This document provides guidelines for dental management of pregnant patients. It discusses considerations like supine hypotensive syndrome and recommendations for treatment in each trimester. It also covers drug classifications and provides guidance on safe use of local anesthetics, analgesics, antibiotics and other drugs during pregnancy and nursing. Overall, the guidelines emphasize the importance of risk assessment and modifying but not withholding treatment, when needed, during pregnancy.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
Tooth preparation for full veneer crowns /certified fixed orthodontic course...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Medication in pregnancy by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Pregnancy is a unique period in a woman’s life. Many changes are happening to her body that may affect the pharmacology of medications. During pregnancy, a woman’s gastric pH is increased and gastric motility is reduced which may interfere with the rate and extent of medication absorption. Maternal plasma volume is increased leading to changes in the volume of distribution. In addition, increases in progesterone and estradiol levels may affect the hepatic metabolism of some medications. Glomerular filtration rate is increased due to increase renal blood flow which may affect renally cleared medications. Despite the changes, the pharmacology of most medications is not altered enough to require dosing changes.1 The placenta is an organ of exchange allowing the mother to pass nutrients and medications to the fetus; therefore, medications administered to pregnant women have the potential to affect the growing fetus. The fetus is generally at the greatest risk of developing teratogenic effects from medications during the first trimester, but it is drug specific. The use of medications in pregnancy should be evaluated for the benefits and risks to both the mother and fetus. Upon evaluation, some medications may be used sparingly during some trimesters and contraindicated in others. 2 All efforts should be made to optimize the risk benefit ratio. Drugs with low molecular weight, low maternal protein binding, low ionization, and high lipophilicity are more likely to cross the placenta and cause pharmacologic affects.1 The developing fetus’s body systems are not mature; therefore, the fetus may lack the ability to metabolize medications causing teratogenic effects. 2 The FDA has categorized the potential teratogenic risk of medications by an A, B, C, D, X system.
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
Tooth preparation for full veneer crowns /certified fixed orthodontic course...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Medication in pregnancy by dr alka mukherjee nagpur m.s. indiaalka mukherjee
Pregnancy is a unique period in a woman’s life. Many changes are happening to her body that may affect the pharmacology of medications. During pregnancy, a woman’s gastric pH is increased and gastric motility is reduced which may interfere with the rate and extent of medication absorption. Maternal plasma volume is increased leading to changes in the volume of distribution. In addition, increases in progesterone and estradiol levels may affect the hepatic metabolism of some medications. Glomerular filtration rate is increased due to increase renal blood flow which may affect renally cleared medications. Despite the changes, the pharmacology of most medications is not altered enough to require dosing changes.1 The placenta is an organ of exchange allowing the mother to pass nutrients and medications to the fetus; therefore, medications administered to pregnant women have the potential to affect the growing fetus. The fetus is generally at the greatest risk of developing teratogenic effects from medications during the first trimester, but it is drug specific. The use of medications in pregnancy should be evaluated for the benefits and risks to both the mother and fetus. Upon evaluation, some medications may be used sparingly during some trimesters and contraindicated in others. 2 All efforts should be made to optimize the risk benefit ratio. Drugs with low molecular weight, low maternal protein binding, low ionization, and high lipophilicity are more likely to cross the placenta and cause pharmacologic affects.1 The developing fetus’s body systems are not mature; therefore, the fetus may lack the ability to metabolize medications causing teratogenic effects. 2 The FDA has categorized the potential teratogenic risk of medications by an A, B, C, D, X system.
