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Penicillin and Pregnancy

Berlyn Smith

Dental Hygiene Department, South College Nashville

RDH 1310-N30: Dental Pharmacology

Ms. Sarah McKinney

5/31/22
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Penicillin and Pregnancy

The purpose of these articles together is to inform others about penicillin allergy in

pregnancy. The articles will inform and emphasize skin testing, drug challenges, and the

outcomes during pregnancy. The articles will also talk about penicillin allergies and when the

testing took place or the timeline during the pregnancy.

Objective

To study the efficiency and how safe penicillin skin testing and drug challenge during
pregnancy.

Safety and Outcomes

In research from Patel et al. (2022), 136 women were tested for penicillin allergy.

Penicillin was the most common culprit medicine, followed by amoxicillin and then an

undetermined drug. In 91 percent of cases, the index reaction happened more than 5 years ago,

and in 92 percent of cases, the reaction was cutaneous or idiopathic. Furthermore, 131 from 133

patients who received skin testing had ambiguous results, prompting them to advance to

incremental challenges. Penicillin IDC was cleared by all 131 ladies. All but one of the 69

women who received intrapartum beta-lactam antibiotics managed them.

Outpatient penicillin allergy testing

Nerlyne Desravines reported that successful outpatient penicillin allergy testing with a

lower chance of anaphylaxis during pregnancy indicated the practicality of doing allergy testing

in the outpatient context.

Furthermore, patients who participated in this specific study ranged in age from 18 to 55

years old, had gestational ages ranging from 14 to 36 weeks, and were scheduled to give birth
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within the University of North Carolina health care system between the year March 2019 and

March 2020.

52 percent of the 46 women who finished testing were in their second trimester.

Regardless of past self-reports of adverse reactions, 43 of the 46 women obtained a negative test

result. Two of the three people who were confirmed to be allergic to penicillin failed the 10%

oral drug challenge, while the third tested positive for penicillin G after an intradermal test.

Coughing, chest tightness, and skin and oropharynx pruritic set in 30 minutes after the two

women with severe penicillin allergies were given a 10% amoxicillin drug challenge; the article

stated that they also vomited 1 and 2 hours later.

Penicillin Allergy

Penicillin allergy testing would be beneficial for pregnant women who have a

background of allergy to penicillin and with an uncertain reaction

According to new research, the possibility of a serious allergic reaction during pregnancy

can be classified into two different parts (Patel et al., 2022). Women who are GBS-colonized or

have had a cesarean delivery can be safely provided with a cephalosporin if penicillin allergy

testing is still not done or is inaccessible. Secondly, people who are at a relatively high risk of

anaphylaxis or a serious organ or dermal reaction should avoid beta-lactam antibiotics but rather

be given clindamycin or vancomycin, as recommended for GBS colonization.

Comparison

The article titled “Safety and outcomes of penicillin allergy evaluation in pregnant

women” stated that compared to women who did not have a penicillin allergy test, there was no

higher risk of c - section and other pregnancy problems than women who had a penicillin allergy

test. Moreover, the outpatient allergy testing emphasized that symptoms were relieved and both
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women were discharged after an injection of epinephrine. The authors claim that the reported

systemic responses rate of 4% is below the general population, meaning that the sample of this

study may be underestimating the occurrence of systemic responses. Finally, according to Patel's

article, the chance of severe adverse effects during pregnancy might be characterized in several

different ways.

Conclusion

The three articles summarized the topic of penicillin and how it affected pregnancy. One

of the most important topics mentioned in all three articles was allergy testing. Many studies

have shown throughout the article, that a percentage of people are allergic to penicillin while

pregnant. The articles also summarized the outcomes of the adverse reactions of penicillin during

pregnancy.
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Citations

Patel, V., Gleeson, P. K., Delaney, K., Ralston, S. J., Feldman, S., & Fadugba, O. (2022). Safety

and outcomes of penicillin allergy evaluation in pregnant women. Annals of Allergy,

Asthma & Immunology : Official Publication of the American College of Allergy,

Asthma, & Immunology, 128(5), 568–574. https://doi.org/10.1016/j.anai.2022.01.032

Pivovarov, J. (2021). Outpatient penicillin allergy testing found safe in pregnancy. OB GYN

News, 56(1), 3. https://link.gale.com/apps/doc/A655088379/HRCA?

u=southcollege&sid=bookmark-HRCA&xid=8cb72bd2

Turrentine, M. A., King, T. L., & Silverman, N. S. (2020). Penicillin Allergy in Pregnancy:

Moving From “Rash” Decisions to Accurate Diagnosis. Obstetrics and Gynecology,

135(2), 401. https://doi.org/10.1097/AOG.0000000000003662

Local Anesthetic in Children

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Berlyn Smith

Dental Hygiene Department, South College Nashville

RDH 1430: Pain Management/Anxiety Control and Medical Emergencies

Ms. Sarah Mckinney

8/16/22
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Local Anesthetic in Children

When it comes to pediatric dentistry, dental anxiety is a significant issue. Due to their

fear of needles, children experience anxiety when receiving local anesthetics. This essay will

discuss and emphasize many techniques for reducing children's anxiety. These include eye

movement distraction, external vibrating devices, and virtual reality. These methods assist

children with their anxiety during the administration of local anesthesia and other treatments

during dental visits.

