Dental care during pregnancy: the national consensus that treatment is safe and should not be deferred

What it says#

Three American documents say the same thing, and they were written by overlapping groups, which is why they agree. The national consensus statement came out of a workgroup meeting convened on October 18, 2011 at Georgetown University by the Health Resources and Services Administration's Maternal and Child Health Bureau, in collaboration with ACOG and the ADA, and coordinated by the National Maternal and Child Oral Health Resource Center. Its opening claim is the one worth memorizing: preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.

That statement then gives each profession its own list. Prenatal care professionals are asked, at the initial evaluation, to take an oral health history, check the mouth for swollen or bleeding gums, untreated decay, mucosal lesions, signs of infection such as a draining fistula, or trauma, to document the findings, and to reassure women that oral health care, including use of radiographs, pain medication and local anesthesia, is safe throughout pregnancy. If the last dental visit was more than 6 months ago, or any problem was found, they advise an appointment as soon as possible and make a formal referral if care is urgent. Oral health professionals get the parallel list: take the history, including how many weeks pregnant and the due date, review medical and dietary histories including tobacco, alcohol and recreational drugs, perform a comprehensive examination with caries and periodontal risk assessment, and take radiographs to evaluate and definitively diagnose oral diseases and conditions when clinically indicated.

Its treatment guidance is practical. Provide emergency or acute care at any time during the pregnancy as indicated by the oral condition. Use standard practice when placing restorative materials, and avoid using dental amalgam during pregnancy if possible and appropriate. Use a rubber dam during endodontic and restorative procedures. Position the patient with her head higher than her feet, semi-reclining as tolerated, with frequent position changes and a small pillow under the right hip, or have her turn slightly to the left, to avoid dizziness or nausea from hypotension. Consult the prenatal care professional over comorbid conditions such as diabetes, hypertension, pulmonary or cardiac disease and bleeding disorders, and over intravenous sedation, general anesthesia, