Pregnant Patient Wants Implant: Should I Proceed?

Without obstetrician recommendations (in written form) confirming that her pregnancy is not pathological nobody can make this decision and I would no do it either.

It would be best to clear surgery through ob/gyn, but why an implant at 5 if replacing bridge? Seems like overkill. #20 and # 30 look like they need attention.

Would you do it on your wife ?? I would not !! What about the radiation from radiographs ? Was the DPT taken whilst she was pregnant?

Dr Al this is exactly what I thought. Altough apparently periapicals have no effects on the fetus whatsoever I still would not take them for my wife. I certainly would not be taking/prescribing OPG for a pregnant patient. On that basis I would refuse to proceed with implant treatment since x-rays are simply part of the procedure. I happened to have 2 pregnant ladies asking for implants over last month and refused in both cases. SM

This is not emergency case. Please explain to your patient why should do delay or after deliver her baby,so this is a treatment for her at this point. good luck to you Dr. Vaziri from Iran

Dear Dr C, actually if she is more than 3 and less than 7 months pregnant and her OBGYN cleared her , there is no real problem in doing implants per se. Your problem is meds, antibiotics are a mannageable complication and non steroidal antinflamatory meds cant be administered after the 7 1/2 months because it could close the av duvt and induce labour, but with a corredct guidance by her obgyn you should be in the clear. Having said that, one allways consider a pregnant women as a problem waiting to happen, so if its not an urgent thing I would delay. Cheers

Everyone has given sage advice. The possibility of post surgical complications impacting the pregnancy cannot be overstated. For an elective dental procedure the risks far outweigh the benefits. My ObGyn friends have saved lives of both the mother and baby only to be sued when the baby had issues. You get the point.

There is too much potential downside to this case. Do not let the patient dictate your treatment timing. Put on your smooth chair-side manner and convince her to delay. If she won't then just say NO! Let someone else lose sleep over it.

1. speak to the obgyn 2. Is it an emergency? Is it an active infection? If not let it be. 3. Which trimester is she in? If she is in her second, then if she needs to have the work down and the OBGYN clears it, then this is the safest trimester to do at least an extraction. Funny, I just had a patient he is 5 months pregnant and an ACTIVE infection on #13. I spoke with her OBGYN, and using Lido with epi, amoxcillin, and peridex were ok. No Motrin should be given. Tylenol is fine. I was allowed to take an xray, but chose not to. So quite simply, did a simple extraction, preserved the socket, and bonded a composite pontic. Otherwise, without permission from the OBGYN, i would not touch this case and tell her to wait until she finished nursing.

Dear Dr C, Just to ease your mind of some alarming comments: "Radiation Protection 136 European guidelines on radiation protection in dental radiology The safe use of radiographs in dental practice: ----------------------------------------------------------- 3.9. Radiography of pregnant patients As the dose, and therefore the risk to the developing fetus is so low (4), there is no contraindication to radiography of women who are or may be pregnant providing that it is clinically justified. There is no need to use a lead protective apron (4, 48) (See Section 4.5.1). However, the use of a lead apron continues to be recommended (or advised) in some nation-states on the grounds it may reassure the patient."(for reassurance purposes only!!!!!!!!!!!) ------------------------------------------------------------- "This is not an emergency case" by Dr Vaziri: I know a lot of pregnant women who want to have their dental work prior to the delivery of the baby as afterwards they will be too busy with the baby and their time will be limited.So in the patient's point of view this might be an emergency... As for the rest of the procedure I totally agree with Dr Alejandro Berg and his comment (except from the statement that a pregnant patient is an accident waiting to happen). In the end of the day it all depends on your expertise and confidence.If you can be in and out in 45 min - 1 hour (tops) then the possibility of arising complications should be 0%. However if you do not feel confident enough ( and by posting this case I believe that you have your doubts ) I suggest to either delay the procedure or refer her to a more confident dentist . In either cases a written clearance from her ob/gyn and a written INFORMED consent from the patient is fundamental prior to commencing any procedure. I would pay more attention to Dr Carnazza comment, especially the second part. Good preparation ,steady /quick hands and a clear mind(just like in any other case ) will be of fundamental importance in this procedure. Sincerely, Dr Veizi ( Athens, Greece.Currently in London , UK.) PS : I still fail to understand how is the implant placement different from the endodontic treatment of a second maxillary molar....or from a surgical extraction of an abscessed tooth???? Maybe some of you gentlemen can enlighten me!!!!!!Or my wife.........

Dr Vezi, The answer is simple. An implant is elective, an abscessed tooth is emergency. As the lawyers they'll explain it better than I will. There is just no good reason to proceed with treatment until your patient is post partum. I would also consider a bridge 4-6. it just makes sense. Anyone else have thoughts?

The patient's condition has obviously been like this for a long time. What is the rush in doing it now ? What benefit is there for the patient in doing it now? Why risk anything in this day and age in a litigious society. Don't let her dictate to you what you already know is the right thing to do. In 6 months - year you're home free. Good luck. AJ

Dr.C Purhaps, if she insists on dictating the treatment plan, rather than trust your guidance, you would be better off not to treat her.

The planned procedure is clearly elective, as opposed to endodontic treatment or surgical removal of an abscessed tooth. Even in the most skilled hands, implant placement occasionally causes problems such as inflammation, pain and infection, which may require medication for treatment. The golden rule with pregnant women is "avoid all medication if at all possible". Don't put the foetus at risk. Don't do this elective procedure whilst the patient is pregnant. You will never satisfy yourself that you weren't the cause of a deformed baby.

