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

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