Ensuring Dental Safety for Pregnant Patients

Managing dental care for pregnant patients is a complex yet crucial responsibility. Dental professionals must navigate treatment choices with caution, especially when prescribing medications. The goal of this article is to provide an evidence-based guide to facilitate safer and more effective treatment plans for pregnant patients.

Revised Drug Pregnancy Categories in Dental Practice

Previously, the FDA provided drug pregnancy categories for healthcare professionals to make decisions about drug therapy. These categories provided a framework for evaluating the risks and benefits of medication use during pregnancy.

In 2015, the Federal Drug Administration (FDA) eliminated the standard pregnancy category letters for prescription medications (A, B, C, D and X). The new recommendations are now in the form of drug labeling that contains increased detail but also increased complexity.

The FDA’s transition from pregnancy category letters to more comprehensive labeling requires dentists to assess medication risks carefully. This change reflects a need for a deeper understanding of medication safety in pregnancy.

Previous FDA Category	Relevance in Dental Practice
A	Generally safe for use. These drugs have been extensively studied in pregnant women, and no increased risk of fetal abnormalities has been identified.
B	May be used cautiously for pain relief and local anesthesia. These drugs have shown no adverse effects in animal studies, but there are limited human studies.
C	Use only if the potential benefit justifies the potential risk. Animal studies have shown adverse effects, but there are no adequate human studies.
D	Avoid use; may have potential adverse effects on the fetus. There is evidence of human fetal risk, but the benefits may outweigh the risks in certain situations.
X	Absolutely contraindicated. These drugs have been shown to cause abnormalities or have a high risk of causing harm to the fetus.

Due to the changes from the FDA, health professionals should no longer be basing their decisions off of the pregnancy categories, but instead be taking a nuanced approach to each medication, and assessing all of the evidence available.

Continuing in this article, we will be summarizing the evidence that we have collected for your convenience.

Medications Commonly Used in Dental Practice

The following table from the 2012 Oral Health Care During Pregnancy Expert Workgroup is particularly helpful as a quick reference when prescribing medications for pregnant dental patients. It provides a concise overview of all of the commonly prescribed medications in dentistry.

Pharmaceutical Agent	Considerations for Pregnant Patients
Analgesics
Acetaminophen	Safe for use during pregnancy. Oral pain is typically managed with non-opioid medications. If opioids are absolutelynecessary, prescribe the lowest dose for the shortest duration (less than 3 days), avoiding refills to reduce dependency risk. Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome.
Acetaminophen with Codeine, Hydrocodone, or Oxycodone
Codeine
Tramadol
Morphine
Aspirin	Avoid use: increased risk of salicylate toxicity in third trimester and premature closure of ductus arteriosus when used after 20 weeks pregnant.
Ibuprofen	Avoid use: increased risk of premature closure of ductus arteriosus when used after 20 weeks pregnant(second and third trimester). If absolutely necessary; may use in lowest doses and duration during first trimester before 20 weeks.
Naproxen
Antibiotics
Amoxicillin	Considered safe for use during pregnancy.
Cephalosporins (eg., cephalexin/Keflex)
Clindamycin
Metronidazole
Penicillin
Ciprofloxacin	Avoid during pregnancy: association between fluoroquinolones and arthropathy.
Clarithromycin
Levofloxacin
Moxifloxacin
Tetracycline	Never use during pregnancy: risk of hepatotoxicity in the mother, the potential for permanent discoloration of teeth in the fetus.
Anesthetics
Local anesthetics with epinephrine (e.g., Lidocaine)	Safe for use during pregnancy.
Nitrous oxide (30%)	Avoid during pregnancy: association with spontaneous abortion.
Antimicrobials
Cetylpyridinium chloride mouth rinse	Safe for use during pregnancy.
Chlorhexidine mouth rinse
Xylitol

Updates Since the Working Group

The above list was published in 2012 by the expert working group and since then additional commentary has been provided on certain medications used in pregnancy.

