Special populations
Dental Management of Patients with Pregnancy
Pregnancy — trimester required to finalise the recommendation
The safe timing and extent of dental treatment depends on the trimester. Select the trimester below and re-assess.
Emergency vs routine management
If EMERGENCY — what to do
- • Emergency dental care (pain, infection, swelling) must NEVER be delayed in any trimester — untreated infection is a greater risk to mother and fetus.Ref: ACOG Committee Opinion 569 (reaffirmed 2022) — Oral Health Care During Pregnancy
If ROUTINE — what to do
- • Select the trimester to see the routine-care plan.Ref: ACOG Committee Opinion 569 (reaffirmed 2022) — Oral Health Care During Pregnancy
Why this matters
- 1st trimester (weeks 1–13): organogenesis — highest risk of drug/radiation teratogenicity and miscarriage; nausea is common. Emergency care only; defer elective treatment.
- 2nd trimester (weeks 14–27): the SAFEST window — organogenesis complete and the patient is comfortable. Routine and needed elective care can proceed.
- 3rd trimester (weeks 28–40): risk of supine hypotension (aortocaval compression), discomfort and preterm labour. Short appointments; early 3rd trimester for simple care, defer elective care until after delivery.
Clinical precautions
- • Left-lateral tilt / pillow under right hip to avoid supine hypotension
- • Radiographs only if essential, with lead apron & thyroid collar.
- • Lidocaine 2% with adrenaline is safe — aspirate, use the minimum effective dose
- • Paracetamol for analgesia; amoxicillin is the antibiotic of choice
Information & tests to request
- • Which trimester is the patient in? — Trimester determines safety: 1st = organogenesis (emergency only), 2nd = safest window for routine care, 3rd = supine hypotension / preterm risk (short, simple care).
Medications to avoid → safer alternative
- NSAIDs — ibuprofen, diclofenac, naproxen (esp. ≥20 weeks / 3rd trimester)Paracetamol (acetaminophen) 500 mg–1 g, max 4 g/day
Risk of premature closure of the ductus arteriosus, oligohydramnios and delayed labour.
- Aspirin in analgesic dosesParacetamol
Bleeding risk and fetal ductus effects (low-dose aspirin prescribed by the obstetrician should be continued).
- Tetracyclines — doxycycline, tetracycline, minocyclineAmoxicillin (or phenoxymethylpenicillin); if penicillin-allergic: azithromycin or clindamycin
Permanent tooth discolouration and inhibition of fetal bone growth.
- Fluoroquinolones — ciprofloxacin, levofloxacinAmoxicillin or cefalexin
Cartilage / joint toxicity concerns in the fetus.
- Clarithromycin / erythromycin estolateAzithromycin (macrolide of choice) or amoxicillin
Fetal-safety concerns (clarithromycin) and maternal hepatotoxicity (estolate).
- Metronidazole — avoid in the 1st trimester and high-dose regimensAmoxicillin; use metronidazole in the 2nd/3rd trimester only if clearly needed
Theoretical teratogenic concern early in pregnancy.
- Codeine, tramadol and other opioidsParacetamol; short-term opioid only with obstetric advice
Neonatal respiratory depression and withdrawal near term.
- Benzodiazepines — diazepam, midazolam (oral sedation)Non-pharmacological anxiety management; refer for specialist sedation if essential
Associated with neonatal sedation / floppy-infant syndrome.
- Prilocaine with felypressin (Citanest Octapressin)Lidocaine 2% with adrenaline 1:80,000–1:100,000
Felypressin has oxytocic properties; prilocaine linked to methaemoglobinaemia.
- Systemic azole antifungals — fluconazole (high dose), itraconazoleTopical nystatin suspension
High-dose fluconazole linked to congenital anomalies.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Supragingival scaling / polish | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Root canal treatment | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Surgical / bony extraction | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
| Implant placement | MODIFY / CAUTION Pregnancy — trimester required to finalise the recommendation |
References
- ACOG Committee Opinion 569 — Oral health care during pregnancy
- ADA — Pregnancy & dental care
- FDA 2020 — NSAIDs ≥20 weeks
- BNF / SDCEP Drug Prescribing for Dentistry
- ACOG Committee Opinion 569 (reaffirmed 2022) — Oral Health Care During Pregnancy
- FDA Drug Safety Communication 2020 — Avoid NSAIDs in pregnancy at ≥20 weeks
- SDCEP. Drug Prescribing for Dentistry, 3rd ed. (2016, updated 2021)
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.