Oral surgery during pregnancy
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Pregnancy, also known as gestation, is the time during which a fetus develops inside a woman's uterus. Pregnancy is typically divided into three trimesters. The common belief has been that, if an oral surgery procedure is recommended, but it’s not an emergency, the second trimester is the ideal time. Pregnancy however, is not a disease and pregnant woman should not be treated differently than the general population. In short, it could be concluded that:
• Dental care is safe and essential during pregnancy
• Pregnancy is not a reason to defer routine dental care or treatment
• Diagnostic measures, including needed dental x-rays, can be undertaken safely
• Emergency care should be provided at any time during pregnancy
drugs safety in pregnancy medications medication in pregnancy treatment during pregnancy healthy pregnancy teratogen teratogenecity teratogenic drugs in pregnancy drugs and congenital malformation
challenges in obstetric prescription
Beautiful Slide Show By Editor Dr. Ragini Agrawal And Dr. Tamkeen khan
Dr. Ragini Agrawal, Chairperson Food , Drug & medico surgical Equipment Committee 2009-2011
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Dental pregnant 1
1. COSIDERATIONS FOR
DENTAL MANAGEMENT OF
THE PREGNANT PATIENT
DENTAL MANAGEMENT GUIDELINES
SUPINE HYPOTENSIVE SYNDROME
DRUG USE DURING PREGNANCY
Osama Al-Khalifa
3. Supine hypotensive syndrome
When the pregnant woman is in
the supine position, there is
impaired venous return to the
heart due to compression of the
inferior vena cava by the fetus
This leads to hypotension,
nausea, dizziness, and fainting.
4. Management
1- Rolling the patient to the
left side to lift the uterus
off the inferior vena cava
2- The pregnant woman
should have the right hip
and buttocks elevated by
about 15 degrees (10 to
12 cm)
3- Administer oxygen
6. DENTAL MANAGEMENT GUIDELINES
First trimester (conception to 14th week)
The most critical and rapid cell division and active
organogenesis occur between the second and the eighth
week of postconception. Therefore, the greater risk of
susceptibility to stress and teratogens occurs during this
time and 50% to 75% of all spontaneous abortions occur
during this period
The recommendations are:
1. Educate the patient about maternal oral changes during
pregnancy.
2. Emphasize strict oral hygiene instructions and thereby
plaque control.
3. Limit dental treatment to periodontal prophylaxis and
emergency treatments only.
4. Avoid routine radiographs. Use selectively and when
needed.
7. DENTAL MANAGEMENT GUIDELINES
Second trimester (14th to 28th week)
Organogenesis is completed and therefore the
risk to the fetus is low This is the safest period
for providing dental care during pregnancy
The recommendations are:
1. Oral hygiene, instruction, and plaque control.
2. Scaling, polishing, and curettage may be
performed if necessary.
3. Control of active oral diseases, if any.
4. Elective dental care is safe.
5. Avoid routine radiographs. Use selectively and
when needed.
8. DENTAL MANAGEMENT GUIDELINES
Third trimester (29th week until childbirth)
Although there is no risk to the fetus during this trimester,
the pregnant mother may experience an increasing level
of discomfort. Short dental appointments should be
scheduled with appropriate positioning while in the chair
to prevent supine hypotension. It is safe to perform
routine dental treatment in the early part of the third
trimester, but from the middle of the third trimester
routine dental treatment should be avoided
The recommendations are:
1. Oral hygiene, instruction, and plaque control.
2. Scaling, polishing, and curettage may be performed if
necessary.
3. Avoid elective dental care during the second half of the
third trimester.
4. Avoid routine radiographs. Use selectively and when
needed
9. Dentist’s Opinion Toward Treatment of Pregnant
Patients
;
Extract a non-restorable painful tooth
55% would extract
43% would not perform any extraction
during pregnancy and would manage the
pain by prescriptions or extirpating the
pulp of the painful tooth
2% did not know the answer
Ra’ed Al-Sadhan and Abdullatif Al-Manee 2008
10. Dentist’s opinion toward treatment of pregnant
patients
Local Anesthetic Agent Choices
75% would use lidocaine without
vasoconstrictor and would not use
prilocaine with felypressin vasoconstrictor.
Ra’ed Al-Sadhan and Abdullatif Al-Manee 2008
11. Dentist’s opinion toward treatment of pregnant
patients
Antibiotic Choices
96% would prescribe Amoxicillin.
65% would not prescribe Clindamycin while 23.5% would
prescribe it and 11.5% were uncertain.
93.5% avoided Tetracycline during while only 1.5% would
prescribe it and 5% were uncertain.
