Anesthesia for dental treatment in pregnant women

There is no doubt: the treatment of pregnant women requires special attention and careful selection of medications. This is true for surgery and (doubly!) for anesthesiology. There are no absolutely safe anesthetic drugs; they all have their own toxicity threshold, which they reach in certain doses. And in each specific case, the anesthesiologist needs to correctly calculate the dose in order to put the patient to sleep, make him insensitive to pain, completely relax all the muscles and even stop his breathing. But all this is only for the duration of the operation itself, after which the person must “wake up”.

Any surgical intervention and associated anesthesia carries a certain risk for any patient. What can we say about a woman carrying a child under her heart! Pregnancy significantly changes the functioning of almost all major organs and systems of a woman. She begins to breathe differently, her liver, kidneys and heart work harder, the composition of her blood changes, her immune system is partially suppressed, her digestive organs are forced to work in a “squeezed” state, etc. And all this changes as the pregnancy itself progresses. When choosing anesthesia, the doctor takes into account the permeability of the placenta for anesthetic drugs, the baby’s ability to “digest” anesthetic “cocktails” and their effect on the formation of a small organism. All this puts a pregnant woman in a special risk group.

Most often, a pregnant woman ends up on the surgical table due to injuries, acute surgical diseases of the abdominal organs (such as appendicitis), exacerbation of chronic surgical diseases and dental problems.

So, in the first and second trimesters, anesthetic drugs are more dangerous for the baby than for the mother, especially between the 2nd and 8th weeks of pregnancy. At this time, the formation of the baby’s main organs occurs, and most anesthetics (painkillers) pass through the placenta, inhibiting the growth and development of cells, thereby increasing the risk of deformities (terratogenic effect). In addition to this, due to the operation itself and the action of anesthetic drugs, placental and uterine blood flow is disrupted, and the child’s nutrition deteriorates.

Surgery is also important for the mother. Due to the release of adrenaline and other stress factors, the risk of miscarriage increases. The mother is more likely to vomit during surgery and have the vomit enter the lungs (aspiration) and develop severe pneumonia. Because of all these dangers, in the first and second trimesters, pregnant women are operated on under general anesthesia only for health reasons, that is, in cases where refusal to operate directly threatens the life of the mother. Minor surgeries can be performed under local anesthesia, where an anesthetic is injected directly into the site of the planned surgery (for example, emergency dental procedures). But even so, some of the anesthetic can reach the baby, and maternal pain can increase the tone of the uterus, worsen uteroplacental blood flow and increase the risk of miscarriage.

If necessary and if possible, doctors try to reschedule the operation to a later date - 14-28 weeks (second trimester), since at this time the child’s organs are formed, and the excitability of the uterus to external influences is minimal.

In the third trimester, the risk of miscarriage and life-threatening complications increases even more; the abdominal organs are displaced and “squeezed” by the uterus, which also puts pressure on the main blood vessels in the abdomen, disrupting blood flow. Increased pressure in the abdominal cavity is transferred to the chest cavity, reducing the volume of respiratory movements, and the need for oxygen, on the contrary, increases: the mother also breathes for the child. Therefore, if major surgical interventions are necessary, doctors try to wait until the child’s lungs mature. First, a caesarean section is performed in the usual manner, and then the necessary operation is performed.

Dental treatment during pregnancy: anesthesia

Can pregnant women have their teeth treated?
What dental procedures can be done by pregnant women?

Anesthesia during pregnancy

Dental treatment and lactation

The birth of a baby is an important event in the life of every woman. In order for everything to go well and the child to be born healthy, it is necessary to prepare for this in advance, including sanitizing the mouth. However, there are situations when a woman finds out about her interesting situation when her teeth and gums are in unsatisfactory condition. What to do?

Pain relief for expectant mothers - the best choice

Epidural anesthesia is considered the safest method of pain relief for mother and baby during pregnancy .
To carry it out, a needle is inserted through holes in the spinal canal directly above the dura mater of the spinal cord, into the epidural space - just where the nerve roots pass that carry pain impulses from the uterus. To make the procedure painless, the skin at the site of the intended injection is numbed before the injection. Then a special needle is inserted into which a thin silicone tube (catheter) is inserted; the needle is removed, and the catheter remains in the epidural space - a strong local anesthetic is injected into it. As needed, a medicinal substance can be added through the catheter, prolonging the analgesic effect to 24-36 hours.

