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Looking for resources to educate my dentist...

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  • Looking for resources to educate my dentist...

    Hello,
    I know this topic has been posted about many times, but I was wondering if there is some articles or resources I can show to my dentist who apparently still tells women to pump and dump 24 hours worth of breastmilk after getting a cavity filled and getting lidocaine and epinephrine. I exclusively pump, and it makes me sick to think about dumping 24 hours of my milk down the drain. He claims it’s because epinephrine is expressed in breast milk. My baby is a 2 months old, born full term. I am scheduled to have the cavity/possible root canal done next week and I would really like to bring him something to read so he stops giving moms incorrect information. Thank you in advance!

  • #2
    Anagrant,

    "Lidocaine is an antiarrhythmic and a local anesthetic. There have been many studies done on the transfer of lidocaine into breast milk. All conclude that lidocaine transfer to milk is minimal and probably safe to use during breastfeeding. The dose of lidocaine in dental procedures is minimal and should pose no harm to the breastfed infant. Maternal plasma and milk levels do not seem to approach high concentrations and the oral bioavailability in the infant would be quite low (<35%). The topical application of lidocaine preparations to the nipple is not recommended. Oral doses as low as 100 mg have produced seizures in toddlers. Doses in infants would be much less. For viscous lidocaine (2%) in infants and children less than 3 years of age, no more than 1.25 mL (equivalent to 25 mg) should be applied topically to the skin every 3 hours. Thus topical use to a mother's nipple is potentially hazardous. Following high doses of tumescent lidocaine in liposuction, avoid breastfeeding for 48 hours." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    1.##Zeisler JA, Gaarder TD, De Mesquita SA. Lidocaine excretion in breast milk. Drug Intell Clin Pharm 1986; 20(9):691-693.
    2.##Dryden RM, Lo MW. Breast milk lidocaine levels in tumescent liposuction. Plast Reconstr Surg 2000; 105(6):2267-2268.
    3.##Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand 1999; 43(4):394-397.
    4.##Giuliani M, Grossi GB, Pileri M, Lajolo C, Casparrini G. Could local anesthesia while breast-feeding be harmful to infants? J Pediatr Gastroenterol Nutr 2001; 32(2):142-144.
    5.##Klein JA, Jeske DR. Estimated Maximal Safe Dosages of Tumescent Lidocaine. Anesth Analg. 2016 May;122(5):1350-9.

    Sandra Lovato R.N.
    InfantRisk Center

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    • #3
      Dear Sandra, thank you so much for your response. Do you happen to have any information on epinephrine specifically? He seemed to be primarily concerned with the epinephrine that is used in combination with lidocaine.

      I also wanted to know what is considered the early neonatal period.

      Again, I appreciate your help and time.
      Last edited by Anagrant; 01-31-2020, 11:15 PM.

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      • #4

        Anagrant,

        Epinephrine is rated an L2-limited data-probably compatible."Epinephrine is a powerful adrenergic stimulant. Although likely to be secreted in milk, it is rapidly destroyed in the gastrointestinal tract. It is unlikely that any would be absorbed by the infant unless in the early neonatal period. In addition, it has a half-life of only 2 minutes." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

        Sandra Lovato R.N.
        InfantRisk Center

        Comment

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