Radiographs for a Patient Who Is 11 Weeks Pregnant
A 31-year-old woman at 11 weeks' gestation presents as a new patient with a broken filling on #19 and no pain. She has no radiographs from the past four years. The dentist's standard new-patient protocol is a full-mouth series of 18 periapicals plus 4 bitewings. The patient says, "I don't want any x-rays while I'm pregnant - my OB said to avoid them." The dentist is finishing with another patient and has told you, "Get the FMX started, she's fine with a lead apron." The patient is seated, the sensor is on the tray, and she is waiting for you to begin.
1. What do you tell the patient, and what do you do about the conflict between her OB's advice and the dentist's order?
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Explain accurately and without pressure:
- Pregnancy is not a reason to refuse all radiographs. With modern equipment - rectangular collimation, thyroid collar, lead apron, digital sensors - a limited series delivers a dose that is a small fraction of natural background radiation over the same period. If she had pain or swelling, the risk of not imaging an infection can be greater than the risk of the films.
- But nothing is being done today without her agreement. She can consent, consent to a limited series, or decline; declining is a legitimate choice that gets documented as informed refusal.
- Practical middle ground: the dentist examines first, then orders the minimum views needed for #19 - typically one periapical and one bitewing, not 22 films. The rest of the full-mouth series can be deferred until after delivery if nothing urgent appears.
- Her OB: you are not going to argue with her physician, and you do not need to. Offer to have the dentist speak with the OB's office if she wants, and note that the final decision about imaging is the dentist's clinical call made with her consent.
Do not tell her "it's totally safe, don't worry." Over-reassurance is what patients remember when they feel steamrolled.
2. Write what you would expect to see in the chart note for this visit, and explain each element.
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A defensible note contains:
- The patient's statement in substance - that she is 11 weeks pregnant, that her OB advised avoiding radiographs, and that she declined the full-mouth series when offered. Quote her if possible.
- That no radiographs were exposed. Explicitly. An absent exposure that was considered must be recorded, or a reviewer will assume films were taken or that the topic never came up.
- The dentist's revised order - e.g., "PA and BW #19 only, after exam," or "radiographs deferred until postpartum; limited exam." Name who changed the order.
- Clinical findings on exam, including the condition of #19 and whether pulpal or periapical signs were present.
- The plan and the recall - when the deferred images will be taken, and the criteria that would trigger imaging sooner (pain, swelling, a failed restoration).
- Informed refusal, if she declined even the limited views, with the risks discussed.
The reasoning: the record has to answer three future questions - what did the patient tell us, what did we decide, and who decided it. A note that only says "FMX deferred" answers none of them.