Pregnant woman in the first trimester needs multiple exts

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This topic contains 5 replies, has 3 voices, and was last updated by  Poonam Amarawat Sat Jul 27, 2019 05:10 am.

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  • #2076

    Madeleine Zhao
    Participant

    Hi Dr. Reznick,

    I saw a pt this morning. She’s in her 1st trimester of pregnancy and needs multiple exts on both max and mand. I would refer her to OS to get all of them out in one visit. She also requested to be ‘ put to sleep ‘ for the procedure.

    My question is, for pt like this, what does OS do? Is it ok to use IV sedation on pregnant women? Is it ok to take multiple broken teeth out in one visit on pregnant women?

    Thanks,

    Madeleine

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  • #2077

    Dr. Jay Reznick
    Keymaster

    Madeleine,

    We try to avoid any dental treatment during the first and third trimesters of pregnancy and do more elective procedures in the second trimester. In the first, we are concerned mostly with affecting the development of the fetus, and in the 3rd trimester, we worry about inducing premature labor. So, if you can, I would wait until your patient is in her 2nd trimester to do the multiple extractions. If there is a more urgent problem, that cannot wait until then, it can be managed under local anesthesia. We try to avoid general anesthesia or IV sedation because of its effects on the developing baby. If we need to use sedation, the 3rd trimester is the safest. We would do something like this in the hospital, with the baby on fetal monitors.

    As with everything we do, there are no absolutes. We weigh the benefits versus the risks and try to make the best decision for our patients.

    #2078

    Madeleine Zhao
    Participant

    Thanks, Dr. Reznick!

    #3949

    Poonam Amarawat
    Participant

    Hi Dr. Reznick
    If we have to do extraction in first trimester what antibiotics n painkiller are best given to patient so that minimal side effects to patient n fetus..

    #3950

    Dr. Jay Reznick
    Keymaster

    This is a case where you definitely want to work in cooperation with the patient’s OB/Gyn. In the first trimester, there is a risk of miscarriage or fetal injury from medications or the stress of surgery. The second trimester is the safest time to do any procedures. If there is a severe infection that can also adversely affect the fetus, so you always need to weigh the risks against the benefits of any treatment. You should not make this decision on your own. You also need to make sure that the patient understands this.
    If the balance of evidence leads you to remove the tooth now, then penicillin/ amoxicillin is the safest antibiotic, and Tylenol #3 is the analgesic of choice, if plain acetaminophen is not sufficient.

    #3951

    Poonam Amarawat
    Participant

    Thanks , Dr Reznick !

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