Hamilelik ve Endodonti Arasındaki İlişki
Özet
Gebelik, annede meydana gelen hormonal, immünolojik ve fizyolojik değişiklikler nedeniyle ağız ve diş sağlığının özel bir yaklaşımla ele alınmasını gerektiren hassas bir dönemdir. Bu süreçte gingival inflamasyon, mikrobiyal flora değişiklikleri ve dental dokuların enfeksiyonlara yatkınlığında artış görülebilir. Gelişen diş çürükleri, periodontal hastalıklar ve pulpal patolojiler yalnızca annenin yaşam kalitesini olumsuz etkilemekle kalmayıp, tedavi edilmediğinde fetüs sağlığını da dolaylı olarak tehdit edebilir. Gebelikte endodontik tedavi gereksinimi, artan odontojenik ağrı prevalansı ve pulpal inflamasyona yatkınlık nedeniyle klinik uygulamalarda önemli bir yer tutmaktadır. Ancak gebeliğin trimesterlerine özgü fizyolojik özellikler ve fetal gelişim evreleri tedavi planlamasını etkileyebilmektedir. Birinci trimesterde organogenez nedeniyle konservatif yaklaşımlar tercih edilirken, ikinci trimester endodontik tedaviler için en güvenli dönem olarak kabul edilmektedir. Üçüncü trimesterde ise maternal pozisyonlama güçlükleri nedeniyle acil olmayan işlemler ertelenebilmektedir. Bu bölümde gebelikte endodontik tedavi; hasta pozisyonlaması, radyografik değerlendirme, lokal anestezik seçimi, irrigasyon ajanları ve intrakanal medikament kullanımı açısından güncel bilimsel veriler ışığında ele alınmıştır. Ayrıca FDA ilaç sınıflamaları ve fetal güvenlik konuları tartışılmıştır. Kanıta dayalı veriler, uygun önlemler alındığında endodontik tedavilerin gebelikte güvenle uygulanabileceğini göstermektedir.
Pregnancy is a sensitive period that requires special consideration for oral and dental health due to hormonal, immunological, and physiological changes occurring in the mother. During this period, gingival inflammation, alterations in microbial flora, and increased susceptibility of dental tissues to infection may occur. Dental caries, periodontal diseases, and pulpal pathologies that develop during pregnancy not only negatively affect the mother’s quality of life but may also indirectly threaten fetal health if left untreated. The need for endodontic treatment during pregnancy has an important place in clinical practice due to the increased prevalence of odontogenic pain and a higher susceptibility to pulpal inflammation. However, physiological characteristics specific to each trimester and stages of fetal development may influence treatment planning. Conservative approaches are generally preferred during the first trimester because of organogenesis, whereas the second trimester is considered the safest period for endodontic treatment. In the third trimester, non-urgent procedures may be postponed due to difficulties in maternal positioning. This section discusses endodontic treatment during pregnancy in light of current scientific evidence, including patient positioning, radiographic evaluation, the selection of local anesthetics, irrigation agents, and intracanal medicaments. In addition, FDA drug classifications and issues related to fetal safety are addressed. Evidence-based data indicate that endodontic treatments can be safely performed during pregnancy when appropriate precautions are taken.
Referanslar
Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care during pregnancy. Dental Clinics. 2013;57(2):195-210.
Ramos-e-Silva M, Martins NR, Kroumpouzos G. Oral and vulvovaginal changes in pregnancy. Clinics in dermatology. 2016;34(3):353-8.
Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: what a dentist must know. Oral Health Dent Manag. 2012;11(4):169-76.
Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Maternal and child health journal. 2006;10(Suppl 1):169-74.
Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant patient. Journal of the Canadian Dental Association. 2009;75(1).
Azofeifa A, Yeung LF, Alverson C, Beltrán‐Aguilar E. Dental caries and periodontal disease among US pregnant women and nonpregnant women of reproductive age, National Health and Nutrition Examination Survey, 1999–2004. Journal of public health dentistry. 2016;76(4):320-9.
Christensen LB, Jeppe‐Jensen D, Petersen PE. Self‐reported gingival conditions and self‐care in the oral health of Danish women during pregnancy. Journal of clinical periodontology. 2003;30(11):949-53.
Mahmud S, Begum F, Uddin M. Assessment of common oral and dental diseases among pregnant women at Dhaka City in Bangladesh. Assessment. 2014;2(2).
