Drugs in Pregnancy: Advice for Dentists

Marjorie Jeffcoat, DMD


November 07, 2012

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Oral Care in Pregnancy

In this month's commentary I will address oral care in pregnancy.

Many of you treat pregnant women, and many of you also have questions about what drugs are safe for the dentist to use when treating these women. An expert panel from the National Maternal-Child Oral Health Resource Center at Georgetown University recently addressed these questions.[1] The results of this panel are available online (Oral Health Care During Pregnancy: A National Consensus Statement, but I will cover the highlights here.

One of the most common questions is what to do about antibiotics when patients are pregnant. Some antibiotics, such as penicillin, are safe in pregnancy. However, you should never prescribe a tetracycline in any form (eg, tetracycline, minocycline, doxycycline), whether it is prescribed in pill or topical formulation. None of those are considered safe in pregnancy. Many clinicians don't realize that not only will these drugs stain baby teeth, but they stain the adult teeth as well because the adult teeth form in utero. So, never prescribe a tetracycline in any form to a pregnant patient. Another category of antibiotics that should be avoided during pregnancy is the fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin).

Another common question is whether pain medications can be taken in pregnancy. Dental patients often come to us in pain. The opioid pain medications (codeine, hydrocodone, etc.) are considered relatively safe during pregnancy. Nonsteroidal anti-inflammatory agents, such as ibuprofen, aspirin, and naproxen, are considered safe for short durations (48-72 hours) but should be avoided during the first and third trimesters.

What about mouth rinses? We may not think about it, but mouth rinses actually are drugs. Mouth rinses are used in adults to kill bacteria. The active ingredients (cetylpyridinium chloride, xylitol) are generally safe, but if the rinse contains alcohol, it should not be used by a pregnant woman. Even though the individual spits out most of the rinse, as much as 9%-14% can still be swallowed or absorbed by the patient. So, I prefer to tell my patients to avoid using alcoholic mouth rinses while pregnant.

It is also important to know about the use of anesthetics in pregnancy. Lidocaine and mepivacaine are generally considered safe in pregnancy. Nitrous oxide, although not contraindicated, has been shown to pose risks in pregnancy, and should be used only if other anesthetic agents are inadequate, and only after consultation with the patient's physician. The dentist should consider safe alternatives to nitrous oxide, which can also be dangerous to pregnant members of the dental team. Every effort should be taken to avoid contact with nitrous oxide, including nitrous oxide exhaled by the patient.

The panel that considered these issues was convened by the US Health Resource and Services Administration's Maternal-Child Health Bureau in collaboration with the American College of Obstetrics and Gynecology and the American Dental Association, and coordinated by the National Maternal and Child Oral Health Resource Center. I urge you to read the document in full.[1]