Radiography of women who are, or think they may be, pregnant

It is understandable that patients are concerned about X-ray examinations if the patient is a pregnant woman because of fears about damage to the developing child that ionising radiation may cause.  Occasionally, a woman may have an X-ray examination but only later discover she was pregnant at the time.

The important thing to recognise for dental imaging is that for normal dental X-ray imaging (intraoral, panoramic and cephalometric radiography, CBCT), the abdomen is never in the primary X-ray beam.  Some scattered radiation is produced during an X-ray examination, of course, but the level reaching the abdomen is so small that, in accordance with international guidelines, the risk for the foetus is deemed negligible.

Pregnancy should not be a contraindication for an X-ray examination in dentistry and a pregnant woman should be referred to imaging when the dentist assesses that the benefit for the pregnant woman is greater than the potential detriment for the foetus which postponement of imaging until after the birth of the child might result in or if there are no alternative techniques that do not involve ionizing radiation. Urgencies such as dental trauma and toothache are an example of when a dentist might refer a pregnant woman to an X-ray examination. Non-urgent imaging might reasonably be delayed until after the pregnancy is completed.

If a pregnant patient is referred to an X-ray examination of teeth or jaw, the imaging should be carried out in such a way as to minimize the foetus’ potential exposure to radiation. International guidelines even state that there is no need to use a lead protective apron on the pregnant woman’s stomach even in the event of CBCT examinations, where dose levels are usually significantly greater than for conventional dental radiography, but since Croatian regulations still stipulate its use, the foetus will be additionally protected. In addition, the use of a lead protective apron will have a positive psychological effect because it will allay the level of concern of the mother-to-be.

If a patient is pregnant or thinks she may be pregnant, talk to her and provide additional information and advice.

In the waiting room, place a visible written warning: “If you are pregnant or think you may be pregnant or if you breastfeed, please note that ionising radiation may harm the foetus. Contact the dentist for advice.”

When carrying out medical X-ray examinations that involve pregnant patients, it is necessary to consult a medical physics expert regarding the optimization.

For members of staff (dentists, X-ray technicians, or other dental staff) who may be pregnant, there is no reason to stop carrying out X-ray examinations of patients so long as the normal requirements of safe use of X-rays are followed, which will ensure that the annual dose of the foetus until pregnancy is completed does not exceed 1 mSv. No additional protection is needed.