Anesthesia in the third trimester. Is it possible to treat teeth during pregnancy with an anesthetic injection in dentistry. Potential risks in dentistry

04.05.2019

Not every pregnancy is perfect. Quite often, in nine months, expectant mothers are faced with emergency situations when anesthesia is needed. Pain relief may be required both during and during surgical interventions that must be performed immediately.

But can anesthesia negatively affect the fetus? For how long are painkillers most dangerous? What drugs are allowed and what are prohibited for use during pregnancy? This is what will be discussed in our article.

When can you need pain relief during pregnancy?

As a rule, during pregnancy, doctors try not to carry out any medical manipulations with the use of any medications, including anesthetics. Therefore, if the operation can be postponed indefinitely, then it is used wait and see tactics- until the baby is born. The exceptions are:

The frequency of using painkillers in pregnant women is on average about 1-2%.

What is the danger of anesthetics for the fetus and the expectant mother?

Anesthesia, like any other medications, can negatively affect the development of pregnancy at any of its stages. This is due to several main factors:

possible teratogenicity (drugs can cause dysfunctions of the fetus and severe deformities);
possible fetal asphyxiation and its death as a result of hypoxia in the mother when using an anesthetic
high probability enhancement that can lead to spontaneous miscarriage or premature birth

The most dangerous is the use of anesthesia between 2 and 8 weeks of pregnancy, when all the organs and systems of the baby are formed and laid. Another dangerous period- the third trimester of pregnancy: at this time, the physiological load on the mother's body is maximum, and the likelihood of developing premature generic activity... Therefore, doctors try, if possible, to carry out surgical interventions in the second trimester - between 14 and 28 weeks, when all organs and systems of the fetus are formed, and the uterus reacts minimally to external influences.

In general, according to statistics, surgical interventions with the use of anesthesia at any stage of pregnancy are not associated with huge risks:

maternal mortality during anesthesia does not exceed the same indicator in non-pregnant women;
developmental frequency congenital anomalies with a single anesthesia, it is comparable to the development of pathologies in pregnant women who have not been exposed to such effects;
the probability of fetal death is on average 6% - when performing operations in the second and third trimesters, 11% - when performing interventions for up to 8 weeks;
the risk of premature birth due to anesthesia is no more than 8%.

Specialists who perform surgery choose the optimal pain management tactics, depending on the complexity of the operation and individual factors. Pregnancy preservation is their main task.

What types of pain relief and drugs are used for anesthesia in pregnant women?

Recent research shows that most pain relievers are safe for both mother and fetus. Also, experts believe that huge role in the subsequent development of deviations, it is not the anesthetic itself, but the technique of anesthesia - it is very important to prevent a sharp decrease blood pressure in a pregnant woman and the level of oxygen in the blood.

For anesthesia in pregnant women are used different drugs... So, in minimal doses, they do not harm the mother and fetus Morphine, Glycopyrolate, Promedol. In small doses, in combination with other drugs for intravenous anesthesia, Ketamine is also used, which increases with prolonged use. For local anesthesia, Lidocaine is used, which crosses the placenta, but is quickly excreted from the baby's body.

In extremely rare cases, nitrous oxide and diazepam are used for pain relief, which can adversely affect the fetus, especially in the first trimester of pregnancy. In addition, some experts argue that local anesthetics containing adrenaline (for example, ultracaine used in dentistry) should also not be used in pregnant women - there is a possibility of sharp vasoconstriction and impaired blood flow to the placenta.

Regional (epidural) and local anesthesia during pregnancy- the most safe methods pain relief. If their use is impossible (in the presence of contraindications or in difficult surgical cases), then they resort to multicomponent anesthesia using artificial ventilation lungs. After the surgical interventions tocolytic therapy is carried out in order to reduce the excitability of the uterus and prevent spontaneous miscarriages or premature birth.

Thus, surgical interventions during pregnancy using anesthesia can harm the unborn baby, especially in the first trimester of pregnancy. Therefore, in order to avoid problems, it is necessary even before planning to eliminate all chronic sources of infection (for example, to cure so that dental anesthesia during pregnancy) and be fully examined.

If, while carrying a baby, intervention is still required, but it is possible to postpone it until a later date (there is no acute pain and an obvious threat to the mother's health), it is best to perform the operation in the second trimester of pregnancy.

