Local Anaesthetics
Maintaining oral health is very essential during pregnancy. Due to the hormonal changes in pregnancy, it is quite common for women to experience oral
health issues that can be treated during pregnancy. Lack of awareness regarding safety of dental treatment in pregnant women a lot of practitioners
and women postpone the essential treatment after the delivery that could results in worse outcomes (Manautou & Mayberry, 2023).
To perform safe and painless treatment local anaesthesia is a prerequisite. Unclear guidelines across the administration of local anaesthesia makes the practitioners hesitant to use them around pregnant and breastfeeding women (Lee and Shin 2017).
Drugs has been categorised into several categories by the Australian Therapeutic Goods Administration (TGA) depending on the harmful effects on the fetus or frequency of malformations. Lidocaine and prilocaine are category A and are considered the safest local anaesthetic agents for pregnant women. Between the two, concentrations of prilocaine are 4% and that of lidocaine is 2%. hence, lidocaine is the preferred choice by the clinicians (Zhou et. al, 2023).
Articaine is also a commonly used local anaesthetic that has been classified in category B3 and thus should not be used in pregnant women (TGA website).
Regarding breastfeeding, many dentists inform mothers to “pump and dump” their breastmilk for 24 hours after receiving local anaesthesia to avoid its passage to the infant. However, this piece of advice is considered outdated, and it is recommended that women continue to breastfeed infant as soon as she is finished with her dental treatment (Cobb et. al, 2015).
Local anaesthesia are large, polymerized molecules that do not cross easily into the lactating ducts. Both lidocaine and prilocaine are considered safe in the lactating mothers. Due to their physiochemical properties, milk to plasma ratio remains consistent (comparing it in 2, 6 and 12 hours in breastmilk and maternal serum) and the transfer of their metabolites are minimal into the breastmilk and thus can be safely administered into the breastfeeding women (Cobb et. al, 2015).
Last updated: 2024 June 20To perform safe and painless treatment local anaesthesia is a prerequisite. Unclear guidelines across the administration of local anaesthesia makes the practitioners hesitant to use them around pregnant and breastfeeding women (Lee and Shin 2017).
Drugs has been categorised into several categories by the Australian Therapeutic Goods Administration (TGA) depending on the harmful effects on the fetus or frequency of malformations. Lidocaine and prilocaine are category A and are considered the safest local anaesthetic agents for pregnant women. Between the two, concentrations of prilocaine are 4% and that of lidocaine is 2%. hence, lidocaine is the preferred choice by the clinicians (Zhou et. al, 2023).
Articaine is also a commonly used local anaesthetic that has been classified in category B3 and thus should not be used in pregnant women (TGA website).
Regarding breastfeeding, many dentists inform mothers to “pump and dump” their breastmilk for 24 hours after receiving local anaesthesia to avoid its passage to the infant. However, this piece of advice is considered outdated, and it is recommended that women continue to breastfeed infant as soon as she is finished with her dental treatment (Cobb et. al, 2015).
Local anaesthesia are large, polymerized molecules that do not cross easily into the lactating ducts. Both lidocaine and prilocaine are considered safe in the lactating mothers. Due to their physiochemical properties, milk to plasma ratio remains consistent (comparing it in 2, 6 and 12 hours in breastmilk and maternal serum) and the transfer of their metabolites are minimal into the breastmilk and thus can be safely administered into the breastfeeding women (Cobb et. al, 2015).
References
Cobb, B, Liu, R, Valentine, E, Onuoha, O 2015, ‘Breastfeeding after Anaesthesia: A Review for Anaesthesia Providers Regarding the Transfer of Medications into Breast Milk’, Transl Perioper Pain Med, vol.1, no.2, pp.1-7.
Lee, J, Shin, T 2017, ‘Use of local anaesthetics for dental treatment during pregnancy; safety for parturient’, Journal of Dental Anaesthesia and Pain Medicine, vol.17, no.2, pp.81-90.
Manautou, M, Mayberry, M 2023, ‘Local Anaesthetics and Pregnancy. A review of the evidence and why dentists should feel safe to treat pregnant people’, Journal of Evidence Based Denta Practice, vol.23, no.2.
Zhou, X, Zhong, Y, Pan Z, Zhang, J, Pan, J 2023, ‘Physiology of pregnancy and oral local anaesthesia considerations’, Peer J Life and Environment, vol.11, no.19985, pp.1-35.
Lee, J, Shin, T 2017, ‘Use of local anaesthetics for dental treatment during pregnancy; safety for parturient’, Journal of Dental Anaesthesia and Pain Medicine, vol.17, no.2, pp.81-90.
Manautou, M, Mayberry, M 2023, ‘Local Anaesthetics and Pregnancy. A review of the evidence and why dentists should feel safe to treat pregnant people’, Journal of Evidence Based Denta Practice, vol.23, no.2.
Zhou, X, Zhong, Y, Pan Z, Zhang, J, Pan, J 2023, ‘Physiology of pregnancy and oral local anaesthesia considerations’, Peer J Life and Environment, vol.11, no.19985, pp.1-35.