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It is the position of the American Dental Association and the American College of Obstetrics and Gynecologists “that emergency treatments, such as extractions, root canals or restorations, can be safely performed during pregnancy and that delaying treatment may result in more complex problems.” 1 , 2 A study published in the Journal of the American Dental Association in 2015 reinforced the safety of dental treatment and local anesthetics for pregnant patients. 3 Another Journal of the American Dental Association article in 2016

toxicity from xenobiotics. This increased risk of fetotoxicity is largely attributed to the immaturity of the mechanisms and structure of the maternal-fetal circulatory exchange. 1 The barrier function provided by the placenta forms the core of the regulatory and filtration capabilities, affecting medications administered to or consumed by the parturient. Transport Across the Placental Barrier Placental exchange is a dynamic circulatory process throughout pregnancy. The determinants of drug transfer are influenced by the structural components

,” “pronunciation of the generic name,” “common brand names” (drugs available in Canada are designated by a maple leaf), “drug class,” “action,” “uses,” “doses and routes of administration,” “side effects/adverse reactions,” “contraindications,” “precautions and identification of pregnancy categories,” “pharmacokinetics,” “drug interactions of concern of dentistry,” and “specific dental considerations.” By being outlined in the above fashion, this book is amazingly complete. Specific emphasis is placed on drug interactions—especially those of interest to the dental

the health care provider. The issue under consideration, however, is the use of nitrous oxide sedation during a single appointment. Clearly, all elective dental treatment should be avoided during pregnancy, especially during the first trimester. However, urgent dental care frequently is required for patients who are pregnant. Under these circumstances, it is not unusual for the patient to be anxious and fearful, often extremely so. For these patients, apprehension should be allayed by using the safest agents available, and nitrous oxide fulfills this requirement. 19

of serotonin taken in concert with tapentadol can lead to dangerously high levels of serotonin to precipitate serotonin syndrome. Tapentadol has not been studied for safety and efficacy in pregnancy, labor and delivery, nursing mothers, and in patients under 18 years of age. Tapentadol is not recommended for use in any of these patient populations. Tapentadol is a Pregnancy Category C drug and should only be used if the benefit outweighs the risk to the mother and fetus. If used during labor and delivery, the neonate may be at risk for respiratory

therapy, hemorrhagic disorders, intolerance or allergy to any NSAID, or pregnancy. In the developing fetus, prostaglandins maintain patency of the ductus arteriosus during fetal development, so they should not be inhibited. Although this concern is most relevant during the third trimester, NSAIDs should generally be avoided throughout pregnancy. In all cases in which NSAIDs are contraindicated, acetaminophen is the conventional nonopioid alternative. Efficacy, Selection, and Dosages All NSAIDs have greater potency as analgesics and

checking any piece of equipment prior to its use in the dental office, these documentation rules designed for general anesthesia machine users are not necessary for this type of equipment once its use has been tested at installation and periodic maintenance as recommended has been performed. Interestingly, some items found in the JC standards have been omitted from the proposed Guidelines such as a required pregnancy test prior to any sedative/GA procedure. Some screening to ensure that women of child-bearing age are not likely to be pregnant, whether verbal or

per os recommendations). The presence of at least 1 aspiration risk factor was identified in 93% of the claims. Of the patients identified within the claims, 61% had either gastrointestinal obstruction or another intra-abdominal process. Management of the aspiration event was judged to be substandard in 59% of the 115 claims. Comment: The findings from this study failed to confirm the application of cricoid pressure and rapid sequence induction as strategies for preventing aspiration. The authors note that although pregnancy and delivery have historically been

metoclopramide should be considered to reduce gastric acidity and volume. NPO and patient positioning considerations are identical to those described earlier for patients with GERD. PREGNANCY AND BREASTFEEDING Clearly, all elective dental treatment should be avoided during pregnancy, especially during the first trimester. However, urgent dental care is required frequently for patients who are pregnant. Under these circumstances, it is not unusual for the patient to be anxious and fearful, often extremely so. For these patients, apprehension should

to be in good health as determined by the investigator on the basis of medical history and physical examination and had to have moderate or severe pain within 6 hours after completion of surgery, as measured by a categorical pain intensity scale (moderate or severe descriptor) and pain intensity of ≥50 mm on a 100 mm visual analog scale (VAS) at baseline. Female subjects of childbearing potential were required to have a negative pregnancy test and had to be practicing abstinence or a medically acceptable form of contraception plus using a spermicidal agent