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Dental Health and Breastfeeding

As with most professionals, my own included, dentistry seems to lack education on breastfeeding as part of undergraduate training if questions sent to this page exemplify a wider issue. I have tried to provide information for CPD inline with that written for other healthcare professionals.

I have developed this powerpoint presentation on the pharmacokinetics of drugs which dentists may use or prescribe for CPD information in an effort to break down the barriers of continuation of breastfeeding.

I am happy to answer individual questions or training. Please contact wendy@breastfeeding-and-medication.co.uk

In summary:

  • Breastfeeding mothers can have local anaesthetic injections with/without adrenaline and continue to breastfeed as normal
  • Breastfeeding mothers can take analgesics for dental pain and continue to breastfeed as normal
  • Breastfeeding mothers can have antibiotics and continue to breastfeed as normal
  • Breastfeeding mothers can use mouthwashes, gels and liquids for mouth ulcers ( e.g. Anbesol®, Bonjela®, Medijel®, Rinstead®, Iglu®, Orajel®) and fluoride toothpastes e.g. Durophat® and continue to breastfeed as normal
  • Breastfeeding mothers can have dental sedation for procedures and continue to breastfeed as normal.
  • White fillings: In some parts of the UK white fillings are recommended in pregnancy and lactation following an EU Directive (July 2018) but have to be paid for by the patient rather than being part of free NHS treatment. The information states that “These restrictions on the use of dental amalgam aim to help reduce environmental mercury pollution and are not a result of any safety concerns about amalgam fillings for dental patients.” 

https://www.sdcep.org.uk/wp-content/uploads/2018/06/SDCEP-Dental-Amalgam-Information-for-Pregnant-or-Breastfeeding-Patients.pdf

  • Tooth Whitening: There appears to be no information available on the use of tooth whitening agents during lactation. Whilst it is unlikely that any significant transfer of the agents used into breastmilk will take place, if it can be delayed until breastfeeding has finished naturally, that would be preferable but there are many questions from mothers about to get married who dont want to wait. Unless the products spill from the bath in which the liquid is placed, resulting in burns to the mother’s mouth absorption into breastmilk is unlikely.

For information on mercury fillings please see the information from InfantRisk December 2023

https://www.infantrisk.com/content/mercury-dental-fillings

Data suggests that maternal exposure to mercury vapor from dental amalgams or restoration is unlikely to have a significant impact on breastfeeding infants. 

The established baseline for mercury levels in human breastmilk is set at ≥ 1 mcg/L.15 A comprehensive study examining mercury content in breast milk from mothers with dental amalgams revealed a range of mercury concentrations in human milk samples, spanning from < 0.2 to 6.86 mcg/L, with an average of 0.37 mcg/L.16 Studies have demonstrated transfer of mercury from a mother’s bloodstream to her breastmilk. Intriguingly, mercury levels in commercial formula samples displayed a broader spectrum, varying from 0.4 to 2.5 mcg/L on average, which was actually higher than the findings in the collected breastmilk samples.16 

Remember, even if materials from mercury amalgams are orally ingested, elemental mercury is not absorbed from a healthy gastrointestinal tract. If a baby consumes miniscule mercury residues in breastmilk, it is likely that it wouldn’t be absorbed, especially as the baby ages and the GI tract matures. 

Conclusion

Breastfeeding with mercury fillings or after dental amalgam restoration is likely safe and the benefits of breastfeeding outweigh the risks. Extra-cautious mothers could choose not to breastfeed for the first three days post-amalgam restoration, but the difference in infant risk will be miniscule.

Powerpoint training for dental practitioners on the pharmacokinetics of drugs they may use in breastfeeding women

In a report Public Health England have made recommendations on dental health and breastfeeding. Full information can be accessed at : www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health#breastfeeding-and-dental-health

  • dental teams should continue to support and encourage mothers to breastfeed
  • not being breastfed is associated with an increased risk of infectious morbidity (for example gastroenteritis, respiratory infections, middle-ear infections)
  • breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay

Delivering Better Oral Health (PHE, 2014 updated content 2017)4 recommends that:

  • breast milk is the only food or drink babies need for around the first 6 months of their life, first formula milk is the only suitable alternative to breast milk
  • bottle-fed babies should be introduced to drinking from a free-flow cup from the age of 6 months and bottle feeding should be discouraged from 12 months old
  • only breast or formula milk or cooled, boiled water should be given in bottles
  • only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided

Recent systematic reviews such as that by Tham and others (2015)6 included studies where children were breastfed beyond 12 months. When infants are no longer exclusively breast or formula fed, confounding factors, such as the consumption of potentially cariogenic drinks and foods and tooth brushing practices (with fluoride toothpaste), need to be taken into account when investigating the impact of infant feeding practices on caries development. Tham and others (2015) noted that several of the studies did not consider these factors and concluded that with regard to associations between breastfeeding over 12 months and dental caries “further research with careful control of pertinent confounding factors is needed to elucidate this issue and better inform infant feeding guidelines”. Good quality evidence on breastfeeding and oral health is an area with significant methodological challenges which have been outlined by Peres and others (2018)7.