Cuco G, Fernandez-Ballart J, Sala J, Viladrich C, Iranzo R, Vila J, et al. Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. European journal of clinical nutrition. 2006;60(3):364-71.
Cengiz SB. The pregnant patient: considerations for dental management and drug use. Quintessence International. 2007;38(3).
Ibhawoh L, Enabulele J. Endodontic treatment of the pregnant patient: Knowledge, attitude and practices of dental residents. Nigerian medical journal. 2015;56(5):311-6.
Fenig E, Mishaeli M, Kalish Y, Lishner M. Pregnancy and radiation. Cancer treatment reviews. 2001;27(1):1-7.
Kandan PM, Menaga V, Kumar RRR. Oral health in pregnancy (guidelines to gynaecologists, general physicians & oral health care providers). JPMA-Journal of the Pakistan Medical Association. 2011;61(10):1009.
Richards AG, Colquitt WN. Reduction in dental x-ray exposures during the past 60 years. The Journal of the American Dental Association. 1981;103(5):713-8.
Barak S, Oettinger-Barak O, Oettinger M, Machtei EE, Peled M, Ohel G. Common oral manifestations during pregnancy: a review. Obstetrical & gynecological survey. 2003;58(9):624-8.
Harris M, Desai R, Chuang T, Hood A, Mirowski G. Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions. Journal of the American Academy of Dermatology. 2000;42(6):1012-6.
Edgar WM, O'Mullane D, Dawes C. Saliva and oral health: British Dental Association London; 2004.
Darveau RP, Tanner A, Page RC. The microbial challenge in periodontitis. Periodontology 2000. 1997;14(1):12-32.
Haag D, Peres K, Balasubramanian M, Brennan D. Oral conditions and health-related quality of life: a systematic review. Journal of dental research. 2017;96(8):864-74.
Naseem M, Khurshid Z, Khan HA, Niazi F, Zohaib S, Zafar MS. Oral health challenges in pregnant women: Recommendations for dental care professionals. The Saudi Journal for Dental Research. 2016;7(2):138-46.
Iida H. Oral health interventions during pregnancy. Dental Clinics. 2017;61(3):467-81.
Jiang H, Su Y, Xiong X, Harville E, Wu H, Jiang Z, et al. Prevalence and risk factors of periodontal disease among pre-conception Chinese women. Reproductive health. 2016;13(1):141.
Almeida LHS, Pilownic KJ, Tarquínio SBC, Felix AC, Pappen FG, Romano AR. Influence of pregnancy on the inflammatory process following direct pulp capping: a preliminary study in rats. Brazilian Dental Journal. 2019;30(1):22-30.
Krüger MS, Lang CA, Almeida LH, Bello-Corrêa FO, Romano AR, Pappen FG. Dental pain and associated factors among pregnant women: an observational study. Maternal and child health journal. 2015;19(3):504-10.
Hargreaves KM, Goodis HE, Seltzer S, Bender IB. Polpa dentária de Seltzer e Bender: Quintessence; 2009.
Hahn C-L, Liewehr FR. Update on the adaptive immune responses of the dental pulp. Journal of Endodontics. 2007;33(7):773-81.
de Andrade ED. Terapêutica medicamentosa em odontologia: Artes Médicas Editora; 2014.
Khalighinejad N, Aminoshariae A, Kulild JC, Mickel A. Apical periodontitis, a predictor variable for preeclampsia: a case-control study. Journal of endodontics. 2017;43(10):1611-4.
Luppi P. How immune mechanisms are affected by pregnancy. Vaccine. 2003;21(24):3352-7.
Abbott P. Are dental; radiographs safe? Australian Dental Journal. 2000;45(3):208-13.
ARAÚJO LPd, XAVIER SR, HARTWIG AD, AZEVEDO MS, PAPPEN FG, ROMANO AR. Endodontic treatment during pregnancy: case series and literature review. RGO-Revista Gaúcha de Odontologia. 2022;70:e20220005.
Hemalatha V, Manigandan T, Sarumathi T, Aarthi Nisha V, Amudhan A. Dental considerations in pregnancy-a critical review on the oral care. Journal of clinical and diagnostic research: JCDR. 2013;7(5):948.
Baranwal R, Duggi V, Avinash A, Dubey A, Pagaria S, Munot H. Propolis: a smart supplement for an intracanal medicament. International journal of clinical pediatric dentistry. 2017;10(4):324.
