Safe drugs used in dentistry for pregnancy and breastfeeding

Below is a table of the commonly used drugs in dentistry and the safety level for pregnant women and those breastfeeding.

Key medication considerations
during pregnancy and  breast-feeding.
AGENT
FDA  PR*
CATEGORY
SAFE DURING PREGNANCY?
SAFE DURING BREAST-FEEDING?
Analgesics and Anti-inflammatories†
Acetaminophen
Aspirin
Codeine
Glucocorticoids (dexamethasone, prednisone)
Hydrocodone
Ibuprofen§
Oxycodone
B C/D C
C C C/D B
Yes
Avoid
Use  with caution
Avoid‡
Use  with caution
Avoid use in third
trimester Use  with caution
Yes
Avoid
Yes Yes
Use  with caution
Yes
Use  with caution
Antibiotics¶# Amoxicillin
Azithromycin
Cephalexin
Chlorhexidine (topical)
Clarithromycin Clindamycin Clotrimazole (topical) Doxycycline Erythromycin
Fluconazole
Metronidazole
Nystatin
Penicillin
Terconazole
(topical)
Tetracycline
B B B B C B B D B
C/D B
C B B D
Yes Yes Yes Yes
Use  with caution
Yes
Yes Avoid
Yes
Yes (single-dose regimens)
Yes
Yes
Yes Yes Avoid
Yes Yes Yes Yes
Use  with caution
Yes
Yes Avoid
Use  with caution
Yes
Avoid; may give breast
milk an unpleasant taste
Yes
Yes
Yes Avoid
Local Anesthetics
Articaine
Bupivacaine
Lidocaine (with or without epinephrine)
Mepivacaine (with or without
l
evonordefrin)
Prilocaine
Benzocaine (topical)
Dyclonine (topical)
Lidocaine
(topical)
Tetracaine
(topical)
C C B C B C C B C
Use  with caution Use  with caution Yes
Use  with caution
Yes
Use  with caution
Yes
Yes
Use  with caution
Use  with caution
Yes Yes Yes Yes
Use  with caution
Yes
Yes
Use  with caution
Sedatives Benzodiazepines
Zaleplon
Zolpidem
D/X C
C
Avoid
Use  with caution
Use  with caution
Avoid
Use  with caution
Yes
Emergency Medications
Albuterol
Diphenhydramine
Epinephrine
Flumazenil
Naloxone
Nitroglycerin
C B
C C C C
Steroid and β2-agonist inhalers are safe
Yes
Use  with caution Use
 with caution Use
 with caution Use
 with caution
Yes
Avoid
Yes
Use  with caution Use
 with caution Use
 with caution
*
FDA PR: U.S. Food and Drug Administration Pregnancy Risk. See Table 1
for FDA PR category definitions.
† In the case of combination products (such as oxycodone with
 acetaminophen), the safety with  respect to either pregnancy or breast-feeding is dependent
on the highest-risk moiety. In the example
of oxycodone with  acetaminophen, the combination of these
two drugs should  be used with  caution, because the oxycodone moiety carries a higher risk
than the acetaminophen moiety.
‡ Oral steroids should not be withheld from patients with  acute severe asthma.
§ Ibuprofen is representative
of all nonsteroidal anti-inflammatory drugs. In breast-feeding patients, avoid
cyclooxygenase selective inhibitors such as celecoxib, as few data regarding their  safe
use in this
population  are
available, and avoid
doses of aspirin  higher than
100 milligrams because of risk
of platelet  dysfunction
 and Reye
syndrome.
¶ Antibiotic
use during  pregnancy: The patient should
receive the full adult dose and for the usual length
of treatment. Serious infections should be treated aggressively. Penicillins and cephalosporins are considered safe.
Use higher-dose
regimens (such as cephalexin 500 mg three times
per day rather  than
250 mg three times
per day), as they are cleared from the system more quickly  because of the increase
in glomerular filtration rate in pregnancy.
# Antibiotic
use during  breast-feeding: These
agents may cause altered bowel flora and, thus, diarrhea  in the baby. If the infant develops a fever, the clinician should take into account
maternal antibiotic treatment.

From 2012 Consensus Statement (ACOG) if link not work search “oral health” on ACOG

210 pregnancies that had dental work showed no differences when using local anesthetics while having dental work Hagai JADA Aug 2015

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

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