Is tooth extraction permissible in a pregnant patient at 22 weeks gestation?

Tooth Extraction at 22 Weeks Gestation

Yes, tooth extraction is safe and permitted at 22 weeks of pregnancy, with appropriate anesthetic precautions and pain management protocols. 1, 2

Timing Considerations

The second trimester (weeks 14-28) is the ideal window for dental procedures, and 22 weeks falls squarely within this optimal timeframe. 3, 4

• Surgical operations can be safely performed during the first two trimesters of pregnancy 5, 1
• While surgery should ideally be avoided between weeks 3-5 post-conception due to possible neural tube defect associations, anesthesia and surgery are safe if medically indicated during the first trimester 1
• Emergency dental treatment can be performed during any trimester when acute pain or infection is present 3
• All periodontal and oral care, including extractions, can be performed at all gestational ages 4

Anesthetic Management Requirements

Proper anesthetic technique is critical and completely safe when following established protocols: 1, 2

• After 20 weeks gestation, position the patient with left uterine displacement to prevent aortocaval compression 2
• Maintain adequate maternal oxygenation and optimize uteroplacental perfusion throughout the procedure 1, 2
• Multimodal analgesia including regional analgesia techniques, local anesthetic infiltration (such as lidocaine), and judicious opioid use are all safe in pregnancy 1, 2, 3
• Avoid strategies that cause hypoxemia, hypotension, acidosis, or hyperventilation 2

Postoperative Pain Management Protocol

Paracetamol is the first-line analgesic for post-extraction pain: 1

• Paracetamol 975 mg every 8 hours or 650 mg every 6 hours is the recommended first-line regimen 1
• Short-term narcotic use is safe if paracetamol is inadequate 5, 1
• Strictly avoid NSAIDs after 28 weeks gestation (though safe at 22 weeks) because they may cause premature closure of the fetal ductus arteriosus and oligohydramnios, especially if used for >48 hours 5, 1

Diagnostic Imaging

Dental radiographs are safe when necessary: 3

• Diagnostic radiographs may be performed after the first trimester if absolutely necessary, using abdominal shielding 1, 3
• Loco-regional anesthesia and dental x-ray images are not contraindicated for pregnant women 4

Antibiotic Coverage

If infection is present or prophylaxis needed: 3, 6

• Amoxicillin, ampicillin, some cephalosporins, and certain macrolides can be safely prescribed 3
• Antibiotics can be used normally and safely during pregnancy for endodontic and surgical dental treatment 6

Critical Safety Considerations

Key precautions to ensure maternal and fetal safety: 1, 2

• Adequate postoperative pain relief is essential to prevent reactive preterm contractions 2
• Pregnant patients undergoing any surgery should undergo thromboembolism risk assessment, as they are at very high risk for venous thromboembolism 1
• Consider low-molecular-weight heparin and pneumatic compression of lower legs when appropriate for extended procedures 1

Common Pitfalls to Avoid

• Do not delay necessary dental treatment due to unfounded safety concerns - preventive and restorative dental treatment is safe during pregnancy 3, 7
• Do not use NSAIDs for pain management - stick with paracetamol as first-line 1
• Do not position the patient flat on her back - use left uterine displacement after 20 weeks 2
• Many dentists are reluctant to treat pregnant women due to lack of information, but this hesitation is not evidence-based 3, 8