Aboalshamat K, Abdulrahman S, Alowadi J, Al-Mutairy N, Fairak M, Alraithi N, et al. Endodontic treatment in pregnancy: knowledge, attitudes, and practices of dentists and interns in Jeddah, Saudi Arabia. The Open Dentistry Journal. 2020;14(1).
Gamba TO, Visioli F, Bringmann DR, Rados PV, da Silveira HLD, Flores IL. Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review. Imaging Science in Dentistry. 2024;54(1):1.
Aliabadi T, Saberi EA, Tabatabaie AM, Tahmasebi E. Antibiotic use in endodontic treatment during pregnancy: A narrative review. European Journal of Translational Myology. 2022;32(4):10813.
Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. The Journal of the American Dental Association. 2015;146(8):572-80.
Xavier HS, Xavier VBC. Cuidados odontológicos com a gestante: Santos; 2004.
Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clinical pharmacokinetics. 2004;43(8):487-514.
Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. Journal of dental anesthesia and pain medicine. 2017;17(2):81-90.
Kuzekanani M. Latest concepts in endodontic management of pregnant patients. International Journal of Dentistry. 2023;2023(1):9714515.
Markose G, Graham R. Anaesthesia: LA in pregnancy. British Dental Journal. 2017;222(1):3-4.
Zhou X, Zhong Y, Pan Z, Zhang J, Pan J. Physiology of pregnancy and oral local anesthesia considerations. PeerJ. 2023;11:e15585.
Mendia J, Cuddy MA, Moore PA. Drug therapy for the pregnant dental patient. Compendium of Continuing Education in Dentistry (15488578). 2012;33(8).
Referanslar
Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care during pregnancy. Dental Clinics. 2013;57(2):195-210.
Ramos-e-Silva M, Martins NR, Kroumpouzos G. Oral and vulvovaginal changes in pregnancy. Clinics in dermatology. 2016;34(3):353-8.
Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: what a dentist must know. Oral Health Dent Manag. 2012;11(4):169-76.
Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Maternal and child health journal. 2006;10(Suppl 1):169-74.
Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant patient. Journal of the Canadian Dental Association. 2009;75(1).
Azofeifa A, Yeung LF, Alverson C, Beltrán‐Aguilar E. Dental caries and periodontal disease among US pregnant women and nonpregnant women of reproductive age, National Health and Nutrition Examination Survey, 1999–2004. Journal of public health dentistry. 2016;76(4):320-9.
Christensen LB, Jeppe‐Jensen D, Petersen PE. Self‐reported gingival conditions and self‐care in the oral health of Danish women during pregnancy. Journal of clinical periodontology. 2003;30(11):949-53.
Mahmud S, Begum F, Uddin M. Assessment of common oral and dental diseases among pregnant women at Dhaka City in Bangladesh. Assessment. 2014;2(2).
Cuco G, Fernandez-Ballart J, Sala J, Viladrich C, Iranzo R, Vila J, et al. Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. European journal of clinical nutrition. 2006;60(3):364-71.
Cengiz SB. The pregnant patient: considerations for dental management and drug use. Quintessence International. 2007;38(3).
Ibhawoh L, Enabulele J. Endodontic treatment of the pregnant patient: Knowledge, attitude and practices of dental residents. Nigerian medical journal. 2015;56(5):311-6.
Fenig E, Mishaeli M, Kalish Y, Lishner M. Pregnancy and radiation. Cancer treatment reviews. 2001;27(1):1-7.
Kandan PM, Menaga V, Kumar RRR. Oral health in pregnancy (guidelines to gynaecologists, general physicians & oral health care providers). JPMA-Journal of the Pakistan Medical Association. 2011;61(10):1009.
Richards AG, Colquitt WN. Reduction in dental x-ray exposures during the past 60 years. The Journal of the American Dental Association. 1981;103(5):713-8.
Barak S, Oettinger-Barak O, Oettinger M, Machtei EE, Peled M, Ohel G. Common oral manifestations during pregnancy: a review. Obstetrical & gynecological survey. 2003;58(9):624-8.
Harris M, Desai R, Chuang T, Hood A, Mirowski G. Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions. Journal of the American Academy of Dermatology. 2000;42(6):1012-6.
Edgar WM, O'Mullane D, Dawes C. Saliva and oral health: British Dental Association London; 2004.
Darveau RP, Tanner A, Page RC. The microbial challenge in periodontitis. Periodontology 2000. 1997;14(1):12-32.
