (every 3-4 months) after scaling and root planing to help prevent the return of gum disease.

Why is Scaling and Root Planing necessary?

Scaling and root planing actually helps gums heal. The gum tissues will have an easier time reattaching themselves to a smoother root surface than a rough one. The smoother surface also helps keep dental plaque from attacking the tooth’s root surface. This makes it far easier to maintain the gum tissue following treatment. Scaling and root planing has been shown to help prevent periodontal disease from spreading and it can also reverse the signs of ginigvitis (the earliest form of periodontal disease).

Following Scaling and Root Planing Treatment

Once the scaling and root planing is completed, oral hygiene preventive care is necessary to keep gums healthy. Periodontal disease can not be cured but it can be held at bay with proper oral hygiene techniques and practices. Brushing and flossing will help fight the dental plaque that is constantly forming around teeth. Antibacterial rinses, such as Peridex, and stannous fluoride rinses help keep bad bacteria at bay. Tartar dissolving products such as Periogen will help keep teeth cleaner between cleanings and allow for greater healing to occur. Regular dental examinations and visits to your hygienist are required to clean areas we are unable to.

Risks of Scaling and Root Planing

Scaling and root planing can introduce harmful bacteria into the bloodstream through the process. Gum tissue can also be at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics for the following reasons:

-Have certain heart problems that place you at increased to get a heart infection called endocarditis.

-Have a weakened immune system.

-Had recent major surgeries or have man made body parts, such as an artificial hip or heart valve.

A simple, conservative procedure like scaling and root planing can reduce periodontal disease’s effects and restore the gum tissue to a healthy state. Without proper treatment, periodontal disease will progress. It will progress past the gingivitis stage into periodontitis. Periodontitis is not reversible like gingivitis. Remember: Once gum tissue is lost, it doesn’t grow back. The earlier you treat gum disease, the better chance you have for recovery. To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing. The earlier you start treating gum disease, the better your chances of being able to take care of the problem without surgery and the lower your risk of losing any teeth. So make an appointment to see your dentist today and put an end to your periodontal disease.