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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.

When you’re pregnant, you become very aware of how important it is to take extra special care of your body. You should also know that pregnancy is a time to take extra special care of your teeth and gums. That’s because hormonal changes in your body during pregnancy can increase your chances of developing cavitiesgingivitis, and advancement of periodontal disease (gum disease).Women with periodontal disease are 7 times more likely to have preterm births and low birth weight babies in certain studies.

Preventive dental cleanings and regular dental exams during pregnancy are not only completely safe, but are highly recommended by both dentists and physicians alike. Pregnancy causes hormonal changes to a  woman’s body. This increase in hormones causes the gums to bleed easily, become inflamed, and trap food causing increased irritation to your gingival tissue.

 It is believed that periodontal disease may lead to premature birth by the spread of oral bacteria to the placenta or amniotic fluid. Systemic inflammation caused by periodontitis may also lead to preterm labor and membrane rupture.  The probable culprit is a chemical called prostaglandin, released into the bloodstream during inflammation, which can induce labor. Prostaglandin is released in very high levels in severe cases of periodontal disease.

Almost one half of women experience pregnancy gingivitis, starting in the 2nd or 3rd month of pregnancy. It generally increases in severity all the way through to the eighth month. Pregnancy gingivitisThis pregnancy gingivitis can be very uncomfortable and cause inflammation, bleeding, redness or tenderness in the gums. If you already have poor oral hygiene and gum disease before pregnancy begins, expect an extreme progression in your periodontal condition as you end your first trimester and onward. In some women, gums swollen by pregnancy gingivitis can react strongly to irritants and form large growths. These are called pregnancy tumors. These are not cancerous and are usually painless in nature. This tumor may require removal by a dentist if it persists.

If you are planning to get pregnant, it is a good idea to see your dentist prior to trying to concieve to ensure your oral health is fine. You should have a thorough exam at this time along with a cleaning and complete treatment on any othe issues you might have to stave off complications during pregnancy.

Once pregnant, there are a few tips to follow:

-Dental treatment such as cavity fillings and crowns should be treated to reduce the chance of infection. If dental work is to be completed during pregnancy, the second trimester is the optimum time. Once you reach the third trimester, it may be very uncomfortable and/or difficult to lie on your back for any extended period of time to recieve treatment

-Elective treatments (for example, teeth whitening or other cosmetic dentistry procedures) should be postponed until after the birth of your new child. It is best to avoid exposing the developing baby to any risks, no matter how small they may be.

-Try to maintain good oral hygiene habits during pregnancy. This includes brushing properly after every meal and flossing every day. If you combine this routine with a healthy, well balanced diet (also limit between meal snacks) and regular dental visits, you will not only help avoid dental problems of your own,  but you will also contribute to the healthy development of your coming baby. Your baby’s teeth first begin to develop at about three months or so into pregnancy. Healthy diets containing dairy products, cheese, and yogurt are a good source of the essential minerals and are good for the developing teeth, gums, and bones of the baby.

-Tell your dentist the names and dosages of all drugs you are taking. This includes any medications and prenatal vitamins prescribed by your doctor as well as any specific medical advice your doctor has given you. Your dentist may make changes your dental treatment plan for your individual case. Certain drugs (for example, tetracycline) can affect the development of your baby’s teeth and should not be prescribed during pregnancy.

Lidocaine is the most commonly used anesthetic drug used for dental work. Lidocaine will cross the placenta after administration. If dental work is needed the amount of anesthesia given should be as little as needed, but still enough to make you comfortable during your dental work. Request additional anesthetic if you are still experiencing pain. When mom is comfortable, the amount of stress you and the baby will feel will be reduced.

Preventing or removing dental infection often involves the use of antibiotics. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled safe in pregnancy, may be prescribed after your procedure with no worries about the health of your baby.

-Dental x-rays should be avoided whenever possible during pregnancy. If X-rays are needed (such as during a dental emergency), your dentist will use extreme caution to protect you and your baby. Advances in technology have made X-rays much safer today than in the past.

The American College of Radiology studies have shown no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.

During the first trimester is when fetal organ development occurs so it is best to avoid all possible risks at this time if possible.

-Loose teeth. As levels of progesterone and estrogen increase it can affect the ligaments and bones that support and stabilize the teeth, causing teeth to loosen during pregnancy. This can happen even without the presence of periodontal disease.

-If morning sickness may be keeping you from brushing your teeth regularly, change to a neutral tasting toothpaste during pregnancy. Ask your dentist or hygienist to recommend brands.

-Rinse your mouth out with water or a mouth rinse if you suffer from morning sickness and have bouts of frequent vomiting.

Is a Pregnant Woman at Greater Risk for Tooth Decay?

YES. We have all heard about pregnancy cravings. Sweet cravings are quite common for women during pregnancy. However, keep in mind that the more frequently you snack, the greater the chance of tooth decay developing. Some recent studies have also shown that the bacteria responsible for tooth decay is passed on from the mother to the child. So be careful of what you eat. Also, during pregnancy, increased acidity in the mouth increases the risk of tooth decay. Vomiting during pregnancy (especially during morning sickness period) can make the problem worse by exposing the teeth to a high quantity of gastric acid. If you have morning sickness, rinse your mouth with a solution of baking soda and water after vomiting. Use one teaspoon of baking soda in a cup of water and mix.

Should I Share the News with my Dentist That I Am Pregnant?

Your dentist should know as soon as you believe you are pregnant. It is best to avoid taking any unnecessary X-rays during your pregnancy. You should also let your dentist know if you are trying to get pregnant. Having this knowledge can help in planning X-rays or other treatments that are needed.

After you have had your baby if you experienced any type of gum problems during your pregnancy, see your dentist soon after delivery to have your entire mouth examined and periodontal health evaluated.

As a mother to be, what you do to take care of your health (including your diet) affects the development of your baby’s teeth and gums as well as their entire bodies. And as your body goes through a process of change, it is also important to pay particular attention to your own oral hygiene. Maintaining a good daily oral routine can help keep potential problems from developing.

Don’t forget that this is a time in your life to enjoy the natural changes that take place in your body, relax, and get ready to welcome your new baby into the world. So radiate health by keeping your smile bright and teeth healthy for many years to come.