DENTAL LOCAL ANESTHESIA AND PREGNANCY

â ¢
Jean Sano, Colmenares Narhayber; Sakkal Antoinette Marisabel Cedillo, Carlos Dur
an. Received: 23/06/2000 Accepted: 05/10/2000
Abstract: The conservation of the welfare of the mother-fetus during pregnancy,
is the primary goal of perinatal health team. Traditionally, the dentist has off
ered conservative treatment options for pregnant women. Currently, this has chan
ged, being able to administer, if necessary, drugs that allow the local anesthet
ic, attributing few side effects and maintaining special care during procedures.
However, most obstetricians and dentists prefer dental treatment is performed d
uring the second quarter, keeping to a minimum during the other periods of gesta
tion. Keywords: Anaesthesia, Dentistry, Pregnancy. Abstract: The conservation of
the welfare of the mothers-fetus unit, Period During the pregnancy, is the fund
amental Objectives of the equipment of the perinatal health. Traditionally, the
dentist has Offered the conservative options of the processing to Women pregnanc
y. At present, this is no longer Malthus; Been Able to Administer Being, of Bein
g NECESSARY, drugs That They permit the local anesthetic, attribute Being FEW co
llaterals and Maintaining specials effects cares During the procedures. However,
the Majority of the Preferred Dentist That Obstetricians and processing be the
dental practice During the second quarter, Being Maintained to the most minimum
one said Routines During the periods of gestation Other. Key words: Anesthesia,
Dentist, Pregnancy.
Introduction The preservation of the mother-fetus during pregnancy, is the prima
ry objective of the perinatal team. The oral cavity as an integral part of the h
uman being has sometimes morbidity may coincide with pregnancy, be a source of a
nxiety for women, the choice of being treated by the dentist as an assistant sin
ce treatment, using a local anesthetic. The review of international literature t
here are isolated reports based on literature reviews, on the use of local anest
hetics during pregnancy in February, as a result even the same dentist when to u
se them in a pregnant woman, has doubts about the safety of drug, both mother an
d fetus, as in some brochures is banned its use during pregnancy 3. Traditionall
y, dentists have offered conservative treatment options for pregnant women. Curr
ently, since this is not so, leaving only for elective treatment (cosmetic), whi
ch should be postponed until after delivery. Local Anesthetics Local anesthesia
is the loss of sensation without loss of consciousness or the central control of
vital functions. Local anesthetics act on any part of the nervous system and on
any nerve fiber. It has a reversible action, with full recovery of function wit
hout damage to the fibers 4. From the historical point of view, local anesthetic
s have been some of the most important drugs in medicine and dentistry. The abil
ity to produce anesthesia, ie the loss of sensation in specific body areas, revo
lutionized the two sciences above, since no general anesthesia required to perfo
rm all five procedures. Einhorn et al 6 allowed synthesize safer local anestheti
cs that do not create dependency. Local anesthetics contain three main component
s, namely: a central hydrophilic, hydrophobic centers separated by an intermedia
te alkyl chain. The center is usually a hydrophobic aromatic group, and the unio
n with this group determines some of their pharmacological properties. Intermedi
ate groups
more prevalent, and thus the two major classes of local anesthetics are esters a
nd amides. Thus, according to the type of chemical group local anesthetics are c
lassified 4,7,8:
â ¢ â ¢
Aminoésteres: cocaine, procaine, procaine, chloroprocaine and tetracaine. Amino
amidas: lidocaine, mepivacaine, prilocaine, bupivacaine, etidocaine and ropivaca
ine. Local anesthetics are differentiated by the latency period, the duration of
action, toxicity, potency and sensitivity of blockade. The desirable properties
of the ideal local anesthetic are: irritability, and lack of local toxicity, no
systemic toxicity, time of onset of brief anesthesia, and prolonged duration of
anesthesia 4,9. Local anesthetics inhibit the production of nerve impulses acti
ng on the cell membrane,€It works by blocking nerve conduction by reducing memb
rane permeability to sodium ions 9. The duration of action of local anesthetic d
epends on the time of actual contact with nervous tissue. Therefore, local anest
hetics are usually an add vasoconstrictor, usually epinephrine or norepinephrine
. However, controversy about the use of vasoconstrictors in local anesthetic for
mulations used in dentistry, for the known risk of adverse effects after systemi
c absorption 4. Vasoconstrictors decrease the rate of systemic absorption of the
