ANESTHESIA AND PREGNANCY
Over the last few months, I have been asked the question about giving anesthetic to our pregnant patients. Let me tell you that one question put me into a deep dive into all the research and my head is spinning.
And wouldn't you know it...I've had an influx of pregnant patients in my chair these last couple of weeks. I have to say it's been perfect timing.
The conclusion I have come to is that there is so much research out there on this topic that this could be a dental specialty in of itself!
What I'm going to share with you today is basic knowledge to set the stage of what we know for certain today, and what we can look forward to in the future.
One thing we know when it comes to dispensing drugs like anesthesia is there are certain considerations which need to be made. The considerations all center around the health of the pregnancy. To date the gold standard of anesthetics we can use with our pregnant patients is Lidocaine and Prilocaine. These anesthetics have been categorized as an FDA B classification. Meaning it is been designated as safe for use due to the lack of evidence of harm to the fetus in animal studies. An easy way to remember that Prilocaine and Lidocaine are approved for use is to remember that they both start with the letter P and L just like the phrase Pregnant Lady. You may have heard this little anecdote before but it's worthy of remembering.
In regard to when we can provide dental treatment for pregnant patients there are a few things we need to evaluate. The first trimester is when most of the organ development is happening. This means we do need to be a little more cautious and aware of what we, as practitioners, prescribe or administer to our patients. You may remember learning about teratogens in dental hygiene school. This is what that term is all about, the impact of items such as drugs, on the developing fetus. For the longest time it has been considered taboo to administer anesthesia during the first trimester to avoid any potential harm to organ development.
Currently, there a few studies which indicate the use of anesthetic drugs during the first trimester as being safe and effective. Most of this research centers around general medicine but I think it won’t be long before there are studies on this topic centered around the field of oral medicine.
The second and third trimesters have historically been the safest time for treatment when considering fetal development. Just remember during the third trimester care needs to be taken for the mother’s position in the chair to help alleviate vascular compression from laying down.
Recently, the Journal of Current Medical Research and Opinion, reinforced the need for dental care during all phases of pregnancy. Especially, highlighting the need to reduce periodontal and carious infections to increase the health of the pregnancy. As dental professionals we already understood this. I find it refreshing to see this information becoming more mainstream in the world of general medicine and those working in the field of obstetrics, including mid-wives.
So what's coming in the future for anesthesia? There is some research coming out about the potential use of articaine with our pregnant patients. Please understand it is a FDA category C drug. There is some information coming out which may impact its drug classification. I have also come across several resources encouraging the use of Articaine during pregnancy because it is healthier for our patients than lidocaine or prilocaine. The theory is since this anesthetic is metabolized by the pseudo cholinesterase of the bloodstream and doesn't depend upon liver or kidney it’s impact on the mother and fetus is benign.
Also, the use of other anesthetics like tetracaine, benzocaine and bupivacaine are often used in the medical field for pregnant patients when regional anesthesia is required. Even though lidocaine has been deemed preferred, its effectiveness sometimes isn’t enough for the procedure to be completed.
WHEN ALL IS SAID AND DONE WHAT SHOULD A CLINICIAN DO?
From all I have read it is clear to me we should continue to care for our patients as we normally would. Allowing our patients to continue with active periodontal or carious infections can be more harmful than using anesthetic to treat these conditions. Use the appropriate anesthetic with minimal amounts needed for the treatment.
There is more information coming out about this special population and the best way to care for them. It has sparked the need to have further understanding of what is considered best practice. I’ll also tell you after beginning this research I want a better understanding of the FDA classifications for pregnancy...so more information to come. I know you are on the edge of your seat waiting to learn more.
Wishing you all well. Now go out there and HIT THEM WITH YOUR BEST SHOT!
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(2020). Pregnancy & Oral Health and Dental Management in Pregnant Patient. Journal of Current Medical Research and Opinion, 3(11), 724-731.