And most importantly, expectant mothers should remember that in many ways our health depends on ourselves. Therefore, in this wonderful period you need to be especially careful.

About 5% of women require emergency dental treatment under anesthesia during pregnancy. The safest period for such manipulations is 14-28 weeks of the period, when all the organs of the child have already been formed. When conducting anesthesia, not only the choice of a safe drug is important, but also the method of its administration.

Can anesthesia be done during pregnancy?

You can't stand the pain. This is stressful for both the expectant mother and the baby. Anesthesia is simply indispensable when carrying out such procedures:

dental treatment, including endodontic treatment - the dental nerve reacts to the slightest mechanical impact causing sharp pain;
extraction of teeth - when removing a tooth from the alveoli, they are damaged nerve endings, and, of course, unbearable pain arises. And if you do not use an anesthetic, painful shock may occur;
prosthetics - the installation of a prosthesis requires the preparation (grinding) of the enamel, this is a rather unpleasant and painful procedure.

However, any kind of anesthesia is potentially dangerous while carrying a baby. Application of various medications, including anesthetics, can negatively affect the development of the fetus.

Therefore, at the dentist's appointment, the patient is obliged to warn the doctor about her pregnancy, and also to name exact date... Then the doctor will be able to pick up special anesthetics, active substances which cannot be overcome placental barrier and do not harm the baby.

Features of anesthesia in dentistry for pregnant women

Safe local anesthetic drugs

Local (local) anesthesia is the most safe view pain relief. It is he who is used for women during pregnancy. As a rule, Lidocaine solution is used for injection. This drug, in small doses, can enter the placenta for early dates pregnancy, but it is quickly excreted from the child's body and is not harmful.

Also during pregnancy, Novocaine can be used, but the dosage is usually reduced.

Anesthetics Ultracaine and Primacaine, which contain adrenaline, are very popular in dentistry. However, they cannot be used during the period of bearing a child. Accidental release of adrenaline into the bloodstream can cause severe vasoconstriction and disrupt blood flow to the placenta.

The dosage of the drug depends on the patient's weight, her pain threshold and the complexity of the planned procedure. As a rule, women are injected with 1 ampoule or half, and with overweight- 2 ampoules. The duration of the anesthetic is from 40 minutes to 2 hours.

The main contraindications for local anesthesia are:

The third trimester is also a dangerous period for dental procedures. It is especially not recommended to carry out any operations at the 9th month, since there is a high risk of increased uterine tone and premature birth.

Is anesthesia harmful during pregnancy? Doctors say yes. This type of pain relief can lead to a sharp decrease in blood pressure in a pregnant woman, while blood oxygen saturation worsens.

Dangerous consequences of general anesthesia:

Operations under anesthesia are performed in extreme cases when there is a threat to the mother's life. Superficial sedation (inhalation of nitrous oxide) is also contraindicated. Therefore, only local anesthesia is used for dental treatment.

If a woman is afraid of injections, then you can first anesthetize the mucous membrane with an anesthetic gel, and only then do an injection into the gum.

Private dental clinics have big choice anesthetic drugs indicated during pregnancy. If you are looking for reliable dentistry, we suggest using the convenient search engine of our website.

The safety of use in the treatment of pregnant women remains currently an unresolved issue. The range of doctors' opinions is as wide as possible: from “it can be used for any period of time, it is absolutely harmless” to “it is absolutely impossible for any week, the risk of complications for the mother and child does not justify the benefits of dental treatment”. The reason for this amplitude of judgments is almost complete absence evidence base of toxicity / harmlessness of local anesthetic during pregnancy. Pharmaceutical companies are in no hurry to test their drugs for pregnant women. Scientific research there is too little on this topic. Therefore, significant filtering of information is required. It is not possible to rely on expert opinion, since there are no experts on this problem in the world. Not only in Russia, but also in countries with developed medicine, the issue of using anesthesia (and even the possibility of dental treatment in general) during pregnancy is decided by each doctor independently. Strict standards there is no assistance for pregnant women.