anesthetic, so that increase the duration of anesthetic effect, lower the dose
of anesthetic required, reduces bleeding in the infiltrated area and decreases t
he overall risk of local anesthesia in May. Importantly, the presence of inflamm
ation decreases the effectiveness of local anesthetics, because the inflammation
causes the pH is more acidic, which decreases the amount of anesthetic in a lip
ophilic and diminish the ability of these drugs to cross the nerve membrane. Loc
al anesthetics are involved in the function of all organs in which there is cond
uction or transmission of nerve impulses. Adverse effects of local anesthetics d
epend on the balance between the rate of absorption and destruction, four reacti
ons are known and are toxic, not related to the drug, 5.10 and allergic idiosync
rasy. Thus, due to greater efficacy and lower incidence of complications of amin
es such as lidocaine, has limited the use of types esters. Pregnancy and local a
nesthesia. Most obstetricians and dentists prefer dental treatment is performed
during the second trimester of pregnancy, if possible. Keeping to the minimum th
ese procedures during the first and third trimesters of pregnancy 11, 12. Avoid
the practice of dental procedures in the first trimester of pregnancy, as is the
period of organogenesis, although dental treatment can not necessarily damage t
hese organs, should be to minimize the potential risks 9.1. Some studies analyze
d exposure to local anesthetics in pregnant women, and have not found an increas
ed incidence of congenital malformations 14, 15 Also during the third trimester,
and primarily the second half of this, procedures should be reduced dental, as
well as being very uncomfortable for the patient, placing her back in the dental
chair during this period of pregnancy, the uterus may increase pressure on the
inferior vena cava, producing hemodynamic changes to mother-fetus, which transla
te into hypotension (product of maternal position and not the effect of the drug
), and difficulty breathing. Therefore, if the treatment ultimately should be pr
acticed during this period should be allowed to reposition the patient every 3 t
o 7 minutes 9-13 As a general rule it is best not to use any drug during pregnan
cy, especially during the first quarter, if not essential, regardless of the dru
g's safety. Sometimes, however, should be administered in the course of treatmen
ts needed. Fortunately, most drugs used in dentistry are not contraindicated dur
ing pregnancy. For safety and the difficulty in obtaining information on the ter
atogenicity of drugs the Food and Drug Adm. (FDA) has established five categorie
s (A, B, C, D, X), which indicate the potential of a drug to cause fetal defects
. Thus, when the dentist is in the choice of prescribing or not a drug to a preg
nant patient, the drugs should be selected in categories A and B, and drugs in t
he remaining categories should be avoided 16, 17.
Local anesthetics injected into the mother can cross the placental barrier, but
the lidocaine appears to be safe in the pregnant patient, and that small doses o
f lidocaine used in dentistry, probably not affect the fetus regardless of trime
ster of pregnancy 1,9, 18, 19. There is literature that reports that local anest
hetics exhibit a faster onset and longer duration of pregnancy 20. Generally lid
ocaine is effective in 2-5 minutes and is effective for 1-2 hours depending on t
he dose, method of administration of each patient and other variables 1.9. The u
se of vasoconstrictors with local anesthetics during pregnancy is still controve
rsial. The gravid uterus is more sensitive to the vasoconstrictive properties of
epinephrine,€than other organs. However, this sensitivity decreases in late pr
egnancy 21. Adrenergic agents undertake uterine blood flow from 1921 to 1924, bu
t this seems to have no deleterious effects on the fetus 24, 25. Epinephrine is
routinely used in anesthesia in obstetrics without any complications. Therefore,
its use during the administration of local anesthesia for dental treatment woul
d not be contraindicated, but should avoid intravascular injections 18. Currentl
y there are numerous publications about the use of acupuncture anesthesia for de
ntal practice, as an alternative to conventional anesthesia. However, it should
be noted that pregnancy can be a contraindication for acupuncture, especially if
the Hoku point must be used, the insertion of a needle at this point can cause
palpitations and smooth muscle contractions, including the uterus, it could indu
ce the loss of pregnancy. But there are other points in this practice do not hav
e this effect, therefore, any point except for Hoku, be used for pregnant women
26-28.
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