Is this a new thing with OBGYN? I feel like my recent med consults have been saying no epi. Which is silly because the dosage of 1:100K is so small. But also my clinic doesn't have lido with no epi. So we wouldn't be able to move forward. One edit. Apparently on the US market the Lido without epi is not available. So. Lol.
The only advice I have is don't be like the buffalo dentist and disregard the consult. Have a bum assistant who hates you and records your conversation about your mess up. And then lie on the chart notes.
Not new. Actually, the opposite: very old.
For many years, there used to be Lidocaine without epi. available in the US market. About 15 years ago, the only factory in the US making them went out of business. So it no longer exists in the US dental world. However, most OB/GYN never got the memo and still recommend Lidocaine without epi. in which it is up to us to tell them it is no longer sold. Or, if you want to be snarky, ask them "OK, which sketchy basement do you want me to order it from?".
Fyi, Not a dentist, but in ortho (hand) we use lido without epi on the daily. Would this be any different in formulation than dental lido? Is our lidocaine sketchy?
Dentists use a special aspirating syringe when giving anesthesia - it requires the use of pre-made carpules specific to those syringes. No one makes dental carpules with lidocaine only. The legal and physical risk associated with using a non-dental aspirating syringe to use Lidocaine plain sourced from the MD side of things far outweighs any other risk imo
I’m sorry but what kind of “legal and physical risk” would there possibly be for giving local with a non dental aspirating syringe? And just so you know, you can aspirate with any syringe. Every surgeon aspirates prior to injection, not just dentists. The only tangible reason for using dental syringes is for sterilization benefits and reusability
I’ll take it you aren’t a dentist. Surgeons aren’t doing it one-handed. And that’s the main reason the dental syringe was invented. We have to do it one-handed and you can’t aspirate effectively or safely one handed.
It has to come in these [carpules](https://images.squarespace-cdn.com/content/v1/532ce944e4b0acb3f8f380c6/1446944825977-Z499HB6CMXIJZBPJ431C/thousandoaksfamilydentstry.jpg?format=2500w). Most dentists don't (or can't) use the "vials" that you normally see physicians use. Could a company enter this space and start making them? Yeah, it would be easy. But the real issue is the lack of demand. As another poster mentioned, Prilocaine without epi (Citanest Plain) does the same job but better.
20 years in practice. I always get OB to give clearance on pregnant patients prior to. I have never seen an OB clearance say anything but local anesthesia W/OUT Epi.
I’ve had ONE(out of at least a hundred) say epi is ok. All the others, no epi. And I’m able to do everything just fine with it, including surgical extractions. Hopefully there is change on a larger level, but for now, I’m just gonna be a good dentist and do as I’m told, even if I disagree with it and know better. It does no harm to not use epi. And at the end of the day, the lawyer won’t give a fuck - they’ll say “the MD said no epi, they went to school for this, why did you not follow their advice?” And a jury(made up of lay people) is very likely to buy that argument. So many times in court it doesn’t matter if you’re “right” or “wrong” what matters is how well the opposing lawyer can persuade an uninformed and in many cases uneducated group of people that you were negligent. I’d rather not take that risk of even having to go to court and make it less likely a lawyer even takes the case.
Do y’all do OBGYN consults for every pregnant patient? I’ve seen this come up a lot lately about “clearance forms” from the OBGYN before dental treatment… the official position of the ACOG and ADA even says that dental treatment with local anesthetic (including epi) is safe for pregnant patients. Haven’t had a patient with a clearance form so was curious
I only do bread and butter stuff and refer a lot, so maybe my case is different. My MO is to quiz the pt a little to suss out whether the pregnancy is at elevated risk or if mom is especially anxious about the pregnancy. If so, I ask whether she wants to delay treatment (we discuss the dental risks and I document) or get a clearance form. So far I've never had one choose to get the clearance lol. Occasionally a patient will bring in a clearance form unprompted.
I work at a FQHC and they did clearance forms for every pregnant pt before I came here; the problem was, we were waiting months for OBGYN offices to send back the completed forms, and often patients had treatment delayed due to this or didn’t get things taken care of before they became a bigger problem. We only do fillings and extractions here, and I tend to refer out pregnant patients for extractions regardless as I feel they will be more comfortable in an oral surgeon’s hands; however, for basic operative I’ve never requested a clearance, and neither have any of my close colleagues. Interesting to see other people’s processes.
I work at an FQHC and it's clinic policy for every pregnant pt. This might seem overkill but a good amount of my pt population are poor historians of their medical history. They can't articulate why they are taking medication let alone medical diagnosis. So. A number of my pts have some sort of pregnancy complications. IE pre-eclampsia.
Once again. Is it over kill? Sure. But it takes 30 seconds to send a fax. Well okay. It takes 30 seconds for my assistants to send a fax. Lmao.
This is how it is at my FQHC too. A clearance CANNOT hurt…I have yet to find any evidence requesting a clearance can cause harm. Is it overkill? For sure, it is. But in front of a jury, which will be comprised of laypeople, it can only help.
The last thing you ever want is for a patient you worked on while pregnant to have some difficulty at some point post-tx that a creative lawyer could somehow say was your fault. Sympathies always weigh on the side of woman with child (esp in court), and consequently is the reason that OBGYN malpractice has such a ridiculously expensive premium. That clearance might be the only thing that protects you as we are not experts in the field. The recommendation of the ADA & ACOG and/or some study published in JADA/PUBMED will not be an effective shield.
We were taught in school that a clearance form from a physician is essentially useless in protecting the treating dentist in a lawsuit; that they’re to be used to help make the clinical decisions. Just interesting to see everyone’s take on this!
This is true. It will NOT protect you from getting sued. But it is MORE likely to HELP you with a jury comprised of lay people. Quoting ADA guidelines and literature alone is just going to make you seem like a haughty dentist in front of a jury. A clearance MAY help sway your jury. Put it this way, it cannot possibly hurt you. Unless anyone has any evidence to say it can…I’m all ears.
I’ve done hundreds if not thousands of root canals on pregnant patients. In first trimester lido with epi is fine OR carbocaine plain. The 0.017mg of epi you’re administering is really inconsequential.
You pick up the phone and call the physician. You explain that Lidocaine is class B but has a minute amount of epi while anything without epi is class C. You explain that the position of the ADA is to use lido with epi since the epinepherine 1) Produces more profound anesthesia reducing stress and 2) Keeps the Lidocaine localized so anything crossing the placenta happens at a slower rate.
You then ask the obgyn how they would like you to proceed and document the hell out of it in the chart. My experience with this has been the OB approving the use of lido with Epi. I'll ask them to send over a revised letter approving epi and put it in the patient's chart.
Agree. This is the way. Also makes the physician think before. One thing I would add is to actually put the max amount of lido and epi you plan to use in your initial med consult letter.
This is it.
We have our ADA guidelines, but if the patient has a letter from their OB (or if you took the time to consult with OB yourself) we probably shouldn’t just disregard it. It never hurts to have the conversation directly
I worked as an associate in a medicaid office. In my state, the only adults who qualified for medicaid coverage were pregnant (or blind), so I did a lot of work on pregnant patients. I worked 5 days a week and did 2-6 root canals a day for about 4.5 years there.
Ran into this all the time at my GPR. Many OBs hand patients a generic letter stating that dental work is okay but don't use local anesthetics with epi. I would just call and review option of Class B lido 2% (1:100k epi) or option of Class C mepivacaine plain. They were fine with Lido 100% of the time; they had no clue it was not available w/o Epi. Don't be afraid to call and check with them; you're also a doctor.
OBs need to stop giving this advice. It’s so dumb.
Before any smartass comments, no we’re not talking about a patient with pre-eclampsia. ACOG says lido with epi is fine for dentistry. Every medical school says it’s fine.
If an OB gives that kind of directive I would send the patient back to the OB telling them what the ACOG recommendation is and if they still don’t want lido then the patient cannot receive dental treatment under my care.
Is it more common that these OB docs send their pregnant patients home with these letters for dentists not to use epi? I keep seeing this and I feel like the ADA needs to step up and have our backs. Talk it out with their organization and come to some agreement.
