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An allergic reaction is caused by our immune systems being sensitive to a specific substance (also called an allergen). An allergic reaction occurs when you make contact with, inhale, swallow, or inject a substance into your body that causes your immune system to produce a reaction. Many allergic reactions are quite  mild, such as hay fever while others can cause breathing or swallowing to stop, and be life threatening. It is believed 1 in 5 people in America are susceptible to allergies of some kind. There are some common dental products that can cause allergic reactions that we should all be aware of.

Allergic Reaction During Dental Care

The dental office utilizes many types of compounds that could potentially be an allergic issue for you as a patient unless you communicate with your dentist. Some know of their allergies, while others may develop new ones at any time after exposure. The usual first response is itching, redness and irritation of tissue. A rash, or welts may occur, swelling of the face, tongue , lips and/or throat may occur in a severe reaction.  The main potential allergens in a dental office include:

-Latex – This is a natural rubber harvested from trees and used in a wide range of products. Dental products that may have latex include masks, gloves, rubber dams, prophy cups, and some syringes.  The latex gloves are the usual culprit as they may contain powder particles which come into direct contact with the skin and mouth. Prolonged exposure to latex and the dust they shed can trigger an allergic reaction. This reaction can be minor to one that is more severe. Luckily, most dental offices are aware of this allergy today and have non latex gloves available for sensitive patients or have made the switch completely for the safety of all patients.

-Local Anesthesia – A very rare reaction but it does happen to a small subset of the population. Dentists use a variety of local anesthetics based on the need and situtation of the patient. The main anesthetic used is lidocaine. A true allergy to local anesthetic is quite rare and it is usually due to a sensitivity to para-aminobenzoic acid (PABA). That term is quite a handful but it is simply a by product of the local anesthetic. There have also been cases of local anesthetic allergies to preservatives added to local anesthetics. Most patients who report an allergic reaction are not actually allergies, but instead a reaction to the effects of epinephrine. This reaction usually takes the form of a rapid heartbeat or an increase in blood pressure.

-Metals – Metals are used throughout dentistry and can be a  concern for many. The most common form of metal allergy is a nickel allergy. Nickel alloys are used to create a lot of our everyday items, like buttons, buckles, zippers and kitchen ware. Nickel is also found in some 14K and 18K gold, and when you sweat, it draws the nickel out. Stainless steel has nickel in it, too, but it’s usually bound so tightly that it won’t affect even the most allergic person. But very allergic people can react to the nickel present in some food items, which include nuts, chocolate, tea, coffee, beer and apricots. Dentists can avoid nickel allergies by the use of dental crowns with no nickel content as well as using orthodontic brackets made of ceramic.

-Pine, Mint- Most fluoride varnishes, not pastes, contain natural pine to make them stick to the teeth. Many dental items are flavored with mint oil to make them taste better. Many people are allergic to pine or mints such as spearmint, peppermint, and cinnamon.

-Acrylic Monomer- Acrylic is used in temporary crowns, and removable dentures. The liquid used to activate and harden the acrylic can cause severe allergic reactions to those susceptible.

Dental Allergies Conclusion

Allergies can develop over time, so it is important to tell your dentist if you notice any allergic type reactions during or after your dental appointment. Also, if you know before any dental treatment that you have any allergies you should tell your dentist so the proper materials can be used to avoid an allergic response. The main goal of any dental treatment is to take care of your dental health and not to compromise it. With a little knowledge and good communication, dental allergy issues can be addressed and avoided altogether. An allergist can test you to help determine what you should avoid to prevent an allergic response.

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.