TREATMENT METHODS FOR GANGRENOUS PULPITIS IN PREGNANT WOMEN

Аннотация

Gangrenous pulpitis is a severe dental condition requiring careful management in pregnant women to ensure maternal and fetal safety. This paper explores diagnostic methods, root canal therapy, conservative treatments, and safe pharmacological interventions. The importance of minimizing stress, using pregnancy-safe medications, and employing alternative techniques such as laser therapy is highlighted. A multidisciplinary approach integrating preventive care and psychological support is essential for optimal outcomes, ensuring effective infection control while safeguarding both maternal and fetal health. Keywords:gangrenous pulpitis,pregnancy, root canal therapy, dental infection, maternal health. Gangrenous pulpitis is a severe dental condition characterized by the necrosis of the dental pulp, leading to infection, pain, and potential complications if left untreated. It is a serious form of irreversible pulpitis, often resulting from untreated caries or chronic inflammation of the pulp. Pregnant women are particularly vulnerable to dental infections due to hormonal changes that affect the immune system, increase blood flow to the gums, and alter the composition of saliva, which can lead to a higher risk of bacterial growth in the oral cavity. Additionally, pregnancy- induced nausea and vomiting can expose teeth to gastric acids, further weakening enamel and making them more susceptible to infections. Treating gangrenous pulpitis in pregnant women requires a careful approach to ensure the safety of both the mother and the developing fetus. The treatment plan must consider the gestational period, the use of safe medications, and the avoidance of any procedures that might induce stress or harm. Due to the complex physiological changes during pregnancy, healthcare providers must work in collaboration to develop an effective yet safe treatment strategy, integrating conservative and pharmacological approaches whileminimizing risks associated with anesthesia, radiographic imaging, and medication use. The first step in managing gangrenous pulpitis in pregnant women is proper diagnosis, which must be conducted with minimal radiation exposure. Radiographic imaging is crucial for assessing the extent of pulp necrosis and the presence of periapical lesions. However, since radiation exposure during pregnancy can pose risks to fetal development, it is essential to use lead aprons and thyroid collars toshield themother and fetus from unnecessary exposure. Digital radiography, which emits lower doses of radiation compared to conventional X-rays, is the preferred diagnostic tool. Clinical examination remains an essential component of the diagnostic process, with symptoms such as spontaneous pain, foul odor from the affected tooth, and purulent discharge being key indicators of gangrenous pulpitis. Once the condition is confirmed, treatment must be initiated promptly to prevent systemic infection, which could pose additional risksduring pregnancy. https://ijmri.de/index.php/jmsi volume 4,issue2,2025 164 The primary treatment option for gangrenous pulpitis is root canal therapy (RCT), which aims to remove the necrotic pulptissue, disinfect the root canals, and seal thetooth toprevent reinfection. RCT is generally safe during pregnancy when performed with proper precautions. The ideal time for endodontic treatment is the second trimester, as the first trimester is a critical period for fetal organ development, and the third trimester poses risks of inducing premature labor due to stress or prolonged positioning of the patient. Local anesthesia is necessary for pain management during RCT, and the use of category B anesthetics such as lidocaine with epinephrine in low doses is considered safe. Epinephrine should be used cautiously, as excessive doses can lead to vasoconstriction, reducing blood flow to the placenta. The use of rubber dams during RCT is essential to prevent the ingestion of debris and medicaments, ensuring patient comfort and safety. The choice of irrigants and intracanal medicaments is another crucial aspect of treatment. Sodium hypochlorite, the most commonly used irrigant, should be used with caution, avoiding excessive concentrations that could cause tissue irritation. Calcium hydroxide, a safe intracanal medicament with antimicrobial properties, is preferred for temporary dressing in pregnant patients, as itpromotes healing and is biocompatible. In cases where RCT is not immediately feasible due to the patient’s condition or gestational limitations, palliativetreatments such as pulpectomy or pulpotomymay be performed to alleviate pain and control infection. A pulpectomy involves the complete removal of the necrotic pulp tissue, while a pulpotomy removes only the coronal pulp, leaving the radicular pulp intact. These procedures provide temporary relief until definitive treatment can be completed. If the infection is severe and spreading, extraction may be considered as a last resort, especially if the tooth is