What are we waiting for? Most dentists are afraid to make the all-important choice to treat or not treat when it comes to a pregnant woman. Science has shown us the importance of treating women even before they become pregnant since we can provide them with a health benefit no other physician can. We are not supplying the best treatment when we are not treating or speaking about the oral systemic and we must.
Let learn from an open letter to all oral physicians…
Dear Dentist- Thank you for being there for patients around the world, fixing and cleaning their teeth and gums. Thank you for your training and your wonderful set of skills which we all need. But today I have a bone to pick with you. For the one thousandth time today, I was asked to write a note for a patient with an obviously infected tooth, giving my permission for you to treat her. For the one thousandth time, I sat before my suffering patient, cursing your name, and wrote this ridiculous note. And now my patient can go back to you, and now you can do the job you should have done when she first came to you with her painful tooth. As an obstetrician, I am expected to be expert in all thing’s pregnancy. Not only that, but I am expected to understand how all things not pregnancy affect all things pregnancy. It was for this that I went to medical school and trained long in my field. You are much the same. As a dentist, you are expected to know all things oral cavity, and furthermore how all things not oral cavity affect all things oral cavity. It was for this that you went to dental school and trained long in your field. And in this training, you no doubt learned something about the dental care of pregnant women. You learned that local anesthetics are not harmful to a pregnancy, and that the narcotics you prescribe for pain and the penicillin-based antibiotics you use for infection are also safe. You probably learned that the milliard’s of radiation your oral films use are trivial compared the amount of radiation it would take to harm a fetus, and if you’re really on it you might even know that an obstetrician would do a 3 rad cat scan right through the fetus if he or she thought it was important enough. At the least, you know that the big lead apron you use is going to block anything that might get to the fetus anyway. You might have read that obstetricians are actually quite interested in oral health, and that we think that chronic oral disease may ironically be a contributing factor to the preterm labor you hope to avoid involvement with by refusing to treat oral disease in pregnancy women. At the very least, you know that a fetus is kept in the uterine cavity, not in the oral cavity. Since you already know these things, really what is going on is that you want your ass covered if under some strange coincidence something bad happens to a pregnancy after you treat a patient. This is nonsense, and I am tired of it.
So forevermore, here is a note for all the pregnant ladies of the world.
- There is nothing you can do under local anesthesia that will hurt a fetus.
- Penicillin antibiotics are safe in pregnancy
- Local anesthetics are safe in pregnancy.
- Narcotics are safe in pregnancy.
- Oral x-rays are safe in pregnancy. Shield the baby like you would any patient.
If after reading this you ever again send away a pregnant patient in pain because they need a note from their obstetrician, I have only this to say:
Grow a pair.
You are doing your patient a disservice. Exercise the wonderful skills you spent years cultivating and help your patient.
We hear about the systemic issues and why and how medical insurance should cover certain benefits, but have we bother to hear what our co-partners are saying.