Nitrous Oxide: It is recommended that pregnant individuals avoid exposure to nitrous oxide. The National Institute of Occupational Safety and Health (NIOSH), recommends exposure limits of N₂O concentrations in dental operations to approximately 25 ppm during analgesia administration.
Meperidine: Meperidine should not be used in pregnant women prior to the labor period, unless in the judgment of the physician the potential benefits outweigh the possible risks. Safe use in pregnancy prior to labor has not been established relative to possible adverse effects on fetal development. Available data with DEMEROL Injection are insufficient to inform a drug-associated risk for major birth defects and miscarriage.
Morphine: Based on the studies reviewed, it is not known if morphine increases the chance for pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).

One case of high heart rate (tachycardia) in a near-term (36 week) fetus was described after a person who was pregnant was given morphine for kidney pain (renal colic). A person using morphine for chronic pain control in their third trimester of pregnancy was observed to have constriction in the blood vessels of the placenta, also known as placental vasoconstriction.
Bupivacaine, Mepivacaine: These local anesthetics should not be used in pregnant women prior to the labor period, unless in the judgment of the physician the potential benefits outweigh the possible risks. Fetal bradycardia with Mepivacaine & Bupivacaine is a potential risk.

Special Considerations in Dental Practice

Timing of Treatments

First Trimester: Avoid non-emergency treatments due to sensitive period of organogenesis.
Second Trimester: Most appropriate for various treatments like tooth extraction, filling, and canal treatment.
Third Trimester: Limited to emergency treatments; prolonged sitting may cause vena cava inferior syndrome.

Types of Treatments

Safe Treatments: Extractions, local anesthetic, root canal treatment, scaling, and root planning.
Emergency Cases: Treat tooth and gingival inflammation promptly to avoid adverse effects on the baby.

The Role of Dentists in Safe Pregnancy

Dentists play a vital role in ensuring the safety of medications prescribed during pregnancy, particularly in dental care. It’s essential to evaluate every medication’s potential impact on both the mother and baby. To assist with this, DentalRx provides an invaluable resource for dental professionals to ensure safe prescribing practices during pregnancy.

In order to help in this endeavour, we have created the mobile and web application DentalRx. Dentists use DentalRx to research medications, including those used in pregnancy, so they may safely prescribe and ultimately provide better patient care.

Play your part with DentalRx

DentalRx provides all of these guidelines and many more dental pharmacology resources in an accessible web and mobile app.

Download Today — Free Forever.

Each prescribing monograph in the DentalRx app features a dedicated section for Pregnancy and Lactation, giving dentists instant access to the most current safety information. Additionally, the app provides specific guidelines for treating pregnant patients, ensuring that dental professionals can make informed decisions with ease—without the need to search through outdated or unclear resources.

By using DentalRx, dentists can confidently prescribe medications, safeguarding both maternal and fetal health while improving the overall quality of patient care. Ensure the safety of your pregnant patients by integrating DentalRx into your practice today.

Conclusion

Understanding the evidence for medication use in pregnancy and their application in dental practice is a crucial aspect of patient care. The well-being of both the mother and the unborn child depends on the dental professional’s knowledge and judgment. Always consult with healthcare providers and consider alternative therapies when appropriate.

Ensuring Dental Safety for Pregnant Patients

Revised Drug Pregnancy Categories in Dental Practice

Medications Commonly Used in Dental Practice

Updates Since the Working Group

Special Considerations in Dental Practice

Timing of Treatments

Types of Treatments

The Role of Dentists in Safe Pregnancy

Play your part with DentalRx

Conclusion

Resources:

Dry Socket / Alveolar Osteitis Treatment Guidelines for 2024

Common Medical Acronyms and Abbreviations for Dentistry

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Ensuring Dental Safety for Pregnant Patients

Revised Drug Pregnancy Categories in Dental Practice

Medications Commonly Used in Dental Practice

Updates Since the Working Group

Special Considerations in Dental Practice

Timing of Treatments

Types of Treatments

The Role of Dentists in Safe Pregnancy

Play your part with DentalRx

Conclusion

Resources:

Dry Socket / Alveolar Osteitis Treatment Guidelines for 2024

Common Medical Acronyms and Abbreviations for Dentistry

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