Metronidazole and Cephalosporines approximately had
similar results as 73.5 – 70% of participants avoided
prescribing them for pregnant patients while 15 – 18.5%
would prescribe them and 11.5% of the participants were
uncertain
Ra’ed Al-Sadhan and Abdullatif Al-Manee 2008
12. Dentist’s opinion toward treatment of pregnant
patients
Analgesic Choices
96.7% would prescribe Paracetamol
27.5% would prescribe Acetaminophen
5 - 13% would prescribe Ibuprofen, Aspirin
and Codeine 76.5 – 85% avoided them
8 – 10.5 % were uncertain
Ra’ed Al-Sadhan and Abdullatif Al-Manee 2008
13. FDA Classifications for drugs used in pregnant and
lactating patients
Category A
Adequate, well-controlled studies in pregnant women
have not shown an increased risk of fetal Abnormalities.
14. FDA Classifications for drugs used in pregnant and
lactating patients
Category B
Animal studies have revealed no evidence of harm to the
fetus, however, there are no adequate and well-
controlled studies in pregnant women.
or
Animal studies have shown an adverse effect, but
adequate and well-controlled studies in pregnant women
have failed to demonstrate a risk to the fetus
15. FDA Classifications for drugs used in pregnant and
lactating patients
Category C
Animal studies have shown an adverse effect
and there are no adequate and well-controlled
studies in pregnant women.
or
No animal studies have been conducted and
there are no adequate and well-controlled
studies in pregnant women.
16. FDA Classifications for drugs used in pregnant and
lactating patients
Category D
Adequate well-controlled or observational
studies, in pregnant women have
demonstrated a risk to the fetus. However,
the benefits of therapy may outweigh the
potential risk.
17. FDA Classifications for drugs used in pregnant and
lactating patients
Category X
Adequate well-controlled or observational
studies, in animals or pregnant women
have demonstrated positive evidence of
fetal abnormalities. The use of the product
is contraindicated in women who are or
may become pregnant.
18. FDA Classifications for drugs used in pregnant and
lactating patients
• Drugs in category A and category B are
considered safe for use, whereas drugs in
category C may be used only if the
benefits overweigh the risks
• Drugs in category D are avoided with
some exceptional circumstances while
drugs in category X are strictly avoided
19. Local anesthetics
Anesthetic agents
• Lidocaine, prilocaine and etidocaine are
category B drugs,
• Mepivacaine, articaine and bupivacaine
are in category C
20. Local anesthetics
Epinephrine
The use of epinephrine, a naturally
occurring hormone, in local anesthesia in
the doses used for dental treatment is not
associated with fetal abnormality, and is
considered to be safe during pregnancy,
but caution should be taken to avoid
accidental intravenous administration.
21. Local anesthetics
Use during lactation
There is no contraindication to using local
anesthetics in a nursing mother, except
cocaine, which is absolutely
contraindicated
22. Local anesthetics
Prilocaine + felypressin use during pregnancy
Felypressin has oxytocic action contraindicating its
use in pregnant patients
STANLEY MALAMED
HANDBOOK OF LOCAL ANESTHESIA
FOURTH EDITION 1997
23. Local anesthetics
Prilocaine + felypressin use during pregnancy
Felypressin has mild oxytocic effect which, in
theory, could impede placental circulation and
therefore is probably better avoided in
pregnancy.
IVOR CHESTNUTT
Clinical Dentistry 3rd edition 2007
24. Local anesthetics
Prilocaine + felypressin use during pregnancy
Felypressin should not be used for a pregnant patient as
it has oxytocic effect which may impede the placental
circulation by interfering with the tone of the uterus. This
contraindication is made particularly valid by the fact that
felypressin is normally available with prilocaine which
also passes the placental barrier and a high dose may
cause fetal methaemoglobinaemia
ROBERTS & SOWRAY
LOCAL ANALGESIA IN DENTISTRY
2nd edition 1979
25. Analgesics
Acetaminophen
Acetaminophen, FDA category B, is the
most useful analgesic to be used during
pregnancy. It can be used in any stage of
pregnancy and in nursing mothers.
Maternal anemia and fetal renal disease
was reported, however, used in high
doses
26. Analgesics
Opioid analgesics
Certain opioid analgesics (oxycodone,
morphine which are category B or
propoxyphene which is category C ) can
be used during pregnancy and lactation.
