DENTAL SPEAK : Should a tooth be extracted during pregnancy?

A middle-aged lady in her thirties, lean yet stoic, and with a pleasant demeanour said as she came into the dental surgery, “Doctor last year when I was expecting my first baby I had a badly decayed molar in my upper jaw. It had a very sharp point that was pressing against the cheek on the left side.

When I lifted my tongue I could feel the razor-like feature of the upper molar. I was in my seventh month of pregnancy. The dentist was a lady and coincidentally she was, after having conversed with her, also in her seventh month.

It was a matter of inner faith with which the lady dentist had chosen not to extract my tooth. Instead, what she did was to inject local anaesthetic around the rotten tooth after which the jutting and piercing portion of the molar was rounded off by a bur in the hand piece. This had resulted in ulceration of both. With the molar ledge smoothened out there was no longer any discomfort. I just continued without paying any attention to the site.

The lady doctor had prescribed me a painkiller and told me, ‘Like you, I would not like to remove my tooth in the seventh month of pregnancy. You can remove it without any complication after the delivery of your child’. I had thus not had any pain. However, it is more than thirteen months since I delivered. The same tooth has surfaced slightly. It is not so harsh or prickly as it was before. I would be grateful if you would kindly carry out the same manner of treatment that was performed by the lady dentist”.

The dental surgeon (DS) examined the site. The patient’s description of the tooth was apt. However, the tooth in reality was the remnant of the second premolar covered by the gums. It was actually the portion of two fused roots. The adjacent molar had been extracted two years back. The second molar had a pulp exposure.

The DS prepared the patient. He said, “I will not follow the line of treatment suggested by you. Instead, you have two matters to attend to. The first being removal of the afflicted molar, after which you need to think about root canal treatment (RCT) of the second molar. There is going to be a waiting period of ten to fourteen days after the removal of the root. RCT will commence then. There will be three sittings for the rct. After a rest of two days the molar will be cut and shaped up to receive a ceramic crown. The RCT as well as the fixation of crown on the molar will take fifteen days.

The patient did not wince. A ceramic crown was the end result. The patient chose to remain with the space of the first molar. She was averse to two of her teeth being cut for the bridgework. On the day of the placement of the crown the patient asked a pertinent question: “Could I have removed that tooth while I was in the seventh month of pregnancy?”

The DS entered into a conversation with the patient: “The first trimester (one to three months of pregnancy) is a period of the development of the foetal organs. The three to eight weeks of this phase is critical with regard to differentiation of the organs. Preferably dental procedures should be avoided in the first trimester. Women may not be aware of their pregnancy for one to two months. It is safer and better to avoid prescribing any drugs to women of childbearing age. The foetus undergoes growth and maturation during the second and third trimester (seventh to ninth month). It is not advisable to have any dental treatment during the third trimester because of the risk of premature birth. The best time for carrying out dental procedures is during the second trimester (four to six months of pregnancy). Advanced surgical procedures should wait two to six months after the baby is born. With regard to your question, you could have removed your carious tooth. It would have been safer to do so in the second trimester then”.

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A famous dental surgeon (DS) salvaged the status of two fractured upper central incisors of an even more famed artist who was involved in a car accident. Upon recovery from the traumatic experience, the artist gratefully commissioned a portrait of the DS. At the unveiling ceremony the portrait turned out to be the DS’s face adorned in the centre of a large incisor tooth. After the ceremony a newspaper reporter asked the DS what he was thinking of at the time of his felicitation. The DS replied candidly, “I’m glad I’m not a gynaecologist!”

Both the gynaecologist and the dental surgeon, working in areas which are widely spaced apart, are wedded to actively promote the health and well being of their patients, entry and exit points notwithstanding.