TOOTHACHE DURING PREGNANCY

People always ask what to do if they have  a toothache during pregnancy.  The answer is it depends.  It depends on the severity of the toothache, the stage or pregnancy, and of course the physician and patient's wishes.

Common questions for a toothache during pregnancy:


  • What trimesters are best for treatment?
  • Is the dental anesthetic or other treatment harmful?
  • Pregnancy drug classifications
  • What about dental xrays, radiographs?
  • What about pain medication?

What are the best trimesters for dental treatment?

We normally try to avoid elective dental treatment in the first trimester.  The early third is the best, the main drawback being the patient being comfortable it the chair if she is getting near to the expected delivery date.

That said, if a patient comes in with an acute abscess or other extremely serious toothache during pregnancy, the mom comes first and treatment needs to be rendered.


Is the dental Anesthetic or other dental materials harmful?

Lidocaine is the most common dental anesthetic, and it is classified as a category B (see below), meaning that it hasn't been shown to demonstrate a risk to the fetus.  Also, it is used I a minuscule amount.

Most drugs have been classified into one of the following categories in order to help determine the risk for use during pregnancy.


Pregnancy Drug Classifications:

Most drugs have been classified into one of the following categories (A, B, C, D, X, N) in order to help determine the risk for use during pregnancy.  Categories A and B are probably ok, C you would likely use with caution, and definitely not use any in category D.  As always it is best to check with your physician before using any drugs and to avoid any drugs as much as possible.


Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Category B

animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.


Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks


Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.


Category N

FDA has not classified the drug.


Dental X-rays/Radiographs.

Obviously we try to limit them as much as possible, but with proper lead barrier usage, the amount of radiation from dental xrays is very minimal and doesn't pose a risk to the fetus.  If you are receiving treatment for a toothache during pregnancy, often times it is essential to have at least one dental x-ray before the treatment is begun, in order to make sure the diagnosis and recommended treatment is accurate.

Pain medication

It is always best to check with your physician, but Tylenol is usually about all that is acceptable.  That said, if your toothache during pregnancy is such that you are unable to sleep or function, it probably falls into the category of being an emergency and needs to be treated regardless of what trimester you are in. 


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