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 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.
-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, spontaneous 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.
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.
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