Fears of doctors and patients

A survey of 702 private dentists in Germany showed that only 61% of them treat pregnant patients, 35.5% postpone treatment for postpartum period, 3.5% are referred to other clinics. Only 10% of dentists perform all the necessary types of treatment, 14% refuse local anesthesia. Almost half of dentists indicated that they would not be treated in the first trimester, and 8.5% in the second. 1

In a survey of 116 dentists in Connecticut, USA, 97% of dentists said they treated pregnant women, but only 45% felt comfortable doing so. 2

Seeking advice from a gynecologist does not clarify the situation much. A survey of 138 obstetricians in North Carolina, USA, found that 49% rarely or never recommend dental examinations to their patients. 3

Women themselves have a poor understanding of the risks of refusing treatment during pregnancy. In a 2012 survey, 2/3 of Australian women said they did not seek dental care during pregnancy, even if they had problems. 4

Is dental treatment really necessary during pregnancy?

Changes in oral cavity and in food consumption during pregnancy may increase the incidence. 5 Lack of treatment leads to and. Periodontitis can cause periostitis and more serious complications.

Hormonal changes in pregnant women increase the incidence of and. 6 Untreated periodontitis, according to some studies, increases the risk of low weight child at birth, 7 premature births, miscarriage and preeclampsia. eight

Timely elimination of periodontal problems improves the health of not only the mother, but also the newborn. 9 Therefore, proper monitoring of oral health during pregnancy and treatment, if necessary, is recommended. ten

Major misconceptions about local anesthesia

There is a special anesthesia for pregnant women

No, expectant mothers are given the same anesthesia as everyone else. The same articaine, mepivacaine, lidocaine and novocaine.

Anesthesia during pregnancy can lead to a lower IQ in the baby and other cognitive abnormalities.

This fact was really mentioned in the medical literature, only it has nothing to do with local anesthesia used in dentistry. A decrease in IQ was observed in children whose mothers received general anesthesia. eleven

Previously used anesthetics were dangerous, while modern ones do not penetrate (or hardly penetrate) through the placental barrier, and therefore are completely harmless. This is most often said about articaine (ultracaine).

In fact, articaine also penetrates, like all other anesthetics. But the percentage of it in the blood of the fetus is really lower - 32% of the content in the mother's bloodstream. Lidocaine has a similar indicator - 52-58%, mepivacaine - 64%. 12 Adrenaline also crosses the placenta and affects the fetus. 13

Anesthesia for pregnant women can be done, but only without adrenaline.

For this reason, many dentists use mepivacaine, an anesthetic that does not have a vasodilator effect, and therefore is used without a vasoconstrictor. However, its analgesic effect lasts on average only 25-40 minutes. 14 This is not enough for most dental procedures. Mepivacaine penetrates the placenta to a greater extent, and even more rapidly (compared to lidocaine and adrenaline). And has a category C according to the FDA classification. This is not the most the best choice for most women. It is indicated for patients with arterial hypertension, paroxysmal ventricular tachycardia, atrial fibrillation, bronchial asthma and allergy to sulfites (added to the carpula to stabilize adrenaline).

Adrenaline itself also has a category C. But the experimental animals were injected with astronomical doses of this drug, at which serious teratogenic effects were revealed. For example, in 1981, adrenaline at a dosage of 500 mg per kilogram of body weight caused a decrease in reproductive capacity in hamsters. 15 Such a horse dose (in terms of weight) is not used in humans even for anaphylactic shock or cardiac arrest. The dental carpool contains 0.009 mg or 0.018 mg of adrenaline, more than 7-8 carpool cannot be done at one time, and the weight of even the most graceful lady is many times greater than the weight of a hamster.

It has been theoretically suggested that a vasoconstrictor can cause fetal hypoxia by reducing uteroplacental blood flow. In an experiment on sheep, a decrease in fetal blood flow was noted for several minutes. 16 But not a single proof of the negative effect of this on the human fetus has been received to date.

In addition, it should be recalled that adrenaline is the body's own hormone; it is present in the bloodstream, regardless of whether it was exogenous or not. And the endogenous hormone is vigorously released just in case of pain, fear, panic. That is, when weak adrenaline-free anesthesia does not provide enough pain relief.

Adrenaline increases the tone of the uterus and can lead to miscarriage or premature birth.

