Root Canal

INFORMATION FOR WOMEN WHO REQUIRE A ROOT CANAL PROCEDURE DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is a root canal procedure?

The root canals are part of a space inside the tooth that contains neurovascular bundles (each consisting of blood vessels and a nerve) and the dental pulp, which consists of various types of cells that support the tooth. Whereas the part of the space inside the tooth underneath the crown (the part of the tooth that shows outside the gum) is called the pulp chamber, the canal system consists of longer, skinnier chambers that run inside the roots of the tooth, the pointy projections of the tooth that anchor the tooth into the bone. The main root canals are those which continue from the pulp chamber and run lengthwise through the roots, but these main canals also have branches that are smaller and run in various directions; these are called side canals, or accessory canals.

When used in reference to a dental treatment, the term root canal refers to a procedure performed at least on the pulp chamber and the main canals, the number of which usually matches the number of roots in the tooth. Usually, there is one main canal per root and the number of roots usually varies from one to three, depending on the type of tooth (molars have more roots than incisors). There is a great deal of variation in the human population, however, so teeth with four or more roots are fairly common. Generally, the more canals there are inside the affected tooth, the more complicated the needed root canal treatment, and the more training and experience the dentist needs. Thus, while many family/general dentists are trained, qualified, and willing to perform root canal treatment on a tooth with a low number of canals, if you need a root canal procedure on a tooth with a more complex root and canal system, your dentist will very likely refer you to an endodontist, a specialist who works only on the inner parts of the teeth. Once your root canal treatment is complete, youll then have to return to your general dentist to have a permanent crown attached to the treated tooth.

As for why you would need a root canal in the first place, the procedure is needed when the pulp chamber and canals become infected with bacteria. In some cases, this happens because of neglect, for instance, if a person does not go for dental checkups and/or waits too long to seek treatment for a dental carie (often just called a cavity), an infection thats limited to the crown, which the dentist can usually treat by cleaning out the infection and filling the hole with material called composite. However, in many cases, entry of infection into the pulp/canal system is not the persons fault but happens because of certain details of the tooth anatomy that make the inner parts of the teeth prone to infection.

How common is root canal treatment during pregnancy?

Although there have been no major studies quantifying the need for root canal treatment during pregnancy, studies do suggest that pregnant women are almost twice as likely to develop dental caries compared with non-pregnant women. This may have something to do with changes in the immune system during pregnancy, but whatever the reason the high risk for tooth decay during pregnancy indicates that the need for an endodontic procedure is not an unlikely occurrence while you are pregnant. Additionally, pregnancy increases your risk of gingivitis (inflammation of the gums) and other gum diseases, including a tumor-like mass called epulis, because of the increased levels of the hormone estrogen in your blood.

You can reduce your risk by going for regular dental checkups. This includes getting your teeth checked when you are planning a pregnancy to see if anything is going wrong inside the tooth, so you can deal with any problems prior to getting pregnant.

How is an infection of the pulp and canal system diagnosed?

Diagnosis of an infection inside the tooth requiring root canal treatment is made with X-ray imaging. In many cases, prior to taking radiographs, there will be a strong hint that you need a root canal based on odor from the infection (bad breath), and generally the history of things going wrong with a cavity or filling. In addition to enabling the diagnosis itself, X-ray imaging also must be performed during the root canal procedure in order for the dentist or endodontist to check key points of the progress of the procedure, such as the successful removal of the infected material, and especially successful penetration by filling material through the root system without gaps that can enable the infection to return with a vengeance.

Does an infected pulp/canal system cause problems during pregnancy?

Along with causing excruciating pain, an infection in the pulp/canal system of the tooth can expand outward, causing an abscess (a swollen mass full of pus) in the soft tissue surrounding the tooth, and/or infection of the bone. These conditions are potentially fatal. If a root canal procedure cannot be performed or is refused, the only remaining option is to extract the tooth.

As for having a root canal procedure, the main issues for a pregnant woman are her blood pressure, breathing, and the potential for reflux of material in the stomach, all of which relate to the positioning of the woman in the dental chair. When positioned in certain ways that can interfere with the return of blood to the heart, pregnant women are at risk of a drop in blood pressure that can lead to fainting; this can be prevented by elevating the right hip. Growth of the womb puts pressure on the stomach, which can cause whats called gastroesophageal reflux, which can interfere with a dental procedure. The movement of the abdominal contents due to womb growth also puts pressure on the diaphragm that moves up and down when you breathe. The solution to all of this is to keep the woman seated up at the highest angle at which the dentist is able to work, as opposed to reclining her.

Does a root canal procedure cause problems for the baby?

