There are three levels of anesthetic, including general anesthesia, regional anesthesia, sedation (sometimes called monitored anesthesia care), and local anesthesia. Local anesthesia is the most commonly used anesthetic used in a dental office.
As a breastfeeding mother, you’ll probably have to get dental treatment sometime during your breastfeeding journey. You may need to get a minor procedure or even more extensive work done such as a filling, a root canal, an extraction or even a surgical procedure. You may wonder if the local anesthesia that the dentist administers before the treatment is safe to use while breastfeeding and whether you may have to pump and dump.
It’s important for breastfeeding mothers to receive the needed dental work and not to avoid a dental visit out of fear of local anesthesia and its safety for their breastfeeding baby. The complications that can arise if dental complications are left untreated is much more serious than receiving local anesthesia and pain relief medications.
What is local anesthesia?
Local anesthesia is a medicine used to temporarily numb a specific part of your body, so you won’t feel pain during minor treatments or surgeries. Local anesthesia comes in three different forms; local application by means of an ointment, a local injection, or a nerve block. In dentistry, a one-time injection into the nerves is used to numb a certain part of the oral cavity so you won’t feel pain during the dental treatment.
Types of local anesthetics
There are different types of local anesthetics, including Ixyburprocaine, Mepivacaine, Procaine and Benzocaine. All of which are considered compatible with breastfeeding.
Lidocaine is the most commonly used local anesthesia and can be used topically, orally or intravenously. Lidocaine has a very poor oral bioavailability of less than 35%, so any amount that may pass through the breastmilk would not be absorbed by the infant’s gut.
Receiving outdated recommendations
Often, doctors, midwives, dentists and other health professionals may advise a mother to pump and dump their breastmilk for 24-48 hours after receiving local anesthesia or pain relief medications. Although this is very cautious, it’s also very outdated. The clinical trials and reported cases have shown that local anesthesia is in fact found in very minimal amounts in the breastmilk and it’s safe to resume breastfeeding immediately after having dental work done.
Why do they give the wrong information you ask? Sometimes they give outdated information because they’re unaware of the new research and recommendations. Other times, they may not know the answer, so they tend to rather stay on the cautious side of things than to put a breastfeeding mother and her baby in possible danger. This is very noble but may actually harm many breastfeeding journeys.
If you ever need any trustworthy information regarding medications and breastfeeding, contact an International Board Certified Lactation Consultant (IBCLC) or a healthcare professional experienced and knowledgeable in working with breastfed babies.
What does the current evidence say?
The transfer of medications into breastmilk depends on the pharmacological properties of the medication. This includes the protein binding, lipid (fat) solubility, molecular weight, pKa, maternal milk-to-plasma ratio and the half-life of the drug.
In general, medications that are highly lipid (fat) soluble, less protein-bound, have a lower molecular weight, a higher pKa or has a longer half live are associated with greater penetration into breast milk.
The physicochemical properties of local anesthesia, when used neuraxially, are ideal because these large, polarized molecules do not cross easily into the milk ducts.
Lidocaine and Bupivacaine are the most commonly used numbing agents in dental procedures such as fillings, root canals or extractions. According to Dr. Thomas Hale, author of Medications & Mother’s Milk, these local anesthetics doesn’t really show up in a mother’s milk, and the small amounts that may show up will not be absorbed by the infant’s gut.
Does local anesthesia affect milk production or the milk supply?
Many breastfeeding mothers may worry that local anesthesia may affect their milk supply, but there is no evidence of this happening. Many breastfeeding mothers go for dental treatment every day without any issues. In fact, it is highly encouraged that they keep going to their routine dental visits to avoid any complications in the first place.
The reason why it may seem that local anesthesia may affect the milk supply is because fasting before sedation is often required and breastfeeding mothers need a certain amount of calories and good hydration levels for an adequate milk supply. If a breastfeeding mother has inadequate intake of calories and hydration, the supply may dip temporarily. It’s important to note that is only temporarily, and as she starts eating, drinking and breastfeeding again, her supply will pick right back up again. If not yet on solid food, ensure that you eat high caloric soft foods.
The potential risks of local anesthesia
Premature or sick infants may be more vulnerable and sensitive to medications taken by the mother. So local anesthesia or the pain medications used after dental care may be a potential risk to these vulnerable babies. It’s important to discuss your specific situation with a healthcare professional experienced and knowledgeable in working with breastfed babies.
When local anesthesia is topically applied to the nipple or breast, the infant may digest it which could potentially be toxic. Therefore, this is not recommended.
The real risk with dental treatment is the pain relievers that the dentist may prescribe to you. Pain medications such as Codeine and Tramadol although used successfully in many cases, are not recommended for breastfeeding mothers.
Most medications used for oral, and IV sedation are considered compatible with breastfeeding.
Nitrous oxide (laughing gas) sedation is also considered to be compatible with breastfeeding. It is virtually insoluble in the bloodstream. “it is rapidly eliminated from the body due to rapid exchange with nitrogen via the pulmonary alveoli (within minutes). A rapid recovery generally occurs within 3-5 minutes. Ingestion of nitrous oxide orally via milk is unlikely.”- Dr Thomas Hale.
Furthermore, if general anesthesia is required, that is also considered compatible with breastfeeding. Many mothers give birth under general anesthesia and breastfeed right after birth every day. Just make sure to let your medical and anesthetic team know that you’re a breastfeeding mother so I can provide breastfeeding safe medications for you before, during and after the surgery.
Overall, the evidence shows that local anesthesia is completely safe to take for breastfeeding mothers and there is no need to interrupt breastfeeding. You can immediately continue breastfeeding after your dentist appointment.
If you’d like more information and support on medications and their safety while breastfeeding, contact an International Board Certified Lactation Consultant (IBCLC) or any of your healthcare providers or healthcare team experienced and knowledgeable in working with in breastfed babies.
Be sure that when you make your dental appointment, that you let the dental office and the anesthesia providers know that you’re a nursing mother.
Even with local anesthesia and pain medications, human breast milk will still be the superior option for your breastfed infant.