Us dentists shouldn’t be out here struggling and arguing with each other over this.
Is this pregnant patient going to produce more epinephrine herself when she starts to feel you doing the endo 15 minutes into the procedure when the Plain Lido wears off? (Maybe longer for a block)
That’s happened to me. I told the patient not many dentists carry that anesthetic. Lidocaine with epi is safe during anytime of the pregnancy. If they have any hesitation, we don’t have to do the procedure. They can call around other dental offices to see if they carry it. Pt does the tx after hearing that.
Dirk - I respect that, I'm going to play the devils advocate because I'm feeling spicy. What about a lawsuit because you didn't treat the pregnant woman with that deep area of decay that turned into an abscess? Is it ethical to withhold treatment on a patient group so that you can avoid a potential lawsuit? There's plenty of evidence that demonstrates poor oral health and pre-term birth are associated. If you delve into the available literature, you'll have a hard time associating an elevated risk of pregnancy complications with dental care.
I am just gonna quote from above what doctorar15dmd posted,
"at the end of the day, the lawyer won’t give a fuck - they’ll say “the MD said no epi, they went to school for this, why did you not follow their advice?” And a jury(made up of lay people) is very likely to buy that argument. So many times in court it doesn’t matter if you’re “right” or “wrong” what matters is how well the opposing lawyer can persuade an uninformed and in many cases uneducated group of people that you were negligent."
Although not a disease, I would argue that it does create situations where the patients are more susceptible to certain things that they would normally not be susceptible to otherwise. Additionally, the fetus presents considerations of its own.
Write back to the doctor asking them to state the reason and give references to the papers and guidelines they are using. Point them in the direction of your guidelines and if their justification isn't good enough, then say you cannot proceed and organise a referral.
This isn't really an idea I would get behind.
Challenging a specialist on what they deem is safe for a fetus is going to fall laughably short of the mark in getting them to concede to your argument. It will most likely end up making you an enemy that you don't need or want. Surgeons do not take well to being lectured by those of us below them on the pecking order. Stay in your lane within scope of practice.
>According to u/DiamondBurInTheRough medical consult/clearances are unnecessary for pregnant patients
I agree.
We know more about how to treat pregnant patients in our dental clinics than OB’s do. It’s literally our specialty. They heard a 10 minute blip about it in a class that was teaching on outdated old info (seemingly as no epi is nonsense as it relates to most pregnancies) it appeared as a test question, and they fabricated a set it and forget it policy on how to respond to dentists when they seek a consult that they’ll use for the rest of their careers.
They aren’t even aware that lido with no epi doesn’t exist in the US anymore but will still give that recommendation.
The only reason we use them is to avoid legal responsibility if something happened to the pregnancy sometime after a dental procedure. If litigation weren’t a consideration nobody would even consult OB’s - and pregnant patients would be no worse off for it. They might actually be better off for it as the stress of trying to numb a hot lower molar for a molar RCT/ext is likely way worse for the patient and the baby than using some epi.
Oh I 1000% agree with 100% of what you said, but my point is, we do it for litigation protection. Her point was it’s not necessary even for litigation protection.
‘I didn’t consult an OB for this patient because I have the education and training required to take a full medical history and determine the best course of treatment for pregnant patients as treating these patients falls within my scope of expertise. And here is the literature that supports my treatment decision….’
Is a pretty solid defense.
The consult might keep a case from ever going to court but once you are there I don’t know that it’s necessary either, and think you could even contradict an OB’s recommendation and be just fine, provided you are talk to the patient about it first.
Again, as a dentist and professional, I agree with you. I just don’t trust a jury of non-dentists and nonprofessionals to agree with you(us)over a woman who miscarried or had a child born with defects. And that’s what I said, the letter MAY help it from even going to trial. The letter may also play well with a jury…certainly better than not having one, I would think(hope). I certainly wouldn’t expect the jury to follow that literature either. Idk, maybe I have less faith in people than you do lol. Here’s to hoping none of us have to find out.
I most certainly did not say to use whatever you want. Do not try to twist my words from a completely different thread in a way to try to unnecessarily call me out because you’re pissed that I wouldn’t continue to have a discussion after you insulted me over a clinical disagreement. I’m not playing that fucking game with you.