This is such a common misconception that it should be explained in detail. Epinephrine activates both the alpha receptors of the uterus (increasing tone) and beta receptors (decreasing tone). So its effect on β 2 -adrenergic receptors is prevalent. Adrenaline reduces the tone of the uterus. 17 Moreover, with epidural anesthesia during labor itself, adrenaline is contraindicated because it induces atony and inhibits the second stage. Miscarriages during dental treatment under local anesthesia have not yet occurred anywhere in the world (or at least there is not a single mention of this in the professional literature).

Previously included in anesthetic solution not only adrenaline was added, but also norepinephrine. Now it has been completely abandoned. So norepinephrine just more activated α-adrenergic receptors and increased the tone of the uterus. Perhaps this is where this delusion was born.

Local anesthesia during pregnancy is completely harmless (if done correctly).

For a long time, indeed, no convincing evidence of a special teratogenic or toxic effect on the child and mother was found. Studies on this issue were sporadic and with a small sample. But in 2015, the results of an observation carried out in 1999-2005 in Israel on 210 pregnant women, whose dental treatment was using local anesthesia, were published. They were compared with 794 pregnant women who did not undergo this procedure. The frequency of anomalies in children of the first group was 4.8%, the second - 3.3%. The authors considered the difference to be insignificant and concluded that the use of dental local anesthetics, as well as dental treatment during pregnancy, did not pose a significant teratogenic risk. 18 Subsequent authors in articles devoted to this problem began to use this conclusion as further evidence of the safety of local anesthesia.

However, among other experts, this conclusion has caused objections. 19 The 1.5% difference did not seem insignificant to everyone. After all, if the percentage of anomalies crossed the 5% barrier, and according to a statistical analysis, the conclusion would have to be changed to the exact opposite - local anesthesia significantly increases teratogenic risks.

In my opinion, 1.5% is still a significant increase in risk. But each future mom she has the right to decide this herself, the dentist should not impose her own opinion on her.

How to choose the optimal anesthetic?

1. To begin with, it is worth deciding: is it really necessary to have anesthesia. Many dental procedures are painless or not painful. Professional cleaning of teeth, treatment and prosthetics of depulped teeth, in some cases, treatment of caries or living teeth are unpleasant, but often it is quite possible to endure them without experiencing unbearable suffering. Therefore, it is recommended that you try this safest approach. If there is serious pain, you do not need to torture yourself - it is wiser to agree to local anesthesia.

Cosmetic procedures (teeth whitening, veneering) are completely inappropriate during pregnancy - they can and should be postponed.

2. From the entire spectrum of anesthetics, in the absence of contraindications, it is preferable to choose 4% articaine with adrenaline 1: 200,000. Articaine, although it has category C according to the FDA classification, is safer than other anesthetics. Its teratogenic effect was found when laboratory rabbits and rats were injected with loading doses of 4% articaine in combination with adrenaline 1: 100,000 (2-4 times higher than the maximum permissible concentration for humans). When using drugs at the level of maximum permissible concentration for humans in experimental animals, no teratogenic effect was found. 20 Moreover, the concentration of 1: 200,000 is twice as low, and no one will use 7 carpool at one time (maximum allowable volume) in pregnant women.

3. If such anesthesia proved to be ineffective, then it is better to use the second cartridge with a ratio of 1: 100,000 articaine and adrenaline. The chances of achieving deep pain relief are greatly increased.

4. If adrenaline is completely contraindicated or significantly increases the risk of complications ( arterial hypertension, paroxysmal ventricular tachycardia, atrial fibrillation, bronchial asthma, hyperthyroidism, pheochromocytoma, etc.), then you need to use 3% mepivacaine without adrenaline.

5. It is permissible to use lidocaine for pregnant women with an adrenaline concentration of 1: 200,000 or 1: 100,000. Lidocaine has a category B. However, the effectiveness of its anesthesia is 1.5 times less than that of articaine. 21 A risk allergic reactions- higher (up to anaphylactic shock).

conclusions

Pregnant women can be anesthetized. And it is necessary (if required).
There is no specific anesthetic for pregnant women.
Some stories about the harm of anesthesia relate to general anesthesia, and not to the local one (and there is still a lot of uncertainty).
Modern anesthetics are better than the old ones, but not completely harmless.
Anesthesia with adrenaline can be done, and in most cases it is even desirable.
Adrenaline lowers the tone of the uterus; miscarriages from local anesthesia have not been reported.
Local anesthesia is not completely safe in dentistry. You need to balance between expected benefits and possible risks.
Of the drugs, 4% articaine with an adrenaline concentration of 1: 200,000 is preferable.
You can also use articaine with an adrenaline concentration of 1: 100,000, mepivacaine without adrenaline, lidocaine with adrenaline.