Of course I would also have to highlight that dental procedures, including sedation, local and general anaesthetic and use of antibiotics and analgesics need not interrupt breastfeeding

Powerpoint training for dental practitioners on passage of drugs in breastmilk

See also:

A Guide To Supporting Breastfeeding For The Medical Profession, Amy Brown and Wendy Jones

Smoking cessation and breastfeeding

A while ago, in my previous working life I was a smoking cessation counsellor. I’m sure that there are many who tried to quit as a New Year’s Resolution or are considering a pregnancy and want to quit now or who now find themselves pregnant . I reworked a presentation I gave in Blackpool a few years ago so that it is aimed at women but could also help those helping mothers to quit smoking. Let me know if I can help wendy@breastfeeding-and-medication.co.uk

See also the impact of paternal smoking on breastfeeding https://insightplus.mja.com.au/2023/40/the-impact-of-paternal-smoking-on-breastfeeding

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2023/02/smoking-cessation-and-braestfeeeding-.pdf

Breastfeeding for Professionals – CPD

Back long ago before books and training material, let alone the website, I wrote a training pack for professionals with support from Roberta Roulstone from Peterborough Hospital. She inspired me to share my knowledge and changed my life. Another person who helped with the IT was Sarah Saunby a very great friend who I miss seeing.

This is an up to date version of that training which I have been picking up and putting down for a while. I hope it helps professionals to protect and support breastfeeding whilst adding to their own CPD.

For once I got round to recording it! But have included a link to the powerpoint as some links got covered up in my recording

Breastfeeding for Professionals Powerpoint

Prescribing during breastfeeding for midwives

I had been asked to talk to midwives for an update today but sadly due to timing wasnt bale to do so. But having saved the day I decided to record the talk anyway

Happy to answer any questions wendy@breastfeeding-and-medication.co.uk

This is the handout of the presentation https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/05/Prescribing-during-breastfeeding-midwives-2022.pdf

and the link to the YouTube video which includes my presentation https://youtu.be/L3b43BgeiR8

What would mothers like their healthcare team to know about IBD and breastfeeding?

The next and most personal blog about what what mothers want their professionals to know. Thank you to the members of the facebook page https://www.facebook.com/groups/BreastfeedingIBD for their views.

What would mothers like their healthcare team to know about IBD and breastfeeding?

See also: https://tinyurl.com/33emh32m facebook live video

Breastfeeding and Chronic Medical Conditions, Wendy Jones

Pharmacists and breastfeeding training powerpoint

This is a presentation based on one I deliver to second year pharmacy undergraduate students at Portsmouth University. Hope that it forms the basis of knowledge of why pharmacists should promote and support breastfeeding. Any queries please email me wendy@breastfeeding-and-medication.co.uk . I’m always open to lecturing opportunities

Pharmacists and breastfeeding training powerpoint

If you find this useful, how about buying the book?

UNICEF UK BABY FRIENDLY INITIATIVE LEARNING OUTCOMES PHARMACY STUDENTS

these learning outcomes are aimed at pharmacy students but provide a valuable CPD tool for qualified pharmacists. Please note the link to training materials on this page

Learning outcomes for pharmacy students

Breastfeeding and Medication – are they compatible. GOLD Presentation

still time to register and listen

Prescribing for breastfeeding mothers

I have decided to stop travelling around as much to deliver presentations at conferences. Just feeling a little too jaded and yes I will admit old. But have decided instead to share the contents via this website in the hope that it can spread good practice further and more easily. Happy to answer any questions if you email wendy@breastfeeding-and-medication.co.uk

prescribing for breastfeeding mothers ppt

If you find it useful maybe you would like to buy my book – on Amazon shorturl.at/kpuyI

Breastfeeding for Pharmacists

I am aware that most pharmacists do not receive any training on breastfeeding during their undergraduate studies. My own PhD studies showed that most of us gained our knowledge from our own personal experiences. As breastfeeding is acknowledged as a major public health area I have begun to prepare some training material for professionals – starting with my own. This is intended to provide a basic understanding of how pharmacists and their staff can help to support new mothers as part of their everyday working practice. More detailed presentations will follow on drugs in breastmilk. If you find this useful and want to know more please buy a copy of Breastfeeding and Medication

Breastfeeding and Pharmacy Training ppt

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