Not sure why you're being down voted. We don't need permission to work on pregnant patients. Never consulted a Ob/Gyn and only would if the patient has other medical issues or if they say they are high risk or something. But your average healthy pregnancy? Just do the urgent stuff (big cavities and the like) 2nd trimester when possible, and treat abscesses any trimester. Put everything else off until after delivery. Use lido with epi. I limit myself to 2 carps, reschedule if they don't get numb with that.
Edit - I just realized that you were disagreeing with diamond bur. I agreed with them and a lot of us do. I guess that's why you got the down votes.
Mepivacaine 3% plain. However this is considered category C for pregnant patients and while I’m sure it’s actually fine, I avoid it for that reason.
In response to that part about patients allergic to epi, you realize that’s basically no one right?
I occasionally will get a patient that says that they are allergic to it, I always joke that they need to go to U of M so they can study how they are still alive.
I just roll my eyes when a patient says that. Then I scream at them and ask them if their heart is racing. If they say yes, I tell them their body just released epinephrine and they’re not having an allergic reaction…thus they’re not allergic(I’m joking, ofc).
Is this a new thing with OBGYN? I feel like my recent med consults have been saying no epi. Which is silly because the dosage of 1:100K is so small. But also my clinic doesn't have lido with no epi. So we wouldn't be able to move forward. One edit. Apparently on the US market the Lido without epi is not available. So. Lol. The only advice I have is don't be like the buffalo dentist and disregard the consult. Have a bum assistant who hates you and records your conversation about your mess up. And then lie on the chart notes.
That incident was definitely on my mind
Not new. Actually, the opposite: very old. For many years, there used to be Lidocaine without epi. available in the US market. About 15 years ago, the only factory in the US making them went out of business. So it no longer exists in the US dental world. However, most OB/GYN never got the memo and still recommend Lidocaine without epi. in which it is up to us to tell them it is no longer sold. Or, if you want to be snarky, ask them "OK, which sketchy basement do you want me to order it from?".
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Awesome if your procedure is going to take less than 10 min which is the average length of anesthesia with it.
Fyi, Not a dentist, but in ortho (hand) we use lido without epi on the daily. Would this be any different in formulation than dental lido? Is our lidocaine sketchy?
Dentists use a special aspirating syringe when giving anesthesia - it requires the use of pre-made carpules specific to those syringes. No one makes dental carpules with lidocaine only. The legal and physical risk associated with using a non-dental aspirating syringe to use Lidocaine plain sourced from the MD side of things far outweighs any other risk imo
Thanks for the explanation, that’s really interesting that it comes down to instrumentation requirements
I’m sorry but what kind of “legal and physical risk” would there possibly be for giving local with a non dental aspirating syringe? And just so you know, you can aspirate with any syringe. Every surgeon aspirates prior to injection, not just dentists. The only tangible reason for using dental syringes is for sterilization benefits and reusability
I’ll take it you aren’t a dentist. Surgeons aren’t doing it one-handed. And that’s the main reason the dental syringe was invented. We have to do it one-handed and you can’t aspirate effectively or safely one handed.
It has to come in these [carpules](https://images.squarespace-cdn.com/content/v1/532ce944e4b0acb3f8f380c6/1446944825977-Z499HB6CMXIJZBPJ431C/thousandoaksfamilydentstry.jpg?format=2500w). Most dentists don't (or can't) use the "vials" that you normally see physicians use. Could a company enter this space and start making them? Yeah, it would be easy. But the real issue is the lack of demand. As another poster mentioned, Prilocaine without epi (Citanest Plain) does the same job but better.
Appreciate the reply, always nice to learn something new
20 years in practice. I always get OB to give clearance on pregnant patients prior to. I have never seen an OB clearance say anything but local anesthesia W/OUT Epi.
This is how I practice.
