Dental Surgery During Pregnancy
Dental surgery is safe and allowed during pregnancy, with the second trimester (weeks 17-28) being the optimal timing for elective procedures, though emergency treatment can be performed at any stage of pregnancy. 1
Timing of Dental Procedures
The second trimester (weeks 17-28) is the ideal window for elective dental surgery because organogenesis is complete and the patient is not yet experiencing the physical discomfort of late pregnancy. 1 However, this does not mean dental surgery should be avoided in other trimesters when clinically indicated.
First Trimester Considerations
- Surgery should ideally be avoided between weeks 3-5 post-conception (gastrulation period) due to possible association with neural tube defects, though anesthesia and surgery are safe if medically indicated during the first trimester. 2
- Emergency procedures for acute pain or infection must be performed regardless of trimester, as untreated dental disease poses greater risks than the procedure itself. 1
Third Trimester Considerations
- Surgical operations can be safely performed during the first two trimesters; in the third trimester, either proceed with surgery or defer until after delivery based on clinical urgency. 2
- After 20 weeks gestation, position the patient with left uterine displacement to prevent aortocaval compression. 3
Anesthetic Management
Local anesthetics are safe throughout pregnancy, with lidocaine being the agent of choice. 1, 4
Key Anesthetic Goals
- Maintain adequate maternal oxygenation and optimize uteroplacental perfusion throughout the procedure. 2, 3
- Avoid hypoxemia, hyperoxia, hypotension, acidosis (hypercarbia), and hyperventilation (respiratory alkalosis). 2
- Multimodal analgesia including regional analgesia techniques, infiltration with local anesthetics, and opioid use on an as-needed basis are all safe in pregnancy. 2
Postoperative Pain Management
Paracetamol (acetaminophen) is the first-line analgesic for mild to moderate pain during any stage of pregnancy. 2, 5, 3
Pain Management Algorithm
- First-line: Paracetamol 975 mg every 8 hours or 650 mg every 6 hours. 5
- Second-line: Short-term narcotic use (morphine preferred) if paracetamol is inadequate. 2, 5
- Avoid NSAIDs after 28 weeks gestation because they may cause premature closure of the fetal ductus arteriosus and oligohydramnios, especially if administered for >48 hours. 2
Common Pitfall
Many dentists unnecessarily avoid treating pregnant patients due to unfounded safety concerns. 1, 6, 4, 7 The evidence clearly demonstrates that preventive, restorative, and surgical dental treatment is safe during pregnancy when appropriate modifications are made.
Diagnostic Imaging
Diagnostic radiographs may be performed after the first trimester if absolutely necessary, using abdominal shielding. 2, 1
- Chest X-ray and imaging with abdominal shielding are safe. 2
- Limit unnecessary exposure to ionizing radiation throughout pregnancy. 2
Medications Safe During Pregnancy
Antibiotics (if infection present)
- Amoxicillin, ampicillin, and certain cephalosporins and macrolides can be prescribed safely. 1
Antiemetics (if needed)
- Ondansetron and metoclopramide may be safely administered, with omission of corticosteroids in the first trimester. 2
Emergency Treatment Protocol
Acute pain or infections necessitate immediate dental intervention regardless of gestational age—emergency treatment can and should be performed during the entire pregnancy period. 1
The risks of untreated dental infection (systemic infection, bacteremia, pain-induced stress) far outweigh the minimal risks of properly performed dental surgery during pregnancy. 1, 7
Thromboembolism Prevention
Pregnant patients undergoing surgery should undergo risk assessment for thromboembolism, as they are at very high risk for venous thromboembolism. 2
- Consider low-molecular-weight heparin and pneumatic compression of lower legs when appropriate. 2