Re: April 2001 cover
I was surprised at Dr. Veale’s objection to a topless woman on the cover of Oral Health (Letters to the Editor, June 2001). All I saw was a stunningly beautiful woman and astonishingly beautiful dentistry. Now I find out she’s topless, too. You guys are holding out on me. Please send the rest of my cover.
William E. Turner, DMD, Cert. Esth. FADI
Thunder Bay, ON
Re: The Pregnant Dental Patient, March 2001
The section in the article on “Radiographs” is in itself not incorrect. This section states, however, that “Although it has been noted that radiation exposure to the uterus during a routine dental diagnostic radiograph is minimal, it is most often suggested that radiographs be avoided, if possible, during pregnancy”. This sentence, as worded, could be misleading to some, and may result in reluctance to take necessary dental radiographs.
It should also be noted that the some of the references used in this article may not be appropriate. Reference seven quotes a 1983 paper that advises taking radiographs in the second or early third trimester of the pregnancy, but which does not give a reference to justify such a protocol for dental radiographs. Reference 8 describes the results of a survey of obstetricians, the majority of whom disapproved of “routine” dental radiographs for pregnant patients. The definition of “routine” is not made clear. Also, there is no indication that the obstetricians surveyed understood the differences between dental radiographs and radiographs of other parts of the body which are more likely to pose a risk to the fetus (see below).
In the pregnant patient, it is now better understood that dental radiography does not involve any risk to the fetus.1,2,3 There is no reason, therefore, not to take any dental radiographs that are necessary for diagnosis and treatment. There is more concern for radiographic procedures involving the lower torso.1
It is generally agreed that decisions to take dental radiographs need not be altered because of pregnancy.4 The decision to take radiographs must be based on need, and this is determined by taking a history’ and performing a clinical and intraoral examination.4
If the clinician feels that radiographs are required for a pregnant patient, they should be taken, using appropriate radiation protection measures (i.e., use of a lead apron, high speed film, properly collimated x ray beam). Such measures, however, should be used for all patients.
If there is obvious clinical evidence of trauma, infection, etc., the need for radiographs is generally well understood and accepted by both the dentist and patient. In the absence of active clinical disease or abnormal symptoms in a pregnant patient, some practitioners might suggest deferring radiographs that would normally be prescribed until after the pregnancy is completed. This is probably not advisable; the decision to defer radiographic examination should be the patient’s. If the practitioner advises such deferral, and it is later discovered that the patient had disease, which could have been detected earlier using radiographs, the practitioner may find himself liable.
Dr. Garnet V. Packota President-Elect
Canadian Academy of Oral and Maxillofacial Radiology
Saskatoon, SK
REFERENCES:
1.X-Rays, Pregnancy and You. HHS Publication No. (FDA) 948087. Center for Devices and Radiological Health, Food and Drug Administration, revised 2001.
2.Radiation Protection in Dentistry. Recommended Safety Procedures for the Use of Dental X-Ray Equipment. Safety Code 30. 99-EHD-177. Health Canada, 1999 (revised 2000).
3.Little JW, Falace DA, Miller CS, Rhodus NL. Dental Management of the Medically Compromised Patient. Fifth Edition, St. Louis: C.V. Mosby Co., pp. 436-437, 1997.
4.Guidelines for Prescribing Dental Radiographs. American Academies of Dental Radiology, Oral Medicine Pediatric Dentistry and Periodontology; Academy of General Dentistry; American Dental Association; Food and Drug Administration. Eastman Kodak Company, 1999.
