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Endodontic treatments (RCT) During Pregnancy

Although pregnancy is not a contraindication to endodontic treatment, it does


modify treatment planning.
Protection of the fetus is a primary concern when administration of ionizing
radiation or drugs is considered.
Ideally, no drug should be given during pregnancy , especially in first trimesters

Pregnancy

It is a major event in any womans life and is associated with physiological changes
affecting especially the endocrine, heart and blood systems and often attitude,
mood or behavior.
Therefore pregnant women should take extra care during this period to avoid any
circumstances that could harm their fetuses, including certain dental treatments.
The female body undergoes many changes during pregnancy due to hormonal
imbalances. Some of the medical complications of pregnancy can include:

1-Hypertension (A common disorder in which blood pressure remains abnormally


high which is a reading of 140/90 mm Hg or greater) is a dangerous complication
leading to greater threat to both fetus and mother. Hypertensive pregnant women
must therefore rest as much as possible and have anti-hypertensive treatment.

2-Blood hypercoagulability (excessive thickening of blood), which can lead to


venous thrombosis (occlusion of blood vessels), particularly postoperatively or
occasionally to disseminated intravascular coagulopathy (A rare, life-threatening
condition that prevents a persons blood from clotting normally).

3-Anemia (A deficiency of red blood cells). Expansion of the blood volume may
cause an apparent anemia but in about 20%, true anemia develops, mainly because
of fetal demands for iron and folate. Pregnancy may worsen pre-existing anemias,
especially sickle cell anemia.

4- Supine hypotension syndrome. In later pregnancy up to 10% of patients may


become hypotensive (low blood pressure) if laid flat( 3 to 7 min ), when the gravid
uterus compresses the inferior vena cava and impedes blood return to the heart and
may get syncope ..

Pregnancy and Dental Work

Preventive dental cleanings and annual exams during pregnancy are not only safe,
but are recommended.

The rise in hormone levels during pregnancy causes the gums to swell, bleed, and
trap food causing increased irritation to gums.

Preventive dental work while pregnant is essential to avoid oral infections such as
gum disease, which has been linked to preterm birth.

If dental work is done during pregnancy, the second trimester is ideal and safe.
Once patient reach the third trimester, it may be very difficult to lie on dental chair
for an extended period of time and may get syncope.

The safest course of action is to postpone all unnecessary dental work until after
the birth. However, sometimes emergency dental work such as a root canal or tooth
extraction may be necessary.

Elective treatments, such as teeth whitening and other cosmetic procedures,


should be postponed until after the birth. It is best to avoid this dental work while
pregnant and avoid exposing the developing baby to any risks, even if they are
minimal.

Lidocaine is the most commonly used drug for dental work. Lidocaine (Category B)
does cross the placenta after administration.

If dental work is needed, the amount of anesthesia administered should be as little


as possible, but still enough to make your patient comfortable.

Dental work often requires antibiotics to prevent or treat infections. Antibiotics


such as penicillin, amoxicillin, and clindamycin, which are labeledcategory B for
safety in pregnancy.

According to the American College of Radiology, no single diagnostic x-ray has a


radiation dose significant enough to cause adverse effects in a developing embryo
or fetus.

Fetal organ development occurs during the first trimester; it is best to avoid all
potential risks at this time if possible.

If non-emergency dental work is needed during the third trimester, it is usually


postponed until after the birth.

During pregnancy, surgical endodontic is normally only considered in the midtrimester and ideally should be avoided

Dental treatment in Pregnancy

Dental treatment is best carried out during the second trimester, but advanced
restorative procedures are probably best postponed until the state of the gums
improves after giving birth and prolonged sessions of treatment are better
tolerated.

In the second and third trimesters the fetus is growing and maturing but can still
be affected by infections, drugs and possibly other factors.

In the third trimester the supine hypotension syndrome may result if the pregnant
woman is laid flat.
The person should therefore be put on one side to allow blood return to recover.
Some pregnant women also have a hypersensitive gag reflex. Elective dental care
should be avoided in the last month of pregnancy, as it is uncomfortable for the
patient.

LOCAL ANESTHESIA

Routine dental treatment of pregnant women under local anesthesia, for example
extraction of teeth, is safe from the second trimester on wards but unnecessary
drugs should be avoided.

Some specific anesthetics have been recommended and approved by the FDA in
case the patient undergoing the root canal treatment is pregnant women.

Nonetheless, the anesthetics that endodontist administer are safe for conceived
women, still the quantity of anesthesia applied to the pregnant women can be a
cause of concern.

In case the administered initial dose is insufficient, you may inject additional
anesthesia enabling the patient feel relaxed.

Incurred pain during treatment stirs the stress, and it could be much more
damaging to the fetus than some more quantity of anesthetic dose

.
Associated Chemicals:

It has been established that neither the cleaning liquid administered during the
treatment i.e. sodium hydrochloride or bleach nor the filing component is
detrimental to the fetus.

Formocresol should not be used with individuals who are pregnant or suspected to
be pregnant.

CONSCIOUS SEDATION

Sedation with diazepam or midazolam are particular hazards and must be avoided
in the first trimester and in the last month of the third trimester of pregnancy.
Nitrous oxide, though able to interfere with vitamin B12 and folate metabolism,
does not appear to be teratogenic(Of or relating to substances or agents that can
interfere with normal embryonic development) though it is advisable to:
restrict use to the second or third trimester,
limit the duration of exposure to less than 30 minutes,
use 50% oxygen,
avoid repeated exposure,
Use scavenging in the dental surgery to minimize staff exposure.

Drugs

Drugs may be teratogenic and should therefore be avoided where possible,


especially in the first trimester.

Many women are unaware of being pregnant in the early part of the first trimester
and therefore it is preferable for women of childbearing age to avoid taking any
drugs, unless absolutely essential.

Aspirin and other NSAIDs may cause closure of the ductus arteriosus in the uterus,
and fetal pulmonary hypertension as well as delaying or prolonging labor and
therefore are contraindicated in the third trimester.

Aspirin, in addition, causes a platelet defect and may induce abortion and is best
avoided throughout pregnancy.

Corticosteroids can suppress fetal adrenals and if taken, a steroid cover is needed
for labor.

X-RAYS OR RADIOGRAPHS

Radiography should be avoided, especially in the first trimester, even though


dental radiography is unlikely to be a significant risk unless the beam is directed to
the fetus.

When an apron is used in dental radiography, gonadal and fetal exposure is


negligible.

It has been estimated that two periapical dental X-rays give an exposure less than
that due to natural radiation for 1 day. Nevertheless, of radiography is essential,
patients must wear a lead apron and exposure must be minimal.

MRI (magnetic resonance imaging) is best avoided during the first trimester.

To perform a successful root canal, we must have a good understanding of the


severity of the infection and the internal layout and shape of the associated tooth
and the related canals.

As per statement of the American College of Radiology, no x-ray used for


diagnostic purpose has such radiation dose prominent enough to impact the
growing fetus or embryo adversely.

In addition, the x-rays are directed to the mouth not the abdomen. Still to be in the
safe side, even we generally provide the patient with a lead cover to avoid x-rays
approaching the abdomen.

ADC and FDA, states that dental radiograph procedures do not need to be altered
because of pregnancy when a lead apron( apron with thyroid color) is use during
dental radiographic procedures, the amount of radiation received in the pelvic
region is nearly zero . the embryo or fetus receives no detectable exposure with the
use of a lead apron

Although scientific evidence indicates that dental x ray procedures can be


performed during pregnancy, many dentists and pregnant patients prefer to post
pond such x-ray procedures because of patients concern.

LACTATION and Dental drugs

Since drugs may pass in the breast milk from mother to fetus, care should be taken
in their use.
Drugs should preferably be taken by the mother immediately after breast feeding,
so that milk levels of the drug is low as possible at the next feed.
Cephalexin is a useful antimicrobial as it is not secreted in the milk.
Fluoride passes into breast milk and of the local water supply contains more than 1
mg/l fluoride, supplements are not indicated for the breast-fed infant.

DRUGS THAT MAY BE USED IN DENTISTRY BUT ARE CONTRAINDICATED IN


LACTATING MOTHERS
Analgesics aspirin (high dose), dextropropoxyphene, diflunisal, indometacin

Antimicrobials tetracyclines, aminoglycosides, co-trimoxazole, fluconazole,


ganciclovir, metronidazole, sulfonamides
Premedication atropine, choral hydrate, beta-blockers
Others antidepressants, barbiturates, etretinate, carbamazepine, corticosteroids
(high dose), povidone-iodine

Risks if Root Canal is Avoided During Pregnancy

In case the endodontist recommends the root canal even after being aware of the
pregnancy status of the patient it means the risks associated with postponing the
root canal are greater than the performing the root canal treatment in pregnancy.
Risks if Case Root Canal is Postponed Due To Pregnancy

Severe Pain: Tooth abscess condition requires immediate root canal treatment and
is generally followed by extreme toothache. Unrelenting pain throughout the phase
of pregnancy can be much more stressful situation that may potentially impact the
mother and child adversely in this critical juncture.

Infection: Tooth infection is the cause that leads to root canal during pregnancy! It
is advisable to treat the infection as early as possible to ward off further
complications even in pregnancy. If it is not treated it can pose threat to the
pregnancy too.

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DR.PANCHAL KUMARE SUMIT .

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