During epidural anesthesia, the patient should be in the most bent position: lying on her stomach, bent over, or sitting, bending over.

After administration of the drug, pain relief develops within 10-20 minutes.

When the catheter is inserted, it may touch a nerve, causing a brief shooting sensation in the leg. Another thing that can accompany anesthesia is sometimes a feeling of numbness, weakness and heaviness in the legs.

The following complications may occur after this type of anesthesia:

Headache appears on days 1-3 after anesthesia in approximately 1% of cases. If a headache occurs, anesthesiologists prescribe bed rest, fluids and painkillers.
Skin itching may occur at the injection site, which can be treated by taking antihistamines under medical supervision.
Due to the prolonged position on the back and the effect of the anesthetic on the intercostal muscles, the woman may have difficulty breathing. In this case, oxygen is prescribed through a special mask.
When an anesthetic is injected into the veins of the epidural space, dizziness, palpitations, a metallic taste in the mouth, and numbness of the tongue may occur. In order to prevent these unpleasant sensations, a test dose is first administered to the woman before the entire volume of the anesthetic is administered.
Sometimes the effect of the anesthetic may affect only one half of the body. This can be easily corrected by tightening the catheter slightly.

Contraindications for epidural anesthesia are:

sepsis;
skin infection at the site of the intended injection;
blood clotting disorder (before epidural anesthesia, a blood clotting test is performed);
bleeding;
neurological diseases;
patient's refusal of pain relief.

For minor operations performed in the third trimester, other types of local anesthesia . They are less dangerous at this time than at the beginning of pregnancy because the risk to the baby decreases as it develops.

When can pregnant women have their teeth treated?

Pregnancy can be roughly divided into three periods (trimesters). Dental treatment can be carried out in the second trimester - it is considered the safest for procedures.

During the first and third trimester, it is better to conduct preventive examinations and treatment planning. It is better to postpone basic dental treatment during pregnancy and a complex of professional hygiene until the second trimester, and if possible, wait until childbirth.

Unfortunately, it is not always possible to follow these recommendations. There are times when emergency intervention is necessary, for example, in the treatment of acute diseases that are accompanied by acute pain and discharge of pus.

Absolute contraindications

At any stage of pregnancy, diagnostics with x-ray radiation are excluded: radiography, computed tomography and similar examination techniques. In case of emergency, the woman is put on a protective apron, even if the procedure is carried out using a modern visiograph with minimal radiation exposure.

The following dental services are contraindicated for pregnant women:

anesthesia, sedation;
anesthesia with lidocaine and adrenoline anesthetics;
bleaching due to increased fragility of enamel;
installation of implants.

Treatment of deep caries with purulent foci, removal of cysts, granulomas is performed if conservative treatment does not help.

Anesthesia during pregnancy

Many people are interested in the question: is anesthesia allowed for pregnant women during dental treatment? Modern anesthetics, such as Ultracaine, will not harm the baby. Lidocaine has not been used during pregnancy for a long time.

Some expectant mothers think that dental treatment is best done without anesthesia, but this is not true. Fear during the procedure and pain have an impact on the emotional state, which negatively affects the condition of the fetus. As for general anesthesia during pregnancy, it is strictly prohibited for women expecting a baby.

The main thing is caution!

Thus, surgical treatment methods and their anesthesia for a pregnant woman are complex and dangerous, but sometimes they cannot be avoided. There is only one way out in this situation: take care of yourself! Try to deal with your chronic diseases that require surgery before pregnancy. Don’t forget about dental problems: sad as it may be, one of the reasons for abortions and premature births is dental intervention during pregnancy, especially acute conditions, that is, dental diseases that cause toothache. Their treatment, as a rule, is also associated with pain. However, most of these diseases can be prevented by treatment before testing.

