The argument regarding whether to perform routine dental work during pregnancy is in a very real way the definition of a "tempest in a teapot." It is akin to a contest between two people to see who can hold his or her hand closest to a fire before getting burned. Sure, they can do it, but why would they want to? The American Dental Association (ADA) (2007) has taken a common-sense approach to the issue. Their recommendation is that emergencies, which almost always require some form of radiography, be handled at any time during pregnancy but that elective procedures be performed only when medically necessary-and during the second trimester. Routine cleanings also should be performed during the second trimester or early in the third trimester. If a patient has periodontal disease or dental complications from some other chronic condition, she should be treated immediately to prevent risk to the fetus. Offenbacher et al (2006) demonstrated in a prospective study that the risks of very preterm births (less than 32 weeks) are potentially caused by the systemic increase in inflammatory chemicals released by the body in response to periodontal disease. A patient with periodontal disease needs to be treated regardless of her gestation.

The question is whether routine care should be provided for a pregnant patient and at what stage during her pregnancy. I would agree with the ADA that routine elective procedures should be performed only during the second trimester and only if medically necessary. Pregnancy is not a long-term, chronic condition, and routine elective procedures can be done at a later time. During pregnancy there are two patients-the mother and her fetus-and we must be concerned about both. Maternal dental treatments, including medications and anesthetics, have an impact on the fetus (Rieken & Terezhalmy, 2006). All the literature seems to agree that there is no direct link between elective procedures during pregnancy and preterm births. My question is, who would like to step forward and be the first documented case to disprove that notion? Is it worth it? There may be times under certain medical conditions when a risk/benefit decision must be carefully weighed. Is pregnancy one of those areas in which it is imperative that a stand be taken? Pregnancy is a short-lived condition, and an elective procedure can be easily performed postpartum, thus eliminating any risk to the fetus. What would be the benefit of performing an elective procedure if one cannot guarantee a healthy pregnancy? In most circumstances, a dentist can easily attain the exact same result in a few months with no risk of potential complications.

There are few clear-cut areas in medicine in which the time for treatment is definitive. The timing of dental care in pregnancy, however, seems to be one. Thus, I go back to my original premise that this argument is a tempest in a teapot and one for which there does not seem to be much of a debate. On one side, we have good rationale that while providing dental care during pregnancy it is unlikely that anything bad will happen. On the other side, when providing only emergency care in pregnancy and delaying elective procedures, we have 100% certainty that nothing will happen-guaranteed. Which side are you on?

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