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X-rays and low birth weight

Discussion in 'Dental' started by DcS, Apr 27, 2004.

  1. DcS

    DcS damn the red baron
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    I got this email tonight from the ADA, thought it was pretty interesting. I'm sure we will be hearing more of it in the press soon.


    The Journal of the American Medical Assn. today published a study that indicates a possible link between dental X-rays administered to women during pregnancy and low-birth-weight deliveries. The study falls well short of establishing causality (which the authors concede), but it does credibly and responsibly present the possibility that X-ray exposure of the thyroid area could be linked to low birth weight. Significant media interest is anticipated, given the topic?s broad appeal. The ADA already has responded to an interview request from the Associated Press, and others are likely. The ADA response to the study highlights:The ADA?s longstanding recommendation that dentists use thyroid collars in addition to aprons; and That rather than avoiding dental visits, women should understand the importance of maintaining good oral health during pregnancy for the sake of both the mother?s and baby?s overall health.

    ADAs full response:

    American Dental Association Statement on "Ante Partum Dental Radiography and Infant Low Birth Weight" (JAMA, April 28, 2004)

    Recently published research associating pregnant women?s exposure to dental X-rays with low-weight births reinforces the importance of the American Dental Association?s long-standing recommendation that, in addition to abdominal shielding (e.g., protective aprons), dentists should use thyroid collars on all patients whenever practical to minimize radiation exposure. ADA recommendations for using leaded aprons and collars were first published in 1989 and reinforced in updated guidelines in 2001.*

    The American Dental Association recommends that pregnant women postpone elective dental x-rays until after delivery; however, there are times when an x-ray may be required during pregnancy to help dentists diagnose and treat oral disease.

    Maintaining good oral health during pregnancy can be critical to the overall health of both expectant mothers and their babies. As such, pregnant women should continue to see a dentist regularly for oral exams and professional teeth cleanings. Left untreated, some maternal oral problems can potentially threaten the health of unborn children. For example, studies have shown that pregnant women with severe gum disease may be at increased risk for pre-term delivery. Preliminary follow up studies have shown professional oral health care administered during pregnancy to this at-risk group actually improved pregnancy outcomes.

    Women should inform their dentists if they are pregnant, might be pregnant or plan to become pregnant. Should dental x-rays be required during pregnancy, the American Dental Association recommends that a protective thyroid collar and apron be used, unless specific clinical conditions indicate otherwise.
     
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  3. POOonYOU

    POOonYOU Junior Member

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    does anyone understand the mechanism of how the thyroid is affected by X-rays. i don't understand how being under the X-rays for such little time can be that harmful.
     
  4. DrJeff

    DrJeff Senior Member
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    Let me first start off by saying that I have absolutely no problems whatsoever radiographing a pregnant lady, and have done it when needed many times. I even took a PA of my wife while she was 3 months pregnant and the lead apron and collar in place, and you know what, we had a perfectly normal, 7lb 1oz baby girl 6+ months later.

    I'd guess that what the underlying factor for most of this data is that the pregnant women being radiographed are being treated for an emergency situation (i.e. toothache). And its likely that in general, the cause of the discomfort is neglect of their oral health all along :eek: (The most common visit frequency of the pregnant women that I've radiographed is measured interms of years, not months) Just as you can make the inference that people that loose their teeth due to periodontal disease have shorter lifespans due to systemic neglect, I'd bet that the same inference can be made to pregnant women who are radiographed. We know that generalized systemic neglect by pregnant women cause low birth weight babies (i.e. poor diet, smoking, drug use, etc), and its likely that from this same cohort is the group of pregnant women being radiographed.

    The most important thing that this article should serve to do, is to teach you to be able to objectively, and critically evaluate and article for its scientifc merit, not its media shock value.
     
  5. wise146

    wise146 Senior Member
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  6. dental2008

    dental2008 Member
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    If anyone would read the article very closely, they did not control for possible cofounders, large ones at that. They did not control for smoking and other risk factors. As far as epidemiology goes, this is only one study and more needs to be done before this holds any truth...

    I have a minor in Epidemiology and seen tons of articles like this one: they have alpha errors...which means they find a link when one does not really exisit. I hope in dental school most people will get an epidemiology course so that we as dentist could determine what makes a great and bad article
     
  7. Jack Worthing

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    wow i remember that stuff from stats- and beta error is when you fail to find a link when there really is one (the less serious error). I never thought i'd see that again for a long while

    i do remember though, when shadowing dentists, that x-ray and pregnant women (without protection) never go together. One of the dentists was pregnant and she mentioned this precaution. She had to make sure not to be exposed.

    DrJeff's analysis looks like good sense. A correlation was found between low birthweight and dental radiography on the mothers, but the radiography is not necessarily the causation of the low-birth weights. Especially given the consideration that they are emergency patients- and considering the inherent risk factors in that population.
     
  8. DcS

    DcS damn the red baron
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    I didn't post the article because of its media shock value. I posted it because I thought it would be helpful to any of us who treat patients on a regular basis. You all are aware how much people pick up from the media, and it's nice to be aware of issues to give them a quick, competent response than to not be aware of the issue they bring up. It's nice when a pt will start halfway into this concern to already have read the report, know its shortcomings, and then instill confidence in your patients that you are knowledgeable and up to date with issues. Like the article above said, the author of the study admitted the lack of causality.
     

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