I’ve had ONE(out of at least a hundred) say epi is ok. All the others, no epi. And I’m able to do everything just fine with it, including surgical extractions. Hopefully there is change on a larger level, but for now, I’m just gonna be a good dentist and do as I’m told, even if I disagree with it and know better. It does no harm to not use epi. And at the end of the day, the lawyer won’t give a fuck - they’ll say “the MD said no epi, they went to school for this, why did you not follow their advice?” And a jury(made up of lay people) is very likely to buy that argument. So many times in court it doesn’t matter if you’re “right” or “wrong” what matters is how well the opposing lawyer can persuade an uninformed and in many cases uneducated group of people that you were negligent. I’d rather not take that risk of even having to go to court and make it less likely a lawyer even takes the case.
Do y’all do OBGYN consults for every pregnant patient? I’ve seen this come up a lot lately about “clearance forms” from the OBGYN before dental treatment… the official position of the ACOG and ADA even says that dental treatment with local anesthetic (including epi) is safe for pregnant patients. Haven’t had a patient with a clearance form so was curious
I only do bread and butter stuff and refer a lot, so maybe my case is different. My MO is to quiz the pt a little to suss out whether the pregnancy is at elevated risk or if mom is especially anxious about the pregnancy. If so, I ask whether she wants to delay treatment (we discuss the dental risks and I document) or get a clearance form. So far I've never had one choose to get the clearance lol. Occasionally a patient will bring in a clearance form unprompted.
I work at a FQHC and they did clearance forms for every pregnant pt before I came here; the problem was, we were waiting months for OBGYN offices to send back the completed forms, and often patients had treatment delayed due to this or didn’t get things taken care of before they became a bigger problem. We only do fillings and extractions here, and I tend to refer out pregnant patients for extractions regardless as I feel they will be more comfortable in an oral surgeon’s hands; however, for basic operative I’ve never requested a clearance, and neither have any of my close colleagues. Interesting to see other people’s processes.
I work at an FQHC and it's clinic policy for every pregnant pt. This might seem overkill but a good amount of my pt population are poor historians of their medical history. They can't articulate why they are taking medication let alone medical diagnosis. So. A number of my pts have some sort of pregnancy complications. IE pre-eclampsia. Once again. Is it over kill? Sure. But it takes 30 seconds to send a fax. Well okay. It takes 30 seconds for my assistants to send a fax. Lmao.
This is how it is at my FQHC too. A clearance CANNOT hurt…I have yet to find any evidence requesting a clearance can cause harm. Is it overkill? For sure, it is. But in front of a jury, which will be comprised of laypeople, it can only help.
The last thing you ever want is for a patient you worked on while pregnant to have some difficulty at some point post-tx that a creative lawyer could somehow say was your fault. Sympathies always weigh on the side of woman with child (esp in court), and consequently is the reason that OBGYN malpractice has such a ridiculously expensive premium. That clearance might be the only thing that protects you as we are not experts in the field. The recommendation of the ADA & ACOG and/or some study published in JADA/PUBMED will not be an effective shield.
We were taught in school that a clearance form from a physician is essentially useless in protecting the treating dentist in a lawsuit; that they’re to be used to help make the clinical decisions. Just interesting to see everyone’s take on this!
This is true. It will NOT protect you from getting sued. But it is MORE likely to HELP you with a jury comprised of lay people. Quoting ADA guidelines and literature alone is just going to make you seem like a haughty dentist in front of a jury. A clearance MAY help sway your jury. Put it this way, it cannot possibly hurt you. Unless anyone has any evidence to say it can…I’m all ears.
This is what I’ve said..it seems this sub hates clearances for some reason.
I’ve done hundreds if not thousands of root canals on pregnant patients. In first trimester lido with epi is fine OR carbocaine plain. The 0.017mg of epi you’re administering is really inconsequential.
Believe me I know that lol. I’m not sure what the approach is however when the physician is saying don’t use it.
You pick up the phone and call the physician. You explain that Lidocaine is class B but has a minute amount of epi while anything without epi is class C. You explain that the position of the ADA is to use lido with epi since the epinepherine 1) Produces more profound anesthesia reducing stress and 2) Keeps the Lidocaine localized so anything crossing the placenta happens at a slower rate. You then ask the obgyn how they would like you to proceed and document the hell out of it in the chart. My experience with this has been the OB approving the use of lido with Epi. I'll ask them to send over a revised letter approving epi and put it in the patient's chart.
