Thursday, May 22, 2014

Pregnancy and Dental Appointments

Oral health is absolutely necessary in attaining and maintaining overall health. It is especially important to maintain good oral health in pregnant women to prevent pathogenic (disease causing) bacteria from being transmitted to the fetus.

You certainly don't want to skip cleanings and annual exams. Routine procedures are not only safe, but are recommended.

During pregnancy, women undergo hormonal changes. When this occurs, a condition called pregnancy gingivitis frequently develops. For more information on pregnancy gingivitis, please refer to my previous blog on the subject by clicking here.

Women that exhibit gum disease are significantly at greater risk for delivering preterm and low birth weight babies.

Although I just said that you certainly want to keep your routine appointments, there are better times throughout the pregnancy than others. In general, avoid appointments in the first trimester and second half of third trimester. .

We want to avoid the first trimester for the benefit of the developing child. Although it's relatively safe, you still want to avoid any unnecessary medications because this is a critical time in the baby's development.

The second trimester is considered to be the best time to have a dental appointment.

We want to avoid dental appointments in the third trimester mostly for the mother's benefit. Laying in a chair for extended periods can be rather uncomfortable.

Many people have concerns with taking x-rays for good reason. However, if x-rays are necessary, they can be taken safely as long as the baby is shielded from radiation. Dental x-rays provide very low levels of radiation.......especially when digital x-rays are taken. You'll likely get more radiation from driving your car to work in the middle of the day than you will from a digital x-ray.

In conclusion, do not defer routine dental care. If considering elective (non-emergency) treatment, do so in the second trimester. If an acute infection occurs, you must address it at any stage of the pregnancy to prevent the bacteria in your blood from traveling to the growing baby. Delay in treatment can result in unwanted results in both the mother and baby.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, May 15, 2014

Breast Feeding and Anesthetics

Interestingly enough, my son's mother asked me if it was safe to breastfeed after an appointment with her dentist (me). In particular, she asked about the effects of the anesthetic. Here are some thoughts on the subject:

  • We certainly want to avoid pain for obvious reasons. An interesting fact about pain is that it suppresses lactation. Therefore, if a mother is in pain, we certainly want to get them out of pain by using local anesthetics.
  • Novocaine hasn't been used in the US since the 40's. Currently, the most commonly used anesthetic in dentistry is lidocaine.  It has been studied extensively and has been determined that it is absolutely safe. Mepivicaine and prilocaine have also been determined to be safe. Not enough research has been conducted on articaine and bupivicaine to declare them to be safe. Although they may be safe, it may be a good idea to avoid these until we can confirm that they are in fact safe. 
  • There are some healthcare providers that suggest refraining from breastfeeding for at least 4 hours as a precaution. Even drug companies discourage women from breastfeeding while taking their medications. These precautions are not based on sound scientific studies. The reasoning for these overly cautious measures is more for legal concerns rather than actual pharmacological reasons. 
  • Some have suggested that local anesthetics without epinephrine (adrenaline) be used. Epinephrine is rapidly metabolized and is not an issue. We all produce epinephrine in our adrenal glands. The quantities that we can produce during a fight or flight response are significantly greater than any amount that can be administered in an anesthetic. Therefore, if we would argue against the use of epinephrine, then we would have to say that anytime the mother felt an instance of anxiety or fear, then they could not breastfeed their child. This is absurd.
  • In one study,  women were given doses of lidocaine ranging from 60 to 500 mg by epidural routes during delivery. The infants were then breastfed or received the mother's milk by bottle. The researchers concluded that there were no effects on the infants. In dentistry, the typical anesthetic carpule only contains 36 mg. So even if we gave 10 carpules, that would only be 360 mg. Well within the parameters of the study.

Always consult consult your dentist about specifics. Every case is different. We must always weigh both the risks and benefits.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, May 8, 2014


Since I personally have a 4 month old that is currently teething, I've been inspired to write this blog.

This time in the child's life can be challenging for both the child and the parents. Fortunately, most infants experience no symptoms to mild discomfort.

The first teeth come in at roughly 6 months of age. Please refer to my Teeth Eruption Timeline blog. Some may come in a little sooner or may be slightly delayed. You can expect teething discomfort to start slightly before the teeth actually come in.

This whole teething process may continue until all 20 baby teeth are in. All of the primary (baby) teeth should be in by the age of 3.

How do you know if your child is teething? Here are some potential symptoms:

  • Your child may be somewhat fussier than usual.
  • You may notice the child biting on fingers, hands, toys or any object.
  • Your child may refuse to eat or drink.
  • Your child may drool continuously. 
  • The child may develop a rash on his or her face.

So what can you do to soothe the discomfort? Here are some things to consider:

  • Use cold teething rings. 
  • Provide safe objects to chew on.
  • DO NOT give aspirin. Use of aspirin is contraindicated in children due to the risk of Reye's Syndrome. This is a potentially fatal condition that involves many organs--especially the brain and liver.
  • Some advocate the use of over-the counter topical anesthetic gel. I'm not to enthusiastic about these gels however. Benzocaine products have been linked to methemglobulinemia. This is a rare but serious condition of the blood.

The author of The Baby Book, Dr. William Sears (a pediatrician) believes that loose stools, runny noses or a fever are caused by teething. Most experts don't agree. These symptoms are completely unrelated. Although, during teething, there are many inflammatory cells in the mouth which will cause the temperature of the mouth to rise slightly. This may lead to inaccurate temperature readings if the temperature is taken in the mouth. Nevertheless, if these symptoms occur, your child should be evaluated to ensure something more serious is not occurring.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit