A DOCS Education member writes:
My patient was six months pregnant. Because she suffered from a deep cavity on the mandibular molar it wasn’t prudent to wait until after she’d given birth. While the woman presented in a state of general nervousness she nevertheless handled herself well. However, I do have questions about her experience and would appreciate your comments.
First, I injected one carpule of 4 percent Citanest® Plain (mandibular block without positive aspiration).
After several minutes I followed with a carpule of lidocaine hydrochloride 2 percent 1:100,000 epinephrine. My patient became nauseous and needed to sit up quickly. Next she vomited.
We applied a cool cloth to the woman’s forehead and let her rest briefly. She then wanted to complete the procedure; however, it was again interrupted by episodes of vomiting. We initially attributed these problems to a bout with the flu. But the patient reported later that once the numbing ceased so did the nausea.
After this appointment we again followed up with the patient. She recalled that upon the delivery of her first child she had received Nubain™, and that prompted a similar reaction.
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
Pregnant patients are more prone to nausea and vomiting—period. If we add the apprehension associated with anxious dental patients, the likelihood increases even more. I suggest consulting with her OB-GYN as to what, if anything, they recommend. You may need that advice should you wish to prevent nausea and vomiting during your patient's next appointment.
