Pregnancy and Root Canal Anesthetics

Pregnancy and Root Canal Anesthetics

Recently I have come across a number of expecting mothers (friends and patients) asking me about different dental treatments, especially root canals while pregnant.

It comes with the territory being a root canal specialist.

I get asked:

“Can I get a root canal treatment while I’m pregnant? What are my options?”

Normally I would tell them that if you need a root canal, then it is more recommended during the second trimester.

Why?

The third trimester is really uncomfortable and it’s hard to lie on your back.

Minimize X-ray exposure.

Although X-rays are necessary, taking proper precautions, such as wearing a lead shield, will protect you and your baby from harmful radiation.

What about the anesthetics during the root canal procedure?

I have patients that have handed me a medical clearance from their OB/GYN instructing either no epinephrine…or better yet lidocaine with no epinephrine.

First off, lidocaine without epinephrine doesn’t exist and the anesthetic without epinephrine is a lower category than lidocaine with epinephrine.

We’ll get to categories in a few.

These requests bring me back to the days of my residency program.

I would treat pregnant women and these same requests were given to me.

A short story:

My professor would tell me they are going to give you their list of demands that are misinformed and confusion, as if they know exactly what root canals or dentistry entails. “They don’t know anything about dentistry and they really need to do their homework” he would chuckle.

If OB/GYN doctors actually looked up the different anesthetic that we use, they typically request is anesthetics that are a lower category in the pregnancy category for the patient than the one that is a better/safer option to prescribe.

Below is the list of how medication are judged during pregnancy.

  • Category A:  Controlled studies show no risk or find no evidence of harm.
  • Category B:  Animal studies show no risks, but there are no controlled studies on pregnant women.
  • Category C:  Animal studies have shown risk to the fetus, there are no controlled studies in women, or studies in women and animals are not available.
  • Category D:  There is positive evidence of potential fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (i.e. life threatening condition to mother).
  • Category X:  Studies in animals or human beings have demonstrated fetal abnormalities, or there is evidence of fetal risk. The drug is contraindicated in women who are or may become pregnant.

Lidocaine with epinephrine is a category B.

Carbocaine or the none brand name mepivacaine, neither of which contain epinephrine, are both category C.

Take note:

Anything without epinephrine (especially when getting a root canal done) doesn’t last very long as an anesthetic.

Resulting in…

Many patients cannot get numb with just carbocaine. Pain during treatment is added stress for the baby and mom.

Ask yourself:

Why would I want to administer an anesthetic that doesn’t work as well to get the patient numb and is lower in category safety for pregnant women?

Beats me.

I just smile and remember my professor’s words about the subject and give my patients the better care and safer anesthetic that they deserve.

My recommendation:

Lidocaine with epinephrine – a “Category B” (animal studies show no risks, but there are no controlled studies on pregnant women.)

That is your safest choice for anesthetics for pregnant and expecting mothers.

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