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by Marjorie Greenfield, M.D.
reviewed by Laura Jana, M.D., F.A.A.P.
Pregnant patients (and some dentists) often wonder what effect--if any--medications will have on them and their babies. Here are some general guidelines for the use of dental medications during pregnancy.
Anesthetics
A good number of dental procedures require anesthesia,
which generally can take place without cause for concern. Local anesthetics
are relatively safe and are preferred over intravenous or inhaled agents
(which may increase the risk of miscarriage in the first trimester). Novocaine
and lidocaine--indeed, all of the "-caines"--can be used. Although the
addition of epinephrine to local anesthetics (to make them last longer)
is usually considered safe in pregnancy, women who are given this drug
run a higher risk of some minor birth defects, so it's best avoided. If
your dentist thinks your care requires the use of epinephrine, have her
check first with your obstetric practitioner.
Pain medications
Acetaminophen is believed to be safe throughout
pregnancy. Non-steroidals like ibuprofen generally are considered safe
until around 32 weeks. If stronger pain medications are needed, narcotics
such as codeine or Percodan can be used for the short term (less than a
few weeks). The fetus might be "sleepy" while you're on the medication,
but your metabolism quickly removes the drug from the baby's circulation.
Narcotic use in pregnancy only becomes an issue when:
It takes place long term (months). In such a case,
the baby might experience withdrawal symptoms after birth.
Large dosages are administered during labor, and
the baby is born before your metabolism can remove the drug from the baby's
circulation. These babies can be born sleepy and may require a medication
called Narcan in order to reverse the effects of the narcotic.
It takes place during breastfeeding, which can
make some babies a bit sleepy. This effect isn't severe enough to require
Narcan but might lead to feeding problems.
If you require strong pain medications while pregnant
or nursing, discuss the options with your obstetrician.
Antibiotics
Dentists often prescribe antibiotics to either
treat or prevent an infection. Barring any allergies, the penicillin and
cephalosporin families of medications are safe to take. Erythromycin, though
sometimes hard on the stomach, also is acceptable. Metronidazole (Flagyl),
which is sometimes used for serious abscesses, can be taken during pregnancy
as well. Tetracycline should be avoided because it can affect the teeth
and bones of a developing fetus.
Fluoride
Although fluoride protects developing teeth from
cavities, the use of supplemental fluoride in pregnancy is controversial.
Some studies have shown that children whose mothers received fluoride during
their pregnancies developed fewer cavities; others found no benefit. It's
not known whether fluoride poses any risk to the fetus. As a general rule,
it's best not to take fluoride beyond the small amount added to city water
supplies.