Dear Dr Goldberg, I did not suggest to Dr C to go ahead with the procedure.I simply advised to weight carefully the ups and downs of this case and if he/she does not feel comfortable to refer or delay. Dear Dr Burgess, Again I did not prioritise this case as an emergency, I simply stated what might go on in the patients mind. In the end of the day , I will not let the patient dictate my treatment plan or the lawyers for that matter.We have our own code of ethics and law in dentistry which is evidence based and not FEAR BIASED. I did make my research prior to commenting and still have not found a link between implant placement and pregnancy failure/complications. Maybe you gentlemen know something that I don't.. I have also based my comment on real data from my own dental practice and the interactions/ treatment that I have provided to pregnant women(I still don't have a law suit on my belt from pregnant women but I do have successful treatments and happy patients).It all comes down to the relationship you have with your patient. In any case I think that your opinion is not Biased but dictated from facts that are beyond the science/ethics of dentistry and more based on the fact that we live in a litigious society.Based on that I would advise my colleague Dr C. to consider all the facts and the patients symptoms/desires prior to any treatment he/she decides to provide. The option of referring the patient to a hospital environment where she can be monitored during the procedure is there for you as well or delay and explain to the patient why... With Respect, Dr Veizi.

Dear Dr C and all commenters, I am not a dentist so I'm not going to comment on the implant procedure. I am a medical radiographer with extensive dental imaging skills. So I would like to point out that radiation risks to the developing fetus is really really low ( you are not doing abdominal x-rays, are you?) To remove all doubt, avoid direct (i.e. the abdominal area) radiation during the 1st trimester or use lead apron. We can do chest x-rays on pregnant patients - how big an area do you think we cover?? Worried that an intra-oral radiograph will affect the fetus? You are directing the beam at the tooth in question, yes? If you can get cone-cut from your x-ray unit, the beam is already tightly collimated. Worried that an OPG/DPT is too much radiation fetus-wise? The technique uses a finely collimated, very thin vertical slit beam directed UPWARDS (~7deg) to the back of the head. The rotational movement allows the area to be captured slice by slice (yes, all OPG machines are nothing but glorified scanners). The upward-angulated beam effectively directs the primary beam away from the fetus, unless you intend to position the patient upside-down. Still worried about OPG radiation risks? Send the patient to a medical imaging facility. Let their radiologists and radiographers worry about it. All too often I heard/read about comments on radiation dose but nobody takes into account AREA COVERED. Some pregnant patients travel on flights; the (cosmic) radiation dose from an 8 hour flight is equivalent to a chest x-ray but obviously covers a much larger area. X-ray beams travel in straight lines. If they didn't, no-one should be in the same building as an x-ray machine.Worried about scatter radiation? Get your x-ray unit tested. A finely collimated beam reduces scatter radiation. Speaking for myself, it doesn't matter personally if the patient is my wife, mother, sister, etc. The most important call to make is: taking into account the benefits versus the risks, is the treatment clinically justified? Rather than refusing treatment on the basis of radiation risks, has the needs of your patient been considered and discussed? If it's your patient and you have their detailed case files and declined the treatment, would they go elsewhere to get what they desire? Would they then have to undergo more imaging by the other dentist (to get the same information you already have)? Regards, Jason

I can not think of any reason why this case should be started with a pregnant patient. On the other hand I can think of many reasons why it should not be done. You are in a position where if any thing goes wrong you are very limited with what you can do. Medications are limited and if there should be a less then optimal out come with both the case and or the pregnancy you will be the first one with egg on their face. Don't expect the OB to support you. I agree with Dr. Grossman if the patient is dictating treatment then you need to avoid this patient.

I agree, get her cleared bybher OB. Why the implant for #5, when a new bridge would work just fine. Teeth #20 and 30 are in greater need of treatment. Radiation from PAs are not an issue! Timing of the case is an issue. I would also be concerned with TMJ issues due to the malocclusion.

This conversation is really about risk management. For our younger colleagues I want to point out that having a "clearance" from an ObGyn will not prevent a lawsuit. It probably means you would both be named in a lawsuit. There is no question that you may do this treatment without complications, but not 100% of the time. If there is a problem with the delivery etc it is very likely that the patient's perception will include you in the list of who harmed her baby. You might win the lawsuit but you might not. If you have been involved in a lawsuit before you will probably have a different perspective on all of this. There is a bit of "dentist hubris" in the statement that lawyers will not dictate (or at least influence) your treatment plan. I wish it were not so but it is being realistic.

Elective surgery and the word pregnant, should never be in the same sentence. In our state, Medicaid pays for removal of 3rds for patients, 21 and under, unless they are pregnant (any age). I get a patient referred to my office, weekly from either the dentist or obgyn, suggesting removal of all four asymtomatic wisdom teeth , because it's free. I never proceed with the asymptomatic case. The number one, litigated specialty, is obstetrics and gynecology . Some of the obgyns get mad at me, when I suggest that , free surgery, is not an indication for treatment. Bv

there is nothing called the patients wants you just tell your patient that she has to wait till delivery and thats it

Hi. I had to post. I am not a dentist but a mother who had a tooth implant procedure done after my pregnancy though I could have had it done during my pregnancy. If you think that anything that you do or give to your patient in any slight way could adversely affect the developing fetus, do not participate in that harm. I am pro choice, but when you choose life than you have to support that decision. Some studies show that radiation and antibodies don't harm the fetus. What about doing an accumulative study.? put all the slightly harmful things together and you are harming. Childhood cancer is higher than ever, autism has been linked to the mother's gut flora and antibodies destroy the healthy gut flora. There are many parents who give their kids soda and juice in bottles. Would you?

no one has died because of not having an implant to replace his/her lost tooth. I would keep the root as such and replace it with an implant after her pregnancy.

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