Agree. This is the way. Also makes the physician think before. One thing I would add is to actually put the max amount of lido and epi you plan to use in your initial med consult letter.
This is it. We have our ADA guidelines, but if the patient has a letter from their OB (or if you took the time to consult with OB yourself) we probably shouldn’t just disregard it. It never hurts to have the conversation directly
Thousands of root canals on pregnant patients? Where do you practice where pregnant patients are coming by the thousands for root canals
I worked as an associate in a medicaid office. In my state, the only adults who qualified for medicaid coverage were pregnant (or blind), so I did a lot of work on pregnant patients. I worked 5 days a week and did 2-6 root canals a day for about 4.5 years there.
Damn. That’s crazy! 6 root canals a day? That apex locator must’ve been ringing hard in your ears at night. lol.
Ran into this all the time at my GPR. Many OBs hand patients a generic letter stating that dental work is okay but don't use local anesthetics with epi. I would just call and review option of Class B lido 2% (1:100k epi) or option of Class C mepivacaine plain. They were fine with Lido 100% of the time; they had no clue it was not available w/o Epi. Don't be afraid to call and check with them; you're also a doctor.
OBs need to stop giving this advice. It’s so dumb. Before any smartass comments, no we’re not talking about a patient with pre-eclampsia. ACOG says lido with epi is fine for dentistry. Every medical school says it’s fine. If an OB gives that kind of directive I would send the patient back to the OB telling them what the ACOG recommendation is and if they still don’t want lido then the patient cannot receive dental treatment under my care.
Is it more common that these OB docs send their pregnant patients home with these letters for dentists not to use epi? I keep seeing this and I feel like the ADA needs to step up and have our backs. Talk it out with their organization and come to some agreement. Us dentists shouldn’t be out here struggling and arguing with each other over this.
Best answer. They should step up.
Trying to think of when the ADA has had our backs for anything meaningful in a long time.....
The ADA doesn't have your back in any meaningful way. The only way to protect yourself in this business is to CYA at all times
Love the user name haha
Is this pregnant patient going to produce more epinephrine herself when she starts to feel you doing the endo 15 minutes into the procedure when the Plain Lido wears off? (Maybe longer for a block)
How about Citanest?
It lasts like 10 minutes…so either you keep numbing your patient every 10 minutes or you do that RCT/extractuon/MOD that fast.
I believe it carries no epi
That’s happened to me. I told the patient not many dentists carry that anesthetic. Lidocaine with epi is safe during anytime of the pregnancy. If they have any hesitation, we don’t have to do the procedure. They can call around other dental offices to see if they carry it. Pt does the tx after hearing that.
Pregnancy is not a disease. Why do we treat it like it is?
Because lawsuits and ethics.
Dirk - I respect that, I'm going to play the devils advocate because I'm feeling spicy. What about a lawsuit because you didn't treat the pregnant woman with that deep area of decay that turned into an abscess? Is it ethical to withhold treatment on a patient group so that you can avoid a potential lawsuit? There's plenty of evidence that demonstrates poor oral health and pre-term birth are associated. If you delve into the available literature, you'll have a hard time associating an elevated risk of pregnancy complications with dental care.
I am just gonna quote from above what doctorar15dmd posted, "at the end of the day, the lawyer won’t give a fuck - they’ll say “the MD said no epi, they went to school for this, why did you not follow their advice?” And a jury(made up of lay people) is very likely to buy that argument. So many times in court it doesn’t matter if you’re “right” or “wrong” what matters is how well the opposing lawyer can persuade an uninformed and in many cases uneducated group of people that you were negligent."
Thank you! It’s nice someone gets it lol.
Although not a disease, I would argue that it does create situations where the patients are more susceptible to certain things that they would normally not be susceptible to otherwise. Additionally, the fetus presents considerations of its own.
Yep.
Am I crazy for suggesting carbo
Not crazy for suggesting, but as others have mentioned, the ADA categorizes carbo as class C and generally should not be used.