Try to avoid places that are dangerous for injury. If you are busy in production, ask management to comply with the Labor Code and transfer to a quiet area. Please note that a car is not the safest place in the city, and even if an ace is driving your car, it is possible that your neighbor on the highway will be a reckless driver. During pregnancy, you should sacrifice panache for convenience: hide thin stilettos, high heels and slippery soles away in the closet. Wear comfortable and stable shoes. Reduce for yourself and for your unborn child the risk of injury in the apartment (sharp corners, boxes falling from mezzanines, swinging stepladders and stools, etc.).

But if the need for surgical intervention does arise, do not delay, consult a doctor. Take care of yourself and your baby.

Dental treatment and lactation

Breastfeeding mothers often experience calcium deficiency, which affects dental health. Is it possible to treat teeth while breastfeeding? Will this affect the baby's health?

Dental treatment during lactation is mandatory. Moreover, modern dentistry offers gentle anesthesia methods that do not affect the child’s body. Since some medications are contraindicated for nursing mothers, please inform your doctor about your situation before treatment.

And remember that prevention is the key to the health of your teeth, so do not forget to visit the dentist every six months to check your oral cavity and, if necessary, carry out treatment at an early stage. This will save you time and money.

Sedation

Sedation is essentially a subtype of general anesthesia, but smaller doses of drugs are used. During the operation, the patient may experience minor discomfort and hear voices, but everything is perceived as erased.

Sedation lasts significantly less than general anesthesia, leaves fewer consequences and is easier to tolerate. Therefore, this method is most often used.

After the operation is completed, the anesthesia wears off quite quickly. It is enough to spend a few hours in the clinic, after which you can go home.

Fetal development in the 1st trimester of pregnancy (1-12 weeks)

10-14 day
delay in menstruation is a reason to consult a gynecologist.
The 1st trimester of pregnancy is considered to be the period of development of the embryo (fetus) from the moment of fertilization of the egg and attachment of the zygote (fertilized egg) to the wall of the uterus until the 12th week.
This stage is characterized by a sequential change
of blastogenesis, organogenesis, placentary
, and also includes
the beginning of the fetal period
, when the fetus has already formed all organ systems, limbs and even the visual appearance of the baby.

It is the 1st trimester of pregnancy that obstetricians and gynecologists call “critical,” because, on the one hand, during this period, the most complex dynamic processes occur in a woman’s body: fertilization, the attachment of the zygote, the formation of all systems of the baby’s body. On the other hand, it is during this period that the fetus is most sensitive to damaging factors, so there is a possibility of pregnancy complications and abnormalities in the development of the fetus, if there are prerequisites for this. Moreover, this risk is even higher than in the 2nd or 3rd trimesters of pregnancy. Non-developing pregnancy

- one of the most significant and common risks that can appear already in early pregnancy.

Mothers who have previously faced the problem of infertility, miscarriage, or ectopic pregnancy

.
The obstetrician-gynecologists of our clinic
will not only conduct prenatal diagnostics themselves as part of a program for monitoring the baby’s development, but will also help correct pathologies in the development of the fetus in a hospital setting.
We manage pregnancies after IVF and have been helping women experience the joy of motherhood for over 20 years.

How is 1-2 weeks of pregnancy going?

Pregnancy period is calculated from the 1st day of the last menstruation

. Pregnancy begins with ovulation and fertilization. At this stage, the zygote attaches to the uterine cavity. It is extremely important that the anatomy (patency) of a woman’s fallopian tubes is not disturbed. The endometrium must be ready to receive a zygote, and there should be no inflammatory processes in the uterine cavity (its mucous membrane) - this increases the likelihood of low placentation. The movement of the zygote through the fallopian tube takes, on average, 2-3 days. Violation of the patency of the fallopian tubes and, in connection with this, the retention of a fertilized egg can cause an ectopic pregnancy.

As part of the planning and management of pregnancy (in the 1st trimester), a woman undergoes ultrasound diagnostics

, and also takes
tests
aimed at identifying such deviations. It is at this stage of pregnancy that it is already possible to determine the fertilized egg in the uterus and, for example, to exclude an ectopic pregnancy.

