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Historically, manufacturers have relied on an alphabetical system to communicate the safety of medications for use with pregnant patients (Table). In 2015, the U.S. Food & Drug Administration began phasing out that system for prescription drugs, replacing it with a narrative section in the package insert that discusses the benefits and risks of using a particular medication with this population.8 The new system will be phased-in, with a full compliance date of 2020.

The alphabetical system (Table) will continue to be used for over-the-counter medications9.

Questions about the local anesthetics or antibiotics used in dentistry are common. Options considered safe for use in these situations include:

Use of other medications calls for consultation with the patient’s obstetrician to weigh risks and benefits. An example of a situation that may benefit from consultation is pain relief. Several analgesics have been placed in pregnancy Category B, which indicates that they are typically safe to use; however, in 2015, the U.S. Food & Drug Administration backed off that classification, stating that the published research is “too limited to make any recommendations” on pain reliever use in this population.14  This suggests that decisions made about medications for pain relief should be arrived at after consultation with the obstetrician.  That said, emergencies call for immediate implementation of standard emergency protocols.

Questions often arise about medication use by patients who are lactating.  Most medication product inserts have information related to use during lactation.  The National Library of Medicine also provides a searchable database (LactMed) on this topic.

Nitrous Oxide Nitrous oxide is classified as a pregnancy risk group Category C medication, meaning that there is a risk of fetal harm if administered during pregnancy.  It is recommended that pregnant women, both patients and staff, avoid exposure to nitrous oxide.15 The National Institute of Occupational Safety and Health (NIOSH), a federal agency affiliated with the Centers for Disease Control and Prevention, recommends use of a scavenging system and exposure limits of N2O concentrations in dental operations to approximately 25 ppm during analgesia administration.16

Dental offices that use nitrous oxide-oxygen can review best management practices on the Nitrous Oxide page.

Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients (Trans.2005:330) Resolved, that the following ADA Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients be adopted.

Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients 1. Dentists are encouraged to inquire about pregnant or postpartum patients’ history of alcohol and other drug use, including nicotine. 2. As healthcare professionals, dentists are encouraged to advise these patients to avoid the use of these substances and to urge them to disclose any such use to their primary care providers. 3. Dentists who become aware of postpartum patients’ resumption of tobacco or illegal drug use, or excessive alcohol intake, are encouraged to recommend that the patient stop these behaviors. The dentist is encouraged to be prepared to inform the woman of treatment resources, if indicated.

American Dental Association Adopted 2005; Reviewed 2017 Dental Examinations for Pregnant Women and Women of Child-Bearing Age (Trans.2014:508) Resolved, that the ADA urge all pregnant women and women of child-bearing age to have a regular dental examination. American Dental Association Adopted 2014 Dental Treatment During Pregnancy (Trans.2014:508) Resolved, that the ADA acknowledges that preventive, diagnostic and restorative dental treatment to promote health and eliminate disease is safe throughout pregnancy and is effective in improving and maintaining the oral health of the mother and her child. American Dental Association Adopted 2014

JADA “For the Patient” page:

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.

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