The issues for the developing baby that typically concern parents-to-be are medications that are needed during and after the procedure, and the X-ray imaging. Medications are the focus of the next few sections. As for the X-ray imaging, there is virtually no danger for the baby, for a couple of reasons. First, the dosage of the radiation that you receive is very small, too small to harm your future child, including during the first trimester, when your future child is an embryo and most sensitive to radiation. Second, for imaging small body parts, such as teeth, X-ray beams are extremely narrow, almost as focused as a laser, so only about 1/50,000th of the tiny radiation dosage thats aimed at your teeth even reaches the baby. The baby is exposed to a much higher radiation dosage each day simply as a result of you living on the surface of Earth. Despite this level of safety, dentists typically cover a pregnant patient with a lead apron a precaution that is unnecessary today but is a tradition leftover from an era when X-ray machines used to send out much higher radiation doses and would scatter the X-rays around the room.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the infected pulp and canals
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication for a root canal procedure during pregnancy?

The categories of medication that are needed for root canal treatment consist of pain medication in all cases and in many cases antibiotics and corticosteroids. It is virtu
ally impossible to have a root canal treatment without receiving some kind of medication for pain. Just before, and during the procedure, the dentist will inject a local anesthetic to stop the nerves from the affected tooth from transmitting pain impulses. There are different local anesthetics, but common ones are lidocaine, bupivacaine, and mepivacaine. In the past, there was some concern about some of these drugs, such as mepivacaine, slowing the baby’s heartbeat. This was based on old research, however, and with proper injection techniques it is no longer a concern. Mixed with the anesthetic in the syringe is usually another drug, called epinephrine, which constricts the blood vessels in the region of the injection to help keep the anesthetic from leaving the area. Sometimes people worry about the epinephrine getting into the womans system and causing constriction of the blood vessels supplying the uterus and placenta, but this an issue only if the injection is not done correctly. Nitrous oxide, a gas that is used as an anesthetic sometimes in dentistry, should be avoided during pregnancy.

Once the procedure is finished, you will need pain medication to take by mouth. The anti-pain drugs acetaminophen and paracetamol are considered safe during pregnancy, whereas a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided, particularly near the end of pregnancy, as they can cause early closure of the ductus arteriosis, a passageway that allows blood from the right side of the baby’s heart to flow into the main artery that supplies body tissues, instead flowing into the lungs, during fetal life. A more powerful group of anti-pain medications called opioids is thought to be fairly safe during pregnancy if used for short periods of time, which is exactly how they are following a dental procedure such as a root canal treatment (you are given a small supply to be taken for a few days, as needed).

When it comes to antibiotics, sometimes these drugs are needed, and sometimes not, but when they are needed the dentist wants to be able to kill off bacteria that live inside the teeth. These tend to be the kind of bacteria that can thrive without oxygen, called anaerobes. Several different types of anaerobes can be a problem, so an antibiotic is chosen that protect against all of them. On top of this, it must be antibiotic that is considered relatively safe during pregnancy. This typically makes penicillin and amoxicillin the top choices, along with a drug called clindamycin (often the first choice if a woman is allergic to penicillin). Some drugs from a group called cephalosporins also can be selected.  Additionally, there is a drug called metronidazole that can be used during the second and third trimesters, but not during the first.

Dentists are generally not as comfortable using corticosteroids compared with physicians, but if your provider wants to use this group of medications in connection with your root canal work, gum treatment, or other dental surgery, you should not worry. Not only is the safety of corticosteroids established during pregnancy, but these drugs are often given specifically to reach the developing baby, in cases when a baby might be born too early, in order to speed up the maturation of the baby’s lungs.

Who should NOT stop taking medication for root canal treatment during pregnancy?

Anyone who has major dental surgery, such as a root canal treatment, certain gum treatments, and even after a simple tooth filling, may require some kind of pain treatment. Certainly, during the procedure itself, you must accept local anesthesia, as the reaction of your body to pain from a procedure, and the associated anxiety can be harmful to the developing baby.

What should I know about choosing a medication for my root canal during pregnancy?

You may find Pregistrys expert reports about the individual medications used during a root canal here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my root canal when I am breastfeeding?

Antibiotics and pain medications can be selected based on their safety profile in nursing mothers. Acetaminophen and paracetamol are safe during breastfeeding.

What alternative therapies besides medications can I use to treat root canal during pregnancy?

A root canal procedure cannot be performed on a pregnant woman without anesthesia, and most people will suffer without some kind of pain medication given for a few days after the procedure. Some controversy surrounds the issue of antibiotics during root canal treatment. Generally, it is accepted that antibiotics are needed for many cases, but the practice of giving antibiotics automatically for all cases is less popular today than it was a few decades ago.

What can I do for myself and my baby when I need a root canal treatment during pregnancy?

Cooperate with your dentist and physicians. Once you need a root canal, there is not much that you can do other than to accept the treatment, because avoiding the treatment will keep you in pain, put the tooth at risk, and put you at risk of developing an abscess or a bone infection. That being said, there is a lot that you can do in terms of prevention to minimize the risk that youll need such treatment while pregnant. Keep in mind that you are vulnerable to dental issues while pregnant. If you are not pregnant yet but trying to get pregnant, go for your regular dental checkup. Also, if you are pregnant, go for your checkup as well. If you need a minor treatment, such as a filling for a dental carie, or some type of gum procedure, this can be done fairly easily, but things get more difficult if the problem is not treated early and develops into something bigger.

Resources for dental issues in pregnancy:

For more information about root canal and other dental issues during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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