Tooth extraction during pregnancy: what is important to consider

Pregnancy is not a "dental moratorium." Toothache, inflammation, or a broken tooth don't wait nine months, and delaying treatment increases the risks for both mother and unborn child. The good news: current recommendations are clear: emergency dental care, including tooth extraction, is acceptable at any stage of pregnancy, while elective procedures are often more convenient in the second trimester. The key to safety is proper diagnosis, gentle technique, and the correct choice of pain relief and medications.

In this article, we'll explore when a removal is truly necessary and how to understand when it's time to delay; how pregnancy will change the procedure; and why X-rays with shielding and local anesthesia with lidocaine are considered safe. We'll discuss which painkillers and antibiotics are acceptable and which should be avoided; how to sit in the chair in late pregnancy; why it's sometimes necessary to contact an obstetrician/gynecologist; and how to care for the socket after the procedure.

We'll break everything down step by step and include checklists: preparation for your appointment, red flags after the extraction, a mini-pain management plan, and simple rules to reduce the risk of dry socket. Our goal is to provide you with clear, calm, and practical answers so you can receive treatment on time and confidently, without sacrificing comfort and safety.

Briefly: is it possible to remove a tooth during pregnancy?

Yes. Emergency treatment (including extractions, endodontics, and fillings) is acceptable in any trimester, while elective procedures are usually more convenient in the second trimester. Both X-rays with shielding and local anesthesia with lidocaine (with or without epinephrine) are considered safe. This is clearly noted by ACOG and the ADA: patients often simply need reassurance that treatment is safe and appropriate during pregnancy—postponing painful or infectious lesions increases the risks for both mother and fetus. [1]

When is the best time? Timing logic

• First trimester (0-13 weeks): don't postpone emergencies (pain, pus, fissure/fracture, pericoronitis). It's best to postpone major planned reconstructions.
• Second trimester (14-27 weeks): the most “comfortable” period for planned extraction of problematic “eights” and the like.
• Third trimester (≥28 weeks): treat as indicated, but monitor position on the chair (semi-recumbent on the left side, with a bolster under the right thigh to avoid compression of the vena cava); break up long visits.
• The main principle: acute pain/infection is treated immediately in any trimester - it is safer than enduring it. [2]

Anesthesia and sedation methods

Local anesthetics

• Standard dental local anesthesia is safe throughout pregnancy. The "gold standard" is 2% lidocaine with epinephrine 1:200,000: epinephrine reduces systemic absorption of the anesthetic and prolongs pain relief; with proper technique, it does not "harm the uterus." [3]

Nitrous oxide

• Nitrous oxide (N₂O) is generally avoided during pregnancy, especially in the first trimester. If strictly indicated, a dual-circuit system with scavenging and leak monitoring is required; staff and pregnant patients are advised to minimize exposure. [4]

X-ray during pregnancy

• Dental imaging with chest and thyroid shields is safe: the doses are extremely low. Do not delay imaging if it affects your dental treatment (e.g., in cases of difficult extraction, suspected residual roots, sinus communication, etc.). This position is clearly stated by ACOG and cited by the ADA. [5]

Pain relief after removal

• First line - paracetamol (acetaminophen) in therapeutic doses: ACOG confirms it as the number one choice as an analgesic and antipyretic during pregnancy (use as directed, for the minimum effective duration). [6]
• NSAIDs (ibuprofen, etc.): Avoid from 20 weeks and later - the FDA warns of the risk of decreased amniotic fluid due to effects on the fetal kidneys, and in the late third trimester - of the risk of premature closure of the ductus arteriosus. In the first half of pregnancy, NSAIDs are also not recommended; if considered, only after discussion with a doctor. [7]
• Opioids: For acute, severe pain, minimal doses for the shortest duration (usually ≤ 3 days) are appropriate and only by prescription; ACOG/CDC emphasize the "minimum dose, minimum days" principle. Always consider non-pharmacological measures and combining paracetamol with topical methods. [8]

Antibiotics: What's OK and What's Not

Group/drug	Reasonable in his testimony	Comments
Penicillins (amoxicillin, penicillin V)	Yes	Often the first line of treatment for odontogenic infection if antibacterial therapy is needed.[9]
Cephalosporins (cephalexin)	Yes	An alternative for penicillin intolerance.
Clindamycin	Yes	Suitable for allergies to β-lactams.
Metronidazole	With caution	Current data are mixed; generally, it is acceptable after the first trimester, but the risk/benefit assessment is individual. [10]
Tetracyclines	No	Contraindicated (staining of fetal teeth, effects on bones).

