Can you have a tooth pulled when you are pregnant or breastfeeding?

How does having a tooth extraction impact pregnancy and breastfeeding?

Needing a tooth extraction during pregnancy or while breastfeeding can raise a lot of questions. Mothers typically have concerns about the safety of the procedure, the potential effects on their child, and the precautions they need to take. Fortunately, with proper planning and adherence to medical guidelines, these procedures can be performed safely.

This guide will help you understand the important factors surrounding tooth extractions for pregnant and breastfeeding women. From evaluating the safest time for a procedure during pregnancy to determining the medications compatible with breastfeeding, this resource addresses the key concerns that matter most to mothers.

Whether you’re navigating issues like X-rays, pain management, or sedation options, this guide offers answers to common questions and is geared toward helping to ensure you have a safe and comfortable experience.

Table of Contents.

• The first portion of this page discusses issues of concern for pregnant tooth extraction patients.

  It addresses questions like – When can the procedure be performed? / Can X-rays be taken? / What medications can be used?

• The latter half of this page covers the issue of performing extractions for breastfeeding mothers

  It answers questions like – Is the mother’s breast milk affected? / What medications can be used?

A) Concerns with extraction procedures for pregnant women.

As an introduction to this subject, here’s a list of questions people frequently have. Our answers here are brief. We explain these issues in more detail in the text that follows this Q&A section.

Quick answers to 6 questions about extractions during pregnancy.

More details …

What is the ideal time to remove a pregnant patient’s tooth?

What’s considered preferable or ideal will vary according to the specifics of the case.

1) The extraction might be delayed until after the baby has been delivered.

Even though extractions can be performed safely during pregnancy if needed, why subject a mother and her fetus to any procedure unnecessarily? So, ideally, oral surgery procedures should be postponed until after the baby is born when possible.

Of course, with pulling teeth, there’s often some type of developing dental problem or emergency associated with needing the procedure, which leads us to the next guideline.

2) With the consent of the mother’s obstetrician, having an extraction is possible during any stage of pregnancy.

However, just because something can be done doesn’t mean that doing so makes the best choice. Instead …

3) When possible, extractions are preferably targeted for the second trimester of pregnancy (week 14 to week 27).

… with emergency cases handled during the first trimester (weeks 1 to 13) and third trimester (week 28 to week 40) when required.

The above guidelines are for patients with problem-free medical histories.

If the mother and child (fetus) are healthy and free from medical complications, both are generally considered low-risk patients during the second trimester (weeks 14 to 27). Therefore, the preferred/ideal time to schedule a tooth extraction is during this period.

If medical concerns exist, different guidelines are followed.

As an example, for women who have a history of previous spontaneous abortion, oral surgery procedures during both the first trimester (weeks 1 to 13) and second trimester (week 14 to week 27) should be avoided.

And because of the potential need for special guidelines like this one, the mother’s obstetrician should always be consulted and their recommendations sought prior to her having a tooth removed.

Miscellaneous concerns with pregnant extraction patients.

Here are some additional guidelines a dentist will need to keep in mind:

• During the first trimester (week 1 to week 13), the fetus is at greatest risk for developmental defects, therefore only urgent extractions should be considered.
• During the last several days of the third trimester, extraction procedures should be avoided because of the possibility of premature labor occurring during the appointment.

• Especially during the third trimester (week 28 to week 40), the need to keep near-term mothers in the fully supine position (lying back in the dental chair) can be a contraindication for extraction procedures because this positioning tends to restrict the mother’s blood flow to the fetus and/or result in a hypotensive episode for her. (Most cases can be accomplished in a more upright or lateral-left (turned to their left side) patient position.)
• Oral surgery performed late in pregnancy may need to include extra breaks or be scheduled as shorter appointments. The fetus tends to place pressure on the mother’s urinary bladder, therefore, causing her to need to urinate more frequently.

▲ Section references – Hupp, Koerner, Fragiskos

What medications are safe to use with pregnant extraction patients?

There’s nothing cut and dried about which drugs are considered safe for use during pregnancy. Opinion based on current research is always evolving.

The FDA (US Food and Drug Administration) recently phased out their previously used “letter grade” classification system that gauged pregnancy risk for prescription drugs. They replaced it with a narrative system where a medication’s packaging insert now includes a section of text describing its known risks and benefits.

This change seems to emphasize the fact that the use of any drug needs to be evaluated individually and on a case-by-case basis. When a question does exist, the patient’s obstetrician should be consulted and their recommendations followed.

Medications generally considered acceptable for use with pregnant extraction patients.

The following medications are typically found in lists considered least likely to harm a fetus when used in moderate amounts. (All held a Category B ranking in the FDA’s previous Pregnancy Risk system.)

a) Pain relievers – acetaminophen (Tylenol).