The main indicator by which pregnancy is diagnosed and its development is further monitored is the hCG level

(human chorionic gonadotropin) in the blood. If the pregnancy test result is positive, the hCG level exceeds 30. Pregnancy can be diagnosed using hCG within 2-4 days after a missed period.

At the initial stage of pregnancy in the 1st trimester, it is extremely important to compensate for the deficiency of nutrients (iron, magnesium, folic acid), which provide the necessary components for fetal growth, and restore hormonal balance. This must be done strictly under the supervision of a doctor and after undergoing tests - spontaneous use of medications, even herbal ones, can cause irreparable damage to the health of the mother and child.*

A notorious historical example is the thalidamide disaster of 1961.

How is 3-8 weeks of pregnancy going?

The embryo develops organs: heart, neural tube, intestines, etc. The placenta performs a number of vital functions: nutrition, respiration, excretion, synthesis of hormones and nutrients, blood circulation. The processes of active protein synthesis and embryonic growth factors require a good blood supply from the mother.

Organogenesis from the 3rd week of pregnancy is considered the most important and risky period of development. Any internal failure in the ligament: “mother - placenta - developing organs of the embryo”

can lead to fatal developmental defects.

At 6-7 weeks

During pregnancy, ultrasound diagnostics can already record the baby’s heartbeat.

At 7-8 weeks

During the 1st trimester of pregnancy, the fetus's limbs are formed, the process of embryogenesis is completed - this means that the embryo has all its organs and tissues formed in its infancy.

The period of 7-8 weeks is optimal in order to undergo the first large-scale clinical and laboratory examination and register.

You can contact our clinic regarding pregnancy management in the 1st trimester - we will issue an exchange card for the expectant mother and help her undergo modern diagnostics in a comfortable environment.

How is the 9th - 12th week of pregnancy?

The stage of active growth and complexity of the baby’s body. The fetus develops a lymphatic system and complex reflexes appear - the child can cover his face with his palms, or bring his thumb to his mouth.

Thus, in the 1st trimester of pregnancy, the most important and significant changes occur in a woman’s body - it begins to work literally for two, directing resources to the active growth and development of the fetus. To ensure good blood circulation, the work of the heart increases. To ensure that the baby receives the necessary amount of oxygen, pulmonary ventilation becomes more intense. The kidneys are now responsible for removing waste products from the mother and fetus. The uterus increases in size, which often leads to stagnant movements in the intestines - constipation. Taste sensations change; a woman may experience nausea and toxicosis

in the 1st trimester of pregnancy. Mild toxicosis in early pregnancy is treated with medication. Moderate and severe toxicosis in the 1st trimester of pregnancy is treated in a day hospital (for example, using hormonal infusion therapy).

It is important that the expectant mother not only undergoes examinations according to the program, but also receives support. When contacting our clinic regarding pregnancy management in the 1st trimester, you can count on the help of highly professional obstetricians and gynecologists, constant feedback from the doctor, and the European level of medical service.

Carrying out bone grafting

There are several types of bone grafting, which will determine the technique used to perform it. The following options for restoring bone deficiency are distinguished:

Autogenous transplantation. It is a transplant of one’s own bone tissue, and therefore requires additional traumatic manipulation - taking a graft from the lower or upper jaws, chin or hard palate.
Splitting of the alveolar process. The optimal operation for replenishing the width of bone tissue. First, the patient's alveolar ridge is sawed, and then it is expanded and the graft is immersed inside.
Sinus lift. It is performed when there is a deficiency of bone height in the area of the maxillary sinuses. The operation consists of lifting the soft tissue of the sinus and filling the space with osteogenic substances.
Barrier membranes. Replantation of a bone block, which involves the additional attachment of a special membrane. This design maintains the shape of the graft and prevents unfavorable elements from penetrating into the operated area.

Any of the listed manipulations is quite traumatic and unfavorable for pregnant girls. It should also be noted that dental implantation is also not carried out during the gestational period, so it will not be possible to use alternative methods for treating bone deficiency.