Is tooth extraction safe at 26 weeks of pregnancy?

Tooth Extraction at 26 Weeks of Pregnancy

Yes, tooth extraction is safe at 26 weeks of pregnancy and should be performed when clinically indicated, particularly for infected teeth, as delaying necessary dental treatment poses greater risks to both mother and fetus than the procedure itself. 1, 2

Optimal Timing and Safety

• The second trimester (weeks 17-28) is the ideal time for dental procedures, including tooth extraction, making 26 weeks an optimal window for treatment. 1
• Emergency dental treatment, including extraction of infected teeth, can and should be performed during any trimester when acute pain or infection is present. 1
• Preventive, emergency, and routine dental procedures are all suitable during pregnancy with appropriate treatment modifications. 3, 2

Critical Indications for Extraction

• Infected teeth require immediate extraction regardless of gestational age, as odontogenic infections can lead to life-threatening complications including brain abscess, sepsis, and maternal death. 4
• Delaying treatment of dental infections during pregnancy has resulted in documented cases of brain abscess requiring multiple surgical interventions, demonstrating that the risk of avoiding treatment far exceeds procedural risks. 4
• Acute pain or infection makes dental intervention absolutely necessary and cannot be deferred. 1

Anesthesia and Medications

• Local anesthetics such as lidocaine are safe during pregnancy and should be used without hesitation for tooth extraction. 1
• Paracetamol (acetaminophen) is safe for post-procedural pain management. 1
• If infection is present, antibiotics such as amoxicillin, ampicillin, cephalosporins, and certain macrolides can be safely prescribed during pregnancy. 1, 5
• Antibiotics during pregnancy are allowed and can be used normally and safely when indicated for dental infections. 5

Radiographic Considerations

• Diagnostic dental radiographs may be performed at 26 weeks if absolutely necessary for treatment planning, as the radiation dose is negligible (<0.01 mGy) and far below the 50 mGy safety threshold. 6, 1
• Dental X-rays with proper abdominal shielding carry negligible fetal radiation exposure of <0.1 mGy. 6
• The risk of missing a serious dental infection far outweighs the negligible radiation risk from diagnostic dental radiographs. 6

Common Pitfalls to Avoid

• Never delay extraction of an infected tooth due to pregnancy concerns—the infection poses far greater risk than the extraction procedure. 1, 4
• Do not avoid necessary dental treatment due to unfounded fears about safety, as this reluctance often stems from lack of information rather than evidence-based risk. 1, 2
• Avoid the misconception that the first trimester is the only "dangerous" period—while organogenesis occurs in the first trimester, the second trimester (including week 26) is actually the safest time for elective procedures. 1
• Do not withhold local anesthesia or appropriate antibiotics when needed, as both are safe and necessary for proper treatment. 1, 5

Procedural Approach

• Position the patient in the left lateral tilt position to avoid vena cava compression during the procedure. 7
• Use standard extraction techniques with local anesthesia (lidocaine). 1
• Prescribe appropriate antibiotics if infection is present (amoxicillin as first-line). 1, 5
• Provide post-extraction instructions including soft diet and proper oral hygiene. 7
• Schedule appropriate follow-up to ensure proper healing and absence of complications. 7