Acetaminophen is generally considered an effective pain reliever for mild to moderate pain. And its use may provide an adequate level of relief for many tooth extraction cases (both pre and post-procedure needs).

Notes: NSAID drugs (Advil, Motrin, Aleve, etc…) are generally considered best avoided during pregnancy. With the patient’s obstetrician’s consent, the use of some kinds of narcotic pain relievers might be considered. (We provide more details about these classes of drugs below.)

b) Antibiotics – penicillin, clindamycin, and cephalosporins (Keflex).

Antibiotics are sometimes needed with extraction cases to help control pretreatment tooth infection and swelling, postoperative infections, or for antibiotic prophylaxis (antibiotic premedication).

c) Local anesthetics – lidocaine (Xylocaine), bupivacaine (Marcaine).

Lidocaine is the most frequently used local anesthetic for dental procedures, including tooth extractions.

Our list above is not all-inclusive.

Current opinions about what medications are safe to use during pregnancy or not are constantly changing. But we will point out that even our abbreviated list of drugs above is inclusive enough that it could be used to fully manage the preop, procedure, and postop needs of most routine extraction cases.

Can NSAID pain relievers be used with pregnant extraction patients?

Notably missing from our list above are NSAID compounds (non-steroidal anti-inflammatory drugs). This class of medications includes ibuprofen (Motrin, Advil), naproxen (Aleve), and aspirin.

Pregnant women are generally advised to avoid taking NSAID compounds, especially during the third trimester, for fear of posing risks to the fetus or complications during delivery.

Can narcotic pain medications be used with pregnant extraction patients?

Also notably missing from our list above are prescription narcotics (codeine, hydrocodone, oxycodone, etc…), which admittedly are routinely used with a large percentage of (non-pregnant) oral surgery patients.

Prescription pain relievers.

In years past, it seems to have been oxycodone and codeine that were most frequently chosen for use with pregnant women. (Respectively Category B and C compounds according to the FDA’s phased-out Pregnancy Risk system. Both were considered “Use with caution” medications.)

The patient’s need for controlling their discomfort vs. concerns for the drug’s potential effect on their fetus lies at the heart of deciding on the use of these kinds of drugs. Usually, the patient’s obstetrician is consulted and their recommendations are followed.

Can sedative medications be used with pregnant extraction patients?

Also missing from our list above are sedative drugs (like those used to relax patients during their oral surgery, a technique termed conscious sedation). Once again, when the use of these types of medications is considered the patient’s obstetrician should be consulted.

• Generally, the use of sedative drugs (oral, I.V.) during pregnancy is best avoided.
• The historic exception has been nitrous oxide (laughing gas) whose use was typically limited to the second trimester (week 14 to week 27) and third trimester (week 28 to week 40), as a mixture with 50% oxygen or more, and just used for short durations (less than 30 minutes).

  Nowadays, the use of nitrous oxide is viewed more controversially. It’s considered best practice to consult with the patient’s obstetrician when making a decision about the suitability of its use.

▲ Section references – Hupp, Koerner, Ouanounou, Patton

Considerations with taking X-rays for pregnant tooth extraction patients.

Here are some brief answers to frequently asked questions. Read our text below for more details.

Answers to questions about dental X-rays during pregnancy.

More details …

Is it safe for pregnant dental patients to have x-rays taken?

Yes, when proper X-ray protocol is followed the level of risk to the developing fetus is small.

• By design, the level of radiation exposure needed for dental X-rays is small, which keeps the radiation dose received by the mother, and even more so by the fetus, low.
• Modern low-radiation dental radiography uses a highly directed (collimated) X-ray beam. When dental X-rays are taken, this narrow beam results in negligible exposure to other parts of the patient’s body, including the area where the fetus lies.
• Despite these built-in safeguards, the use of a protective apron that drapes over the mother’s torso is still required. The lead shielding (or sometimes barium or tungsten) it contains protects the mother’s body and fetus from radiation exposure.

Additional guidelines.

In all cases, only essential x-rays should be taken. And always just the minimal number required.

It’s preferable to avoid taking x-rays during the first trimester (week 1 to week 13) of the pregnancy since this is a period of active fetal organ development.

We will point out that it may not be possible for a dentist to provide proper extraction care without having radiographs of the tooth’s root(s) and surrounding bone tissue.

▲ Section references – Hupp, Koerner

X-ray of a severely decayed molar slated for removal.

Knowing a tooth’s root structure is a valuable aid in removing it without complication.

The completed extraction.

B) Concerns with extraction procedures for women who are breastfeeding.

To start this section, here are some brief answers to frequently asked questions. Read our text below for more details.

Answers to questions about tooth extractions and nursing.

More details …

Issues a dentist must consider when planning an extraction for a nursing mother.

The primary concern with nursing mothers having a tooth pulled is that medication(s) used during her procedure are secreted by her body into her breast milk and therefore could adversely affect her infant.