Important: Antibiotics are prescribed only when indicated (spread of infection, cellulitis, immune risks, inability to immediately debride the lesion). For simple removal without signs of infection, prophylactic antibiotics are not necessary. [11]

How does the removal process work? What changes due to pregnancy?

• Positioning: semi-sitting, with a slight turn to the left side and a cushion under the right thigh in the II-III trimesters (prevention of inferior vena cava syndrome).
• Short sessions: Several short visits are better than one long one.
• Gentle surgery + cooling: minimal trauma, thorough irrigation, ice pack "10-20 minutes on and off".
• Home recommendations: avoid rinsing or spitting vigorously for the first 24 hours, avoid drinking through a straw, and avoid smoking/vaping (this dramatically increases the risk of dry socket). Eat soft, warm foods. Brush with a soft brush, avoiding the socket. (For more information on dry socket, see a separate article. Key: if pain persists on the 2nd or 3rd day, get examined.) [12]

Table. "I want everything safe": a checklist before extraction

Paragraph	What to say/do
Pregnancy period	Please provide the exact date and any pregnancy complications.
Contact information for an obstetrician/gynecologist	Get the dentist's number/name - sometimes the dentist will consult before sedation/non-standard therapy.
Medications and allergies	List of all medications/supplements; allergies to antibiotics/anesthetics.
Food and water	Have a snack and drink water 1-2 hours before (unless otherwise directed).
Position on the chair	Ask for a pillow/bolster under your right hip in the second and third trimesters.
Home set	Paracetamol, salt sachets for warm "baths" from the 2nd day, soft brush, cold compress.

Frequently asked questions

• Are X-rays really safe during pregnancy?

Yes, with shielding (chest and thyroid shield) and if clinically indicated. Do not delay the x-ray if it is needed for safe treatment. [13]

• Will epinephrine in anesthetic be harmful?

In dental doses, with proper technique – no. On the contrary, it reduces the systemic absorption of lidocaine and improves pain relief. [14]

• Can I take ibuprofen?

It's best to avoid it for the entire pregnancy, but not after 20 weeks (FDA warning). The number one choice is paracetamol as directed by your doctor. [15]

• What about nitrous oxide?

In general, it is not recommended for pregnant women; if discussed, only under strict indications, with skevening and leak control. [16]

Are antibiotics necessary "just in case" after a tooth extraction?
No. Only if indicated (signs of widespread infection, cellulitis, immune risks). [17]

Red flags after tooth extraction - see a doctor immediately

• Increasing pain, unpleasant odor/taste and “empty socket” on the 2-3rd day (suspected dry socket).
• Fever, increasing dense swelling, pus, pain when swallowing/limited mouth opening (suspected infection).
• Bleeding that is not stopped by a pressure bandage.

(The doctor will evaluate, clean the hole, apply a medicated dressing if necessary, and adjust the pain relief; antibiotics - only if there is an obvious infection.) [18]

An important note about paracetamol and "information noise"

In September 2025, the hypothetical risks of acetaminophen (paracetamol) were again discussed. ACOG officially confirmed that acetaminophen remains the pain reliever and fever reducer of choice during pregnancy, when used judiciously and under the advice of a physician. Politicized statements in the media do not invalidate the accumulated evidence. Refer to your obstetrician/gynecologist and authoritative clinical guidelines. [19]

Results

• Tooth extraction during pregnancy is possible and necessary if indicated. Emergency care is acceptable in any trimester; elective procedures are more often scheduled for the second trimester. X-rays with shielding and lidocaine (with adrenaline) are safe. [20]
• Pain relief: Paracetamol is the first choice; NSAIDs should be avoided after 20 weeks (and generally not preferred). Opioids should be used only at the minimum dose for the shortest period if pain is severe. [21]
• Antibiotics - as indicated: penicillins/cephalosporins/clindamycin are most often suitable; tetracyclines are contraindicated. The choice of metronidazole is individual, usually not in the first trimester. [22]
• Nitrous is generally not used by pregnant women; if considered, it should only be used with scavenging and within strict safety limits. [23]