4.13.24
Quick Review #125 - #pregnancy #pregnantpatient #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental
When treating a pregnant patient in dentistry, there are some essentials to consider beforehand:
Pharmacological Considerations:
• Drugs are harmful for the body, especially during pregnancy, as they affect both the mother and the fetus. All drugs—prescription, illegal, or over-the-counter—should be considered harmful to the fetus unless proven otherwise.
• Certain drugs are contraindicated due to their potential harm to the fetus, such as causing respiratory depression that may induce fetal hypoxia.
• An acronym to remember safe medications is “SAFE Moms Take Really Good Care”:
-Sulfonamides (except Sulfa drugs like Kerinctus)
-Aminoglycosides (nephro/ototoxic)
-Fluoroquinolones (cartilage damage)
-Erythromycin (maternal acute cholestatic hepatitis)
-Metronidazole (mutagenic)
-Tetracyclines (tooth discoloration)
-Ribavirin (teratogenic)
-Griseofulvin (teratogenic)
-Chloramphenicol (gray baby syndrome)
Substance:
• Alcohol should be completely avoided.
• Analgesia should be obtained using acetaminophen with or without codeine.
• Caffeine should be limited as it may cause growth retardation.
• Local anesthetics with epinephrine (bupivacaine, lidocaine, mepivacaine) can be used during pregnancy.
• Nicotine should be avoided due to risks of low birth weight and lung problems in newborns.
Inhalation Anesthetics:
• Nitrous oxide should not be used in the first trimester but is acceptable up to 9 hours a week, at no less than 50% oxygen, in the second and third trimesters.
• Prilocaine and articaine may cause methemoglobinemia.
Key Points:
• Defer surgery until after delivery if possible; the second trimester is preferred if necessary.
• Consult the patient’s obstetrician if surgery cannot be delayed.
• Limit radiography to absolutely necessary cases, and use a lead apron.
• Consider drugs being administered.
• Use nitrous oxide in the second and third trimester only, with at least 50% oxygen.
• Avoid long periods of supine positioning and allow frequent breaks to void.
• Monitor for signs of preeclampsia, such as hypertension (HTN), edema, and proteinuria.
Medications to Avoid During Pregnancy:
• ASA
• NSAIDs
• Aminoglycosides
• Benzodiazepines
• Chloral hydrate
• Corticosteroids
• Diphenhydramine
• Morphine
• Phenobarbital
• Promethazine
• Propoxyphene
• Tetracyclines
References:
1. American Dental Association. (2019). Guidelines for the Management of Pregnant Patients in the Dental Setting. Retrieved from the American Dental Association website.
2. Malamed, S. F. (2013). Sedation: A Guide to Patient Management. St. Louis, MO: Elsevier.
3. Phero, J. C., & Becker, D. E. (2013). Managing the Pregnant Oral and Maxillofacial Surgery Patient. Journal of Oral and Maxillofacial Surgery, 71(11), 1939-1953.
4. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #oralsurgeon #dentist #doctorgallagher #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency