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    Oh, by the way ...Should I have dental work done while I'm pregnant?


    Sharon T. Phelan, MD
    As you finish a routine prenatal visit on Ms. Torres, a 26-year-old G2P1 at 28 weeks' gestation with an uncomplicated pregnancy, she asks "Oh, by the way, I cracked a tooth and I think I'll need a crown, maybe even a root canal. Can either be done while I'm pregnant?"

    OVER THE PAST FEW YEARS there has been more emphasis placed on dental care and status as it pertains to overall health. In fact, poor dental hygiene is associated with an increased risk of cardiovascular disease, rheumatoid arthritis, and other medical concerns. The proposed mechanism is likely an inflammatory process.

    A number of recent studies have also linked periodontal disease to preterm labor, low birthweight, or both, although the exact relationship is unclear.1 A case–control study, for instance, found that women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm births or term births. However, the periodontal disease was not associated with selected markers of upper genital tract inflammation.2 In addition, early nonsurgical periodontal care during pregnancy does not seem to decrease the occurrence of preterm delivery or low birthweight.3 So the research to date does not suggest a cause-and-effect relationship between poor dental status and poor pregnancy outcomes.4

    Nonetheless, poor dental status, especially caries and/or broken teeth, can cause pain and interfere with nutritional intake, which is reason enough for ob/gyns to encourage pregnant patients to have necessary dental work done.

    Here are a few suggestions that may make the experience less problematic for both the patient and her dentist, given the advanced pregnancy:

    • Patients like Ms. Torres will clearly need an anesthetic for the procedure. Local injection is preferred since inhalation anesthesia can place her at more risk of aspiration. Pregnant women must always be treated as if they have a full stomach. Being supine with inhalation anesthesia will require her to be truly NPO to minimize this risk.
    • This procedure will take some time, even with a very experienced dentist. Lying flat on her back in a dental chair for this long may precipitate supine postural hypotension. This can be very alarming for both patient and dentist. The patient should be told to bring a small sofa throw pillow that she can place under one hip or the other to tip her large pregnant uterus off the vena cava. This should minimize the occurrence of a hypotensive episode.
    • If antibiotics are required, tetracycline should not be used.
    • X-rays may be taken of the tooth as necessary. Ideally the abdomen should be shielded.

    MANY DENTISTS ARE APPREHENSIVE about treating an obviously pregnant woman. It often facilitates her care to write a letter to the dentist outlining the above with a statement that it is acceptable to provide this care during the pregnancy. It is actually best, for the overall health of the mother and the pregnancy, to provide the necessary intervention.

    DR. PHELAN, Department Editor, is Professor, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM. A member of the Contemporary OB/GYN Editorial Board, she is an Oral Examiner for the American Board of Obstetrics.

    REFERENCES

    1. Jarjoura K, Devine PC, Perez-Delboy A, et al. Markers of periodontal infection and preterm birth. Am J Obstet Gynecol. 2005;192:513-519.

    2. Goepfert AR, Jeffcoat MK, Andrews WW, et al. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol. 2004;104:777-783.

    3. Michalowicz BS, Hodges JS, DiAngelis AJ, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006;355:1885-1894.

    4. Goldenberg RL, Culhane JF. Preterm birth and periodontal disease. N Engl J Med. 2006;355:1925-1927.

    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.

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