● Monitor the concentration of the drug in the nursing infant if there is a potential risk to the infant. ● Have the mother take the medication immediately after breastfeeding or before the infant is due for a lengthy sleep period (Consolini, 2019; Kolen, 2020). The U.S. Library of Medicine’s Drugs and Lactation Database (LactMed) provide guidance regarding specific drugs that are excreted in breast milk (PubChem, 2020; Centers for Disease Control, 2020; U.S. National Library of Medicine, n.d.). Table 2 presents drugs that are frequently used in dentistry and are excreted in breast milk, along with recommended guidelines.
mother’s physician or the child’s pediatrician if there is a concern about the use of any medication which is adjunctive to dental treatment and its effect upon the infant during breastfeeding. A recent Israeli study found no apparent harm to infants from breastfeeding mothers’ chronic use of any one of various types of psychotropic medications (Kronenfeld et al., 2018). To minimize drug exposure to the breastfed infant, clinicians should consider the following before prescribing drugs to lactating women: ● Assess the necessity of drug therapy. ● Select the safest drug (e.g., acetaminophen rather than aspirin for analgesia).
Table 2: Drugs Frequently Used in Dentistry that are Excreted in Breast Milk Use in Dentistry Drug Guidelines Herpes infections Acyclovir
Topical acyclovir applied in small amounts away from the mother’s breasts should pose no risk. To prevent exp paraffins, only water-miscible cream or gel products should be used. High doses of aspirin should be avoided during breastfeeding, especially with very young infants. Low-dose as considered for anti-platelet therapy.
Pain
Aspirin
Trigeminal neuralgia
Carbamazepine Carbamazepine appears at relatively high levels in breast milk but usually below the anticonvulsant therapeutic infant for various symptoms and developmental milestones.
Antibiotic coverage Clindamycin
Clindamycin can potentially cause adverse effects on the infant’s gastrointestinal flora. An alternate drug may infant for diarrhea, candidiasis, or blood in the stool.
Antibiotic coverage Erythromycin
Erythromycin is acceptable in nursing mothers.
Candida
Fluconazole
Fluconazole is acceptable in nursing mothers because the levels in breast milk are lower than those given to infants.
Nondental pain Fluoxetine
If fluoxetine is required by the mother, breastfeeding can be continued.
Pain
Ibuprofen
Ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.
Pain
Naproxen
Levels of naproxen in breast milk are low, and adverse effects in infants are uncommon.
Antibiotic
Penicillin
Penicillin V and penicillin G are acceptable to use during breastfeeding.
Trigeminal neuralgia
Phenytoin
Because of the low levels of phenytoin in breast milk, no difficulties are usually experienced in breastfed infant alone.
Oral mucosal infections
Tetracyclines
Short-term use of tetracyclines (doxycycline) is acceptable in nursing mothers.
Note : From U.S. National Library of Medicine. (n.d.). LactMed: A TOXNET database. Retrieved on June 6, 2018, from http://toxnet.nlm.nih.gov/cgi- bin/sis/htmlgen?LACT CONCERNS OF MIDDLE-AGED AND OLDER FEMALE DENTAL PATIENTS
Middle age is the period of life beyond young adulthood and before the onset of old age (generally between 45 and 64 years of age). During the middle years, female patients can experience a number of dental concerns, including temporomandibular disorder (TMD), trigeminal neuralgia, and other atypical facial pain. Temporomandibular disorders affect at least twice as many women as men (National Institute of Dental and Craniofacial Research [NIDCR], 2018). Temporomandibular disorder is the second most common musculoskeletal disorder second only to lower back pain. Approximately 33% of the population has had at least one (TMD) symptom and about 3.6% to 7.0% of the population had enough symptoms for which they sought treatment. Females have an increased prevalence of in the 25-44 year-old age range had an 18% prevalence of TMD compared to a 10% prevalence of males in the same age range (Huggins and Wright, 2021). The prevalence was approximately 7% to 8% in non-Hispanic white women up to age 50, but it decreased after Menopause Both clinicians and women identify the approach of menopause by changes in menstrual cycle regularity and the amount of menstrual bleeding or by vasomotor symptoms such as hot
age 55. Overall, age seemed to play a greater role for women than for men. Patients with TMD may describe the pain as a dull ache or as sharp and shooting; the area may be tender and aching; the pain may vary from mild to severe; and the pain may be bilateral or unilateral (Mayo Clinic, 2017c; Mayo Clinic, 2018). Some patients also complain of clicking joints, tinnitus, popping noises in the ear, vertigo, and deviation of the jaw (NIDCR, 2018; Shahidi et al., 2018). Upon examination, there may be tenderness of the masticatory muscles and some restriction of opening, with jaw deviations. Crepitus of the joint may be present. Treatments for TMD include various types of medications (nonsteroidal anti-inflammatory drugs, muscle relaxants, etc.), therapies (occlusal splints, warm and moist packs, cognitive behavioral therapy), and surgical or other procedures (Mayo Clinic, 2017b; NIDCR, 2018).
flushes or night sweats. Other symptoms, such as vaginal dryness, poor sleep, depressed mood, and decreased libido, are commonly attributed to menopause. Considerable evidence
Page 126
Book Code: DHFL2624
EliteLearning.com/Dental
Powered by FlippingBook