Literature

Pistorius J, Kraft J, Willershausen B. Dental treatment concepts for pregnant patients - results of a survey. Eur J Med Res. 2003 Jun 30; 8 (6): 241-6.
Pina PM, Douglass J. Practices and opinions of Connecticut general dentists regarding dental treatment during pregnancy. Gen Dent. 2011 Jan-Feb; 59 (1): e25-31.
Wilder R, Robinson C, Jared HL, Lieff S, Boggess K. Obstetricians "knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight. J Dent Hyg. 2007 Fall; 81 (4): 81.
George A, Shamim S, Johnson M, Dahlen H, Ajwani S, Bhole S, Yeo AE. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth. 2012 Sep; 39 (3): 238-47
Kidd E, Fejerskov O. Essentials of dental caries. 3rd ed. Oxford: Oxford University Press; 2005. pp. 88-108.
Amini H, Casimassimo PS. Prenatal dental care: A review. Gen Dent. 2010; 58: 176-18
Vergnes JN, Sixou M. Preterm low birth weight and maternal periodontal status: A meta-analysis. Am J Obstet Gynecol. 2007; 196: 135.e1-135.e7.
Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006 Feb; 113 (2): 135-43.
López NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 2005; 76 (11 Suppl): 2144-53.
Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. J Dent Anesth Pain Med. 2017 Jun; 17 (2): 81-90. Translation of this article into Russian:.
Yu CK, Yuen VM, Wong GT, Irwin MG. The effects of anesthesia on the developing brain: a summary of the clinical evidence. F1000Res. 2013 Aug 2; 2: 166.
Strasser K, Huch A, Huch R, Uihein M. Placental transfer of carticaine (Ultracain) a new local anesthetic agent. Z Geburtshilfe Perinatol. 1977 Apr; 181 (2): 118-20.
Morgan CD, Sandler M, Panigel M. Placental transfer of catecholamines in vitro and in vivo. Am J Obstet Gynecol 1972; 112: 1068-75.
Haas A. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002 Oct; 68 (9): 546-51.
Hirsch KS, Fritz HI. Teratogenic effects of mescaline, epinephrine, and norepinephrine in the hamster. Teratology. 1981 Jun; 23 (3): 287-91.
Hood DD, Dewan DM, James FM., 3rd Maternal and fetal effects of epinephrine in gravid ewes. Anesthesiology. 1986; 64: 610-613.
Mike Samuels, Nancy Samuels. New Well Pregnancy Book: Completely Revised and Updated. 1996
Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. J Am Dent Assoc. 2015 Aug; 146 (8): 572-580.
Best AM. More on local anesthetics in pregnancy. J Am Dent Assoc. 2015 Dec; 146 (12): 868-9.
Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis, Mosby; 1997.

From this article you will learn:

is it possible for pregnant women to do anesthesia during the treatment and extraction of teeth,
what painkillers can pregnant women drink,
what antibiotics can pregnant women take.

Medicines and pregnancy -

The use of drugs by pregnant women has two main problems:

During pregnancy, a woman's body undergoes changes that affect the metabolism of drugs, i.e. on their absorption, distribution in the body, on the rate of excretion of drugs by the kidneys. This leads to the fact that doctors sometimes have to prescribe higher concentrations of drugs than they would like.

But on the other hand, there is a risk for the child not only from taking the drug by the mother. The fetus may have bad influence diseases of the mother, for the treatment of which the drugs are directed. Therefore, the doctor always needs to correlate these risks when deciding on the prescription of the drug. In addition, each drug has its own threshold concentration, exceeding which can lead to the development of disorders in the fetus, but at concentrations below the threshold, violations do not occur.

Moreover, on different timeframes pregnancy there are certain differences in the penetration of drugs through the placenta –

in early pregnancy, the placenta is relatively thick, which reduces its permeability.
on later dates During pregnancy, the thickness of the placenta decreases and thus the permeability to drugs increases.