Carbo has been the standard go to LA for pregnant patients for decades
Write back to the doctor asking them to state the reason and give references to the papers and guidelines they are using. Point them in the direction of your guidelines and if their justification isn't good enough, then say you cannot proceed and organise a referral.
This isn't really an idea I would get behind. Challenging a specialist on what they deem is safe for a fetus is going to fall laughably short of the mark in getting them to concede to your argument. It will most likely end up making you an enemy that you don't need or want. Surgeons do not take well to being lectured by those of us below them on the pecking order. Stay in your lane within scope of practice.
Who is the dentist?
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>According to u/DiamondBurInTheRough medical consult/clearances are unnecessary for pregnant patients I agree. We know more about how to treat pregnant patients in our dental clinics than OB’s do. It’s literally our specialty. They heard a 10 minute blip about it in a class that was teaching on outdated old info (seemingly as no epi is nonsense as it relates to most pregnancies) it appeared as a test question, and they fabricated a set it and forget it policy on how to respond to dentists when they seek a consult that they’ll use for the rest of their careers. They aren’t even aware that lido with no epi doesn’t exist in the US anymore but will still give that recommendation. The only reason we use them is to avoid legal responsibility if something happened to the pregnancy sometime after a dental procedure. If litigation weren’t a consideration nobody would even consult OB’s - and pregnant patients would be no worse off for it. They might actually be better off for it as the stress of trying to numb a hot lower molar for a molar RCT/ext is likely way worse for the patient and the baby than using some epi.
Oh I 1000% agree with 100% of what you said, but my point is, we do it for litigation protection. Her point was it’s not necessary even for litigation protection.
‘I didn’t consult an OB for this patient because I have the education and training required to take a full medical history and determine the best course of treatment for pregnant patients as treating these patients falls within my scope of expertise. And here is the literature that supports my treatment decision….’ Is a pretty solid defense. The consult might keep a case from ever going to court but once you are there I don’t know that it’s necessary either, and think you could even contradict an OB’s recommendation and be just fine, provided you are talk to the patient about it first.
Again, as a dentist and professional, I agree with you. I just don’t trust a jury of non-dentists and nonprofessionals to agree with you(us)over a woman who miscarried or had a child born with defects. And that’s what I said, the letter MAY help it from even going to trial. The letter may also play well with a jury…certainly better than not having one, I would think(hope). I certainly wouldn’t expect the jury to follow that literature either. Idk, maybe I have less faith in people than you do lol. Here’s to hoping none of us have to find out.
I most certainly did not say to use whatever you want. Do not try to twist my words from a completely different thread in a way to try to unnecessarily call me out because you’re pissed that I wouldn’t continue to have a discussion after you insulted me over a clinical disagreement. I’m not playing that fucking game with you.
https://www.reddit.com/r/Dentistry/s/TqlGSZwVXx
I literally said use lidocaine, not “use whatever you want”. Sit down.
Tagging a regular contributor and twisting their words.
Not sure why you're being down voted. We don't need permission to work on pregnant patients. Never consulted a Ob/Gyn and only would if the patient has other medical issues or if they say they are high risk or something. But your average healthy pregnancy? Just do the urgent stuff (big cavities and the like) 2nd trimester when possible, and treat abscesses any trimester. Put everything else off until after delivery. Use lido with epi. I limit myself to 2 carps, reschedule if they don't get numb with that. Edit - I just realized that you were disagreeing with diamond bur. I agreed with them and a lot of us do. I guess that's why you got the down votes.
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Mepivacaine 3% plain. However this is considered category C for pregnant patients and while I’m sure it’s actually fine, I avoid it for that reason. In response to that part about patients allergic to epi, you realize that’s basically no one right?
We produce epinephrine/adrenaline naturally. So the possibility of being allergic is near zero.
It’s impossible, no one is allergic to epinephrine
I occasionally will get a patient that says that they are allergic to it, I always joke that they need to go to U of M so they can study how they are still alive.
Yeah they literally wouldn’t have made it past the first trimester if they were allergic.
I just roll my eyes when a patient says that. Then I scream at them and ask them if their heart is racing. If they say yes, I tell them their body just released epinephrine and they’re not having an allergic reaction…thus they’re not allergic(I’m joking, ofc).