• When evaluating what risk exists, it’s not just the type of medication and its dosing (amount and duration) that’s of concern. The infant’s age and weight will need to be considered too.
• Anytime a question exists, it’s the mother’s obstetrician/infant’s pediatrician who should have the final say in what medications are allowed.

Drugs generally considered acceptable for use with breastfeeding extraction patients.

One would expect that most dentists would consider the following list of medications safe to use with lactating mothers when used in moderate amounts.

The amount of these drugs that pass into breast milk is low and not considered a level where the infant should be adversely impacted. Their use is not considered a contraindication for breastfeeding.

a) Pain relievers – acetaminophen (Tylenol).

Acetaminophen is generally considered an effective pain reliever for mild to moderate pain. And its use may provide an adequate level of relief for many tooth extraction cases (both pre and post-procedure needs).

Notes: The use of some NSAID and narcotic pain relievers may be permissible with nursing mothers. We provide more details about these classes of drugs below.

b) Antibiotics – penicillin, erythromycin, and cephalexin (Keflex).

Antibiotics are sometimes needed with extraction cases to help control pretreatment tooth infection and swelling, postoperative infections, or for antibiotic prophylaxis (antibiotic premedication).

c) Local anesthetics – lidocaine (Xylocaine), bupivacaine (Marcaine).

Lidocaine is the most frequently used local anesthetic for dental procedures, including tooth extractions.

Our list above is not all-inclusive.

Current opinions about what medications are safe to use during pregnancy or not are constantly changing. But we will point out that even our abbreviated list of drugs above is inclusive enough that it could be used to fully manage the preop, procedure, and postop needs of most routine extraction cases.

A source for further information – The Drugs and Lactation Database.

The LactMed database is a compilation of known drug considerations for breastfeeding. The database is maintained by the U.S. National Library of Medicine and can be accessed via the National Institutes of Health’s (nih.gov) website where individual medications can be looked up. Here’s the link:
Drugs and Lactation Database LactMed.

Is the use of local anesthesia during extractions a contraindication for breastfeeding?

No, the local anesthetics in our list above (lidocaine, bupivacaine), when used in conjunction with performing dental procedures like having a tooth pulled, have not been found to significantly impact a mother’s milk or adversely affect her nursing infant.

No special precautions are required following the mother’s oral surgery. She may breastfeed her child immediately. There’s no requirement to discard (pump and dump) breast milk due to the use of these local anesthetics.

Can breastfeeding mothers use NSAID pain relievers after having a tooth pulled?

It may be permissible for nursing mothers to take certain kinds of NSAID medications (non-steroidal anti-inflammatory drugs). In all cases, the final decision should be made by the child’s pediatrician or the patient’s obstetrician.

Aspirin is typically not recommended. Ibuprofen (Advil, Motrin) is frequently allowed in part because it only passes into breast milk in low amounts. Naproxen (Aleve) passes at higher levels and therefore must be used with caution.

Can breastfeeding mothers use narcotic pain relievers after having a tooth pulled?

Narcotics (like codeine, hydrocodone, oxycodone, etc…) taken by the mother are excreted by her body into her breast milk and therefore have the potential to produce a detrimental effect on her feeding child (infant drowsiness, central nervous system depression, with possible serious consequences). However, the actual level of the medication that enters the mother’s milk varies according to the specific compound and dosing regimen.

A decision about using narcotics needs to weigh the lactating patient’s need to control their discomfort vs. concerns for potential effects on her infant. Or, a substitute for active nursing might be utilized during the period when the breast milk is affected (such as planning to pump and store breast milk in advance or feeding the child a substitute formula). The dentist should consult with the patient’s obstetrician or infant’s pediatrician when making their decision.

Can breastfeeding mothers be given sedative medication for extraction appointments?

Many of the Sedatives used in dentistry are excreted into a lactating mother’s milk and therefore have the potential to produce a detrimental effect on her feeding child (infant drowsiness, central nervous system depression, with possible serious consequences). The level of the drug that enters the mother’s milk varies according to the specific compound and dosing regimen.

A decision about the use of sedation with a nursing mother’s oral surgery needs to weigh her needs vs. concerns for the infant. Or, a substitute for active nursing might be utilized during the drug’s period of effect (such as planning to pump and store breast milk in advance or feed the child a substitute formula). The dentist should consult with the patient’s obstetrician or infant’s pediatrician when making their decision.

Laughing Gas

The exception to other commonly used dental sedatives is nitrous oxide (laughing gas). As opposed to oral or I.V. drugs, it is administered as a gas mixed with oxygen that you breathe. Its short half-life in the body (bloodstream) makes the extensive passage of it into the mother’s milk unlikely.

▲ Section references – Hupp, Koerner, Ouanounou, Patton

What’s next?

We have more info about extraction planning.