Eye movement distraction

This study's primary goal is to evaluate the efficacy of eye movement distraction (EMD)

in improving anxiety in children who fear needles during administering local anesthetics in the

dental office.   According to the text, children were instructed to simply close their eyes, take a

few deep breaths, and rotate their eyes alternately in a clockwise and counterclockwise motion.

The children also were directed to use their fingers to note the amount of number of spins

(Tirupathi et al., 2019). When administering LA, the kids were constantly engaged.  However,

Children who were in the control group received typical local anesthetics

treatment. Furthermore, the outcomes of the research included that the FPS-R scores of the

children in the eye movement distraction compared to the control group were lower, which is

statistically significant. In children between the ages of eight to thirteen who are fearful of

needles, EMD as a kind of redirection can be utilized to successfully reduce the anxiety brought

on by intraoral needle prick pain (Tirupathi et al. (2019).

External Vibrating Device

This study's objective was to evaluate the efficiency of counter stimulation and external

vibrating devices on children's anxiety, uncertainty, and sensory abilities during administering
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local anesthetic. Furthermore, because pediatric patients provide established anxiety of sharp and

pointy materials, treatments involving needles are crucial sources of apprehension and fear in

children. Local anesthetic (LA) is a commonly used treatment for treating pain in dentistry.

According to new research, managing the children while treating their dental issues and figuring

out potential coping mechanisms for their dental anxiety should be the first steps in a two-step

session for behavior management of children who has anxiety during dental appointments

(Sahithi et al., 2021). 100 children between the ages of four and eleven whose treatment was

pulpectomy or tooth removal were separated into 2 different groups randomly. The first group

was given a Buzzy device, which is a pain-relieving device that may assist children to

experience less discomfort during injections and other treatments that use needles. Moreover, the

second group was given counterstimulation for a similar reason. After the study, the results

concluded that when children need treatment such as pulp therapy and tooth removal, the Buzzy

device was more effective than counter stimulation in reducing stress and anxiety related to

needles (Sahithi et al. (2021).

Virtual Reality

The focus of this article is on evaluating and analyzing the impact of VR glasses and

traditional behavior strategies to control children's anxiety during pulpotomy. Research from

Dowidar et al. (2022) emphasized that a non-pharmacological method for reducing a children's

anxiety during a dental procedure is virtual reality (VR) glasses. This leads to a study of 20

preschoolers between the ages of four and five that were recruited for the study. The

preschoolers who were selected to participate were separated into different groups. The first

group of individuals was given virtual reality glasses to regulate and distract children. The

second used more traditional behavior management methods. During the dental assessment, the
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first group who was given the VR glasses scored substantially lower on the anxiety rating scale

than the other group. According to the study, the result was VR glasses helped ease preschoolers'

dental fear, particularly during intraoral examinations (Dowidar et al., 2022).

Comparison

When it comes to children, eye movement distraction, an external vibrating device, and

virtual reality all lessen dental fear. Eye movement has been shown to lessen anxiety in children

by diverting their attention. Since they were occupied the entire time, the children were kept

occupied while the local anesthetic was being administered. Additionally, using an external

vibrating device to help children through dental procedures was successful. The vibrating device

distracted children from what was happening.   Finally, children who were having problems with

their dental fear and were receiving dental procedures found that virtual reality was useful.

Children can successfully be assisted in overcoming their fear of needles and dental anxiety

using any one of these three different techniques.

Conclusion

In conclusion, there are numerous ways to lessen stress when receiving local anesthetics

for dental treatments, even if dental anxiety is a significant issue in pediatric dentistry.
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References

Dowidar, K., ElHabashy, L., & Deghady, A. (2022). EFFECT of virtual reality glasses

distraction on the anxiety of preschool children during pulpotomy treatment(randomized

controlled clinical trial). Alexandria Dental Journal, 47(2), 212–219.

https://doi.org/10.21608/adjalexu.2021.70615.1178

Sahithi, V., Saikiran, K. V., Nunna, M., Elicherla, S. R., Challa, R. R., & Nuvvula, S. (2021).

Comparative evaluation of efficacy of external vibrating device and counterstimulation

on child’s dental anxiety and pain perception during local anesthetic administration: a

clinical trial. Journal of Dental Anesthesia and Pain Medicine, 21(4), 345.

https://doi.org/10.17245/jdapm.2021.21.4.345

Tirupathi, S. P., Krishna, N., & Rajasekhar, S. (2019). Eye movement distraction: a new

distraction technique for management of dental anxiety during intraoral local anesthesia

administration in children. International Journal of Clinical Pediatric Dentistry, 12(6),

507–509. https://doi.org/10.5005/jp-journals-10005-1690