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Safety of Dental Anesthesia During Pregnancy

Use of local dental anesthesia is safe during pregnancy according to the American College of Obstetricians and Gynecologists (ACOG) pregnancy guidelines for oral care.


dental local anesthetic
dental local anesthetic

The ACOG specifically says that patients often need to be reassured that it is safe to use. Thus, that is our purpose here today, to reassure you who is an expecting mother that it is safe to receive all forms of local anesthetic for whatever dental treatment that you need.


Dental treatments where it's safe to receive anesthesia:


In fact it is safe to get these needed procedures done at any stage of the pregnancy. You don't have to wait for the second trimester or until after you give birth to do them. If you're experiencing pain you can have it addressed right at this moment.


Despite dental anesthesia being safe to use while you're pregnant, the ACOG does state that elective procedures should be postponed until after giving birth. This includes cosmetic treatments such as teeth whitening and botox.


The reason dental anesthesia is considered safe

All medications are given a pregnancy risk category by the FDA from category A to category D and X. The safest drug is classified as A while category X should not be used at all. Here is a chart showing the different categories and what they mean.


We also found a scientific study by the Journal of Dental Anesthesia and Pain Medicine, which has all of the local dental anesthetics listed via pregnancy risk categories. It seems like all of them are at least a category C in safety with two of them being a category B. The category B ones are definitely the safer ones and they are Lidocaine and Prilocaine.

Dental Anesthetic

Max Dosage

FDA Pregnancy Risk Category

Lidocaine

500 mg

B

Articaine

-

C

Mepivacaine

550 mg

C

Prilocaine

400 mg

B

Bupivacaine

90 mg

C


The most commonly used local anesthetic in dental offices is Lidocaine, which is a category B drug. There have been no human studies but all animal studies have demonstrated no risk. This is the second safest drug category. It is due to this reason that the ACOG states that it is safe to use it on pregnant women.


Maximum dosage has significant leeway

Another reason why it is safe to use it is because the anesthetics often have a high maximum total dosage prior to overdosing. For instance, you can give a pregnant woman about 500 mg of Lidocaine before it reaches their limit.


Lidocaine anesthetic
Lidocaine anesthetic

The typical carpule of local anesthetic contains about 34-36 mg. For most dental procedures, your dentist only needs to give you about 1-2 doses of it for you to be adequately numb. This means that you're receiving about 76-78 mg of it in total, which is far below the max level.


If you want to get into the nitty gritty of the calculations with maximum dosages, there was a study done by the Anesthesia and Pain Control journal that details it. According to them, each carpule of lidocaine contains about 36 mg.


Dental anesthetics WITH epinephrine

Another often asked question is whether or not your dentist should use local anesthetics on expecting mothers that contain epinephrine which is basically adrenaline. According to the ACOG, it is safe to do so regardless of if it has epinephrine or not.


We would actually like to make a point that dental anesthetics WITH epinephrine is actually safer than those without it. According to the scientific study we listed above, the adrenaline makes it safer for the patient.


What the epinephrine does is that it constricts the blood vessel where it is given locally. This makes the numbing last longer in the area by preventing it from being absorbed into the bloodstream. This makes it safer via two reasons.


Reasons it is safer with epinephrine:

  • Less anesthetic is required to keep the patient numb, thus patient receives less injections in total.

  • Since it gets absorbed into the bloodstream slower, the body can break it down faster. It doesn't overwhelm your body's ability to catalyze it.


Also just in case you missed it, the pregnancy risk categories for the anesthetics INCLUDES epinephrine. In other words, it is perfectly safe to be using it for your dental procedure. In fact, you should ask for it since it is safer with it than without it.


What about Novocaine?

You may be surprised but Novocaine (procaine) isn't really used anymore. It was first invented in 1905 and was widely used then but it has since mostly been replaced by the newer anesthetics. It was mostly around 1948 when Lidocaine became approved by the FDA that it started to become phased out and discontinued.


Procaine (novocaine)
Procaine (novocaine)

However, due to how widely used the name Novocaine was, many patients still refer to it to this day. Your dentist definitely doesn't use it anymore but they'll still call it that so that patients know that it is meant for numbing your tooth!


Takeaway

To reiterate, dental anesthesia is safe to use during pregnancy according to the ACOG. There are also studies which show that most of the local anesthetics are a pregnancy risk category B or C, which is considered relatively safe.


In other words, don't let the thought of it potentially harming your unborn child be the barrier to you receiving the dental care that you need. It won't harm your fetus at all.


Aside from that, it is also very safe to use epinephrine with the local anesthetic. The adrenaline actually makes it safer to use than if you used it without it. Now that's some food for thought!

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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