“What Are Key Considerations When Treating A Pregnant Patient?”

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