Significant developmental disorders of the fetus, as a rule, are the result of exposure to drugs in critical periods organogenesis of the fetus (this is the 1st trimester of pregnancy). Exposure to the same drugs in the 2nd and 3rd trimesters usually leads to organ dysfunctions, and not their bookmarks, as it happens in the 1st trimester.

Today, about 30 drugs with proven teratogenic activity in humans are known, and most of them are no longer used today. Previously, it was believed that many of the common drugs, such as aspirin, glucocorticoids, diazepam, have teratogenic effects, but extensive research has proven the safety of these drugs.

A teratogenic effect is usually understood as a violation embryonic development child (the occurrence of anomalies and malformations) - as a result of exposure to teratogenic factors. except chemical factors(some drugs) teratogenic factors also include some physical and biological factors(for example viruses).

The importance of a doctor's prescription –
if the doctor sees the need for an appointment medicinal product, then the pregnant patient needs to receive an appointment in the form of a properly executed prescription, certified by the seal and signature of the doctor. The recipe is official document... I think that you should not take drugs, the appointment of which the doctor refuses to certify with his seal and signature on the prescription.

1. Anesthesia in dentistry for pregnant women -

So, what kind of anesthesia can pregnant women ...
Pain relief during pregnancy in dentistry is carried out preferably with local anesthetics such as Ubistezine with an adrenaline (epinephrine) concentration of 1: 200.000

Epinephrine reduces the toxicity of anesthetics by slowing the absorption of the anesthetic into the bloodstream - thereby reducing its peak blood concentration. In addition, the addition of epinephrine reduces the total amount of anesthetic required for pain relief.

However, adrenaline can also have negative properties, because in high concentrations, it can reduce uterine blood flow. Numerous studies on this have shown that the use of a dose of epinephrine (epinephrine) at a concentration of 1: 200,000 is safe for a healthy pregnant woman. Provided, of course, if the woman's pregnancy is not complicated high blood pressure and chronic hypoxia fetus.

2. Pain relievers for pregnant women -

Pain-relieving tablets for pregnant women, see table 1. But let's say right away that the most safe drugs are Paracetamol and Ibuprofen. It should only be noted here that Ibuprofen is contraindicated for pregnant women in the 3rd trimester (in the 1st and 2nd trimesters, it is approved for use).

Taking medications, dosages, duration of administration - must be agreed with the attending physician. Due to the fact that there may be certain conditions and chronic diseases in the mother's body, which can make these drugs less safe than they are, for example, for a healthy pregnant woman.

3. Antibiotics for pregnant women -

So, is it possible for pregnant women to drink an antibiotic, and what antibiotics can pregnant women take ...
Betta-lactam antibiotics, for example, the penicillin group, are the drugs of choice in the treatment of pregnant women. In table 1 you will see a list of the safest antibiotics (safety category "B").

Antibiotics are prohibited following groups: tetracyclines and fluoroquinolones. With caution (undesirable, but in some cases necessary) - sulfonamides and some representatives of aminoglycosides. It is best to discuss this with your obstetrician-gynecologist before starting antibiotics.

Medicines and breastfeeding -

When deciding on the appointment of a drug to a nursing woman, the doctor takes into account -

drug toxicity indicator,
the dose and duration of the drug intake,
the age of the breastfed baby
the volume of milk consumed,
the effect of the drug on lactation.

Ways to reduce the ingestion of medication with milk to a child –

temporary cessation of feeding,
refusal to feed the child during peak concentrations of the drug in the blood plasma (in this case, a consultation with a doctor is necessary here, because without him you will not figure out what's what),
taking the drug during the longest sleep of the child.

What antibiotics can be used by pregnant and lactating women, as well as pain pills and injections for dental treatment, are listed in Table 1.

Table 1. Medicines of choice in dentistry during pregnancy and lactation.