However, chronic use of narcotics may
result in growth retardation and physical
dependency
27. Analgesics
Aspirin
Aspirin is FDA category C. It is a
prostaglandin inhibitor and it is known to
cause constriction of the ductus arteriosus
and prolongs labour. It is also secreted in
the breast milk. Therefore, it should be
avoided particularly during the third
trimester of pregnancy and while nursing
28. Analgesics
Ibuprofen
Ibuprofen is a category B analgesic in the
first and second trimesters, but it is a
category D drug during the third trimester
because it has been associated with lower
levels of amniotic fluid, premature closure
of the fetal ductus arteriosus and inhibition
of labour when taken during this time. It
should be prescribed only after
consultation with and advice from the
obstetrician.
29. Antibiotics
Penicillins and cephalosporins
Beta-lactam ring-derived antibiotics
(penicillins and cephalosporins) are the
first-choice antibiotics for orofacial
infections. They are categorized as FDA
class B drugs. These antibiotics cross the
placenta but are known to be safe when
used in pregnancy.
30. Antibiotics
Macrolides
Macrolides (erythromycin, with the exception of
estolate form, clindamycin, azithromycin) are
categorized as FDA class B drugs. They pass
the placental barrier but only in small amounts.
Therefore, they are recommended for use in
pregnant women who are allergic to penicillin.
Clarithromycin, also a macrolide, is categorized
as FDA class C. It is mostly recommended for
use in pregnant HIV patients for the treatment of
Mycobacterium avium complex (MAC)
31. Antibiotics
Tetracyclines
Tetracyclines are classified FDA category
D, and thus should only be used when
there is no other alternative treatment
available, such as in the treatment of a
patient with syphilis who has an allergy to
penicillin
33. Antibiotics
Ciprofloxacin
Ciprofloxacin, a broad-spectrum
floroquinolone antibiotic used to treat
periodontal disease associated with
actinobacillus actinomycetemcomitans, is
in category C. Its use in pregnancy has
been restricted because of arthropathy
and adverse effects on cartilage
development observed in immature
animals. There are not enough data to
definitively determine its safety in humans
35. Antifungal drugs
Nystatin and clotrimazol are FDA class B drugs
and they are considered to be safe during
pregnancy and lactation. Ketoconazole and
fluconazole are FDA class C. Ketoconazole is
secreted in breast milk and is reported to cause
adrenal insufficiency and hepatotoxicity in
newborns, therefore it should be avoided during
nursing. There are no reported adverse effects
of using fluconazole during nursing
36. Corticosteroids
Corticosteroids are FDA category C drugs.
Corticosteroids are commonly used to
treat various inflammatory oral conditions.
Corticosteroids are generally used as local
topical preparations (ointments, mouth
washes, lozenges) in treating inflammatory
oral conditions.
37. Corticosteroids
systemic corticosteroids complications that
arise are premature rupture of embryonic
membranes, hypertension, and gestational
diabetes mellitus. When administered
systemically, the lowest effective dosage
should be given and the fetus should be
monitored for infections and adrenal
insufficiency
38. Corticosteroids
Despite the secretion of corticosteroids in
the breast milk, the American Academy of
Pediatrics Committee on Drugs
recommends using prednisone and
prednisolone in nursing mothers when it is
indicated.
39. Sedatives and hypnotics
Nitrous oxide (N2O) has not been classified into any
category by the FDA and its use in pregnancy is
controversial due to unproven deleterious effects on the
pregnant woman and fetus. Nitrous oxide inhibits
methionine synthetase activity in rats, but it is not known
to affect humans. Nitrous oxide also causes
vasoconstriction and may reduce uterine blood supply.
Because methionine synthetase is vital for the
production of DNA, it is best to avoid the use of nitrous
oxide in the first trimester of pregnancy, when
organogenesis is occurring
40. Sedatives and hypnotics
• If N2O is required, it is better given in the
second and third trimesters, to be
administered for less than 30 minutes with
at least 50% oxygen.
• Barbiturates and benzodiazepines are
categorized as FDA class D drugs and
should be avoided during pregnancy and
nursing
41. Conclusion
During pregnancy, dental treatment may
be modified but need not be withheld,
provided the risk assessment is made
properly for both the patient and the fetus