I have never been pregnant. Now that I have presumably lost some credibility with my target audience, let me try to redeem myself. I am a dentist familiar with pregnancy-related dental treatment issues. As an expectant parent, you are particularly concerned about the influence of dental amalgams (silver fillings), radiographs (x-rays), and anesthetics on the developing fetus. How am I doing so far?

Traditionally, dentists have offered conservative treatment options to pregnant women. Today, dental visits during pregnancy are not taboo. Oral infections should be treated immediately because they can rapidly spread throughout the body. Systemic infections can adversely affect the fetus. If you are experiencing pain, emergency treatment and minimal emergency radiographs should be completed immediately. Toothaches usually do not subside without professional intervention! Annual dental exams and routine teeth cleanings are encouraged. However, elective treatment should be postponed until after you give birth. Elective treatment includes most cosmetic dental procedures. Routine radiographs should also be postponed.

Most obstetricians and dentists prefer that dental treatment take place during the second trimester, if possible. Many physicians and dentists agree that dental care during the first trimester should be kept to a minimum. The first trimester is the time when most of the fetal organs are developing. While dental treatment may not necessarily harm these organs, it is best to minimize any potential risk. During the second half of the third trimester, dental care should also be minimized. This is mostly due to the comfort of the expectant mother. When laying back in the dental chair during the late stages of pregnancy, the uterus can place pressure on the inferior vena cava (the main vein which returns blood to heart from the lower extremities). Not only is this uncomfortable, but it can also create a loss of consciousness. If treatment is to be rendered at this time, a shifting in the mother's position must be allowed every 3-7 minutes. In addition, if the situation is stressful (as visiting the dentist can be for some people), premature labor can be induced.

An article that appeared in the May, 1992 issue of the Journal of the American Dental Association (JADA) entitled "Treating the Pregnant Patient: Four Basic Rules Addressed" reviewed a survey of obstetricians. These obstetricians answered questions regarding consultations prior to dental treatment, use of radiographs during treatment, and stress during care. Ninety-one percent of the obstetricians stated that they did not want to be consulted prior to routine dental care, and 56% stated they did not require consultation prior to emergency care. Ninety-seven percent stated that emergency radiographs were acceptable. Only 27 percent asked for consultation prior to use of local anesthetic as it is a commonly used agent and has no documented ill-effects. Obstretricians were most concerned about the use of prescription drugs such as antibiotics and analgesics. A very low percentage of surveyed obstetricians wanted to be consulted prior to administration of local anesthetic. The main concerns are radiographs and certain types of medications which might be prescribed during the course of dental treatment. The antibiotics dentists prescribe, incluing penicillin and its derivatives, are usually fine for the developing fetus.

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