Had an endodontic procedure very early in first pregnancy, looking for reassurance (X-rays, local anesthesia w/ epi, sodium hypo, etc.)

[mapleleafsnjesus]

Hello all! I recently became pregnant for the first time. I conceived on the 13th, so that puts me at about 1 month pregnant?

I already had a temporary filling from a few months ago for a tooth that needed a root canal. The pain came back, so I scheduled the procedure.

Today, instead of having the entire procedure done, the endodontist opted to drill, clean/sterilize, and place another temporary filling until I reached my second trimester.

I had 2 bite wing x-rays done with two "lead blankets." I was given quite a lot of local anaesthetic (lidocaine with epi at 1:100,000). The doctor used sodium hypochlorite (bleach solution) to clean and irrigate the roots before putting in a new temporary filling.

This was a lot for me, and I'm nervous with this being my first pregnancy, and it still being so early on. (My positive test came back at 9 days post ovulation, and I've been testing daily with a steady increase in hCG levels. I'm now at 14 days, and this would be my missed period.)

Any links to research and/or anecdotal advice would be so welcome. Thank you in advance!

 

[neilfern]

@mapleleafsnjesus I can't speak to the dental equipment or drugs given, but I am an x-ray tech, so can talk about the x-rays. I will start with the 'scary' information first, and then the realistic information.

Radiation exposure is what we call a stochastic teratogenic risk to a fetus. It is considered harmful to expose pregnant people to radiation because there is a risk for creating abnormalities. However the risk is stochastic because there is no known threshold at which the risk will occur. We know that as radiation exposure increases the risk increases, but we don't have exact thresholds at which we can say it certainly will increase.

It is generally accepted that the highest risk to a fetus is radiation exposure during the formation of the nuchral cord. That typically begins around week 3 and is completed by week 7. The dentist should not have given you lead to wear, as latest research shows that lead gowns may actually increase the radiation risk.

Now in saying all of that - a bitewing dental x-ray is one of the lowest possible x-ray exposures. They were not directed towards your uterus, but directly away from it. Yes, there is scattered radiation present, but it is very minimal. The likelihood of any danger to your fetus is exceedingly low. I would personally not feel concerned about the risk. So, take a deep breath. Your baby will be fine.

 

[froggtmom]

@neilfern Agree to all of this with a couple additions:

The risk for fetal abnormalities/birth defects only becomes detectable at 0.1 Gy of radiation. That sounds small, but it would take over 10,000 dental xrays directed straight at the uterus to achieve that (that's actually true, that's not just a made up number), and if you did that, the risk would STILL be low.

The lead shielding would NOT increase the radiation in this case. That is an issue with hospital systems that have AEC, and situations where the lead might be in the image. In a dental setting, there's no risk of the lead being up over their face where the image is being taken, and many dental systems don't have AEC anyway. They didn't do anything wrong in this case. As I said above, the radiation to the baby would be low without the lead, but with it, it will be 0. I'm not sure a geiger counter would even be able to see it under the lead.

 

[neilfern]

@froggtmom I agree with your note about AEC, but recent research has shown that lead gown usage in any x-ray can increase dose to the patient. Because the lead covers the body, higher intensity radiation scatter can still enter the body - or enter from areas not covered by lead. However it is attenuated by the body/lead and therefore becomes low energy scatter. It no longer has the energy required to leave the body and pass through the lead covering and is therefore bounced back into the body. That's why there has been a move away from lead usage in many cases.

 

[froggtmom]

@neilfern Interestingly, the lower energy the radiation, the less likely it is to scatter. Lower energies tend to just get absorbed instead. This is even more true in high density materials like lead - you need seriously high energy (higher than any diagnostic unit can even make at the tube) to get a lot of scatter off lead. So really, the lead gown isn't going to reflect anything back into the patient or increase dose that way.

The two reasons the lead gown can increase dose to the patient are through the AEC increasing the technique, and the possibility of needing a repeat image if the lead blocks some important anatomy. Since it offers minimal benefit, they recommended to just stop using it.

I don't mean to be argumentative here, we're both in agreement and here to help OP be confident that she's safe. I'm a medical physicist who also serves as RSO for some hospitals, so this is my thing. I just like to discuss radiation when it comes up!

 

[ctay6318]

@mapleleafsnjesus My understanding is that dentists avoid procedures in the first trimester because it's a liability. The chance of miscarriage in the first trimester is unfortunately high, and so people might associate a miscarriage with dental work if they've had any dental work done before their miscarriage. I don't think there's any actual association, but there are real fears about the distress/liability surrounding a perceived association.

In the third trimester, laying in a chair for hours is a (small) genuine risk. So second trimester is best.

I've had plenty of dental work done while pregnant, including during the first trimester and very early on. It certainly would not be my preference, but all my kiddos have been fine!

Good luck, OP!

 

[rein_29]

@mapleleafsnjesus Congratulations on your pregnancy!

My OB says bite wing X-rays with lead apron are fine in early pregnancy. Dental procedures are safest during the second trimester so that’s when I had my fillings done and I’m probably going to have to get a crown soon also. Sorry you have to get a root canal

 

[mrsmiller]

@mapleleafsnjesus So nearly the exact thing happened to me like the week before I found out I was pregnant. I had a cracked, infected root canal that got x-rayed multiple times, flooded with anesthesia once (didnt work), and then numbed again at an oral surgeon before finally being extracted and having a bone graft put in. I remember sitting in the oral surgeon’s chair and they asked me if I was pregnant and I said “not a chance” lol…….

Anyway all that to say baby is just fine! We had her anatomy scan two weeks ago and everything came back A-ok. Tomorrow I’m getting a fetal echocardiogram due to an underlying high-risk health condition, but it’s standard for all folks with my condition and the docs expect this to turn out fine.

Odds are your tiny one will be just fine

 

[charlotte99]

@mapleleafsnjesus When I was a few weeks pregnant (hadn't found out yet), I went to a chiropractor for lower back pain. Did multiple x-rays and got adjusted. Didn't have any issues with my pregnancy.