Medicine:	Pregnancy risk category *	Lactation risk category *
Local anesthetics(injections for dental treatment) -
Lidocaine Mepivacaine	B(Maybe) C(undesirable)	Safe Safe
Analgesics –
Paracetamol Ibuprofen	B(Maybe) in 1m, 2m trimesters - B(Maybe) in the 3rd trimester - D(absolutely impossible)	Safe Safe
Antibiotics –
Penicillins Cephalosporins Clindamycin Metronizazole	B(Maybe) B(Maybe) B(Maybe) B(Maybe)	Safe Safe Safe Safe
* - in accordance with the classification of the Office for the Control of food and medicines (FDA, USA). Description of risk categories "B", "C", "D" is given below

Drug safety categories -

Currently, the safety of drugs for the fetus is classified in accordance with the recommendations of the FDA specialists. This classification was developed in the United States and is usually followed by doctors in all countries. You can see the drugs of choice for emergency dental interventions in pregnant and lactating women in Table 1.

FAQ

First of all, one that does not hurt the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or variety of the toothbrush. As for electric brushes, they are the preferred option for uninformed people; although you can brush your teeth with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between teeth.

Rinse aids are optional hygiene products that effectively cleanse the entire oral cavity of harmful bacteria. All these funds can be roughly divided into two large groups- therapeutic and prophylactic and hygienic.

The latter include mouthwash, which eliminates unpleasant odors and promotes fresh breath.

With regard to therapeutic and prophylactic, these include rinses that have an anti-plaque / anti-inflammatory / anti-carious effect and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence in the composition different kinds biologically active ingredients... Therefore, a rinse aid must be selected for each a specific person individually, as well as toothpaste... And due to the fact that the product is not washed off with water, it only strengthens the effect of the active components of the paste.

Such cleaning is completely safe for dental tissues and less traumatic. soft tissue oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are processed with an ultrasound scaler (this is the name of a device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from the water droplets, which enter the treatment zone and cool the tool tip). The cell membranes of pathogenic microorganisms are ruptured by these molecules, which causes the microbes to die.

It turns out that cleaning with ultrasound has a complex effect (provided that it is actually used quality equipment) both on the stone and on the microflora as a whole, cleansing it. Oh mechanical cleaning you can't say that. Moreover, ultrasonic cleaning more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your position. Moreover, a pregnant woman is recommended to visit a dentist every one to two months, because, as you know, when carrying a baby, teeth are significantly weakened, suffer from a deficiency of phosphorus and calcium, and therefore the risk of caries or even tooth loss increases significantly. For the treatment of pregnant women, it is necessary to use harmless anesthetics. The most suitable course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required preparations that strengthen the tooth enamel.

It is quite difficult to treat wisdom teeth due to their anatomical structure... Nevertheless, qualified specialists they are successfully treated. Prosthetics of wisdom teeth is recommended in the case when one (or several) adjacent teeth is missing or it needs to be removed (if you also remove a wisdom tooth, then there is simply nothing to chew with). In addition, the removal of a wisdom tooth is undesirable if it is in the right place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor-quality treatment can lead to the most serious complications.

Here, of course, a lot depends on the taste of the person. So, there are completely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal braces with colored metal / elastic ligatures. It's really trendy!

To begin with, this is simply unattractive. If this is not enough for you, we will give the following argument - calculus and plaque on the teeth often provoke bad breath. Isn't that enough for you? In this case, we move on: if the tartar "grows", this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets are formed, pus constantly flows out of them, and the teeth themselves become mobile ). And this is already a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria increases, which is why there is an increased tooth decay.

The lifespan of an established implant will be tens of years. According to statistics, at least 90 percent of implants are performing well 10 years after insertion, while the average lifespan is 40 years. What is typical given time will depend both on the design of the product and on how carefully the patient cares for it. That is why during cleaning in mandatory it is necessary to use an irrigator. In addition, you must visit the dentist at least once a year. All these measures will significantly reduce the risk of losing the implant.

Removal of a cyst of a tooth can be performed by a therapeutic or surgical method. In the second case, we are talking about tooth extraction with further cleaning of the gums. In addition, there are those modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complex operation, which consists in removing the cyst and the affected root apex. Another method is hemisection, in which the root and the tooth fragment above it are removed, after which it (part) is restored with a crown.

As for the therapeutic treatment, it consists in cleansing the cyst through the root canal. This is also a difficult option, especially not always effective. Which method should you choose? This will be decided by the doctor together with the patient.

In the first case, professional systems are used to change the color of teeth, based on carbamide peroxide or hydrogen peroxide. Obviously, it is better to give preference to professional whitening.