Haag D, Peres K, Balasubramanian M, Brennan D. Oral conditions and health-related quality of life: a systematic review. Journal of dental research. 2017;96(8):864-74.
Naseem M, Khurshid Z, Khan HA, Niazi F, Zohaib S, Zafar MS. Oral health challenges in pregnant women: Recommendations for dental care professionals. The Saudi Journal for Dental Research. 2016;7(2):138-46.
Iida H. Oral health interventions during pregnancy. Dental Clinics. 2017;61(3):467-81.
Jiang H, Su Y, Xiong X, Harville E, Wu H, Jiang Z, et al. Prevalence and risk factors of periodontal disease among pre-conception Chinese women. Reproductive health. 2016;13(1):141.
Almeida LHS, Pilownic KJ, Tarquínio SBC, Felix AC, Pappen FG, Romano AR. Influence of pregnancy on the inflammatory process following direct pulp capping: a preliminary study in rats. Brazilian Dental Journal. 2019;30(1):22-30.
Krüger MS, Lang CA, Almeida LH, Bello-Corrêa FO, Romano AR, Pappen FG. Dental pain and associated factors among pregnant women: an observational study. Maternal and child health journal. 2015;19(3):504-10.
Hargreaves KM, Goodis HE, Seltzer S, Bender IB. Polpa dentária de Seltzer e Bender: Quintessence; 2009.
Hahn C-L, Liewehr FR. Update on the adaptive immune responses of the dental pulp. Journal of Endodontics. 2007;33(7):773-81.
de Andrade ED. Terapêutica medicamentosa em odontologia: Artes Médicas Editora; 2014.
Khalighinejad N, Aminoshariae A, Kulild JC, Mickel A. Apical periodontitis, a predictor variable for preeclampsia: a case-control study. Journal of endodontics. 2017;43(10):1611-4.
Luppi P. How immune mechanisms are affected by pregnancy. Vaccine. 2003;21(24):3352-7.
Abbott P. Are dental; radiographs safe? Australian Dental Journal. 2000;45(3):208-13.
ARAÚJO LPd, XAVIER SR, HARTWIG AD, AZEVEDO MS, PAPPEN FG, ROMANO AR. Endodontic treatment during pregnancy: case series and literature review. RGO-Revista Gaúcha de Odontologia. 2022;70:e20220005.
Hemalatha V, Manigandan T, Sarumathi T, Aarthi Nisha V, Amudhan A. Dental considerations in pregnancy-a critical review on the oral care. Journal of clinical and diagnostic research: JCDR. 2013;7(5):948.
Baranwal R, Duggi V, Avinash A, Dubey A, Pagaria S, Munot H. Propolis: a smart supplement for an intracanal medicament. International journal of clinical pediatric dentistry. 2017;10(4):324.
Aboalshamat K, Abdulrahman S, Alowadi J, Al-Mutairy N, Fairak M, Alraithi N, et al. Endodontic treatment in pregnancy: knowledge, attitudes, and practices of dentists and interns in Jeddah, Saudi Arabia. The Open Dentistry Journal. 2020;14(1).
Gamba TO, Visioli F, Bringmann DR, Rados PV, da Silveira HLD, Flores IL. Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review. Imaging Science in Dentistry. 2024;54(1):1.
Aliabadi T, Saberi EA, Tabatabaie AM, Tahmasebi E. Antibiotic use in endodontic treatment during pregnancy: A narrative review. European Journal of Translational Myology. 2022;32(4):10813.
Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. The Journal of the American Dental Association. 2015;146(8):572-80.
Xavier HS, Xavier VBC. Cuidados odontológicos com a gestante: Santos; 2004.
Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clinical pharmacokinetics. 2004;43(8):487-514.
Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. Journal of dental anesthesia and pain medicine. 2017;17(2):81-90.
Kuzekanani M. Latest concepts in endodontic management of pregnant patients. International Journal of Dentistry. 2023;2023(1):9714515.
Markose G, Graham R. Anaesthesia: LA in pregnancy. British Dental Journal. 2017;222(1):3-4.
Zhou X, Zhong Y, Pan Z, Zhang J, Pan J. Physiology of pregnancy and oral local anesthesia considerations. PeerJ. 2023;11:e15585.
Mendia J, Cuddy MA, Moore PA. Drug therapy for the pregnant dental patient. Compendium of Continuing Education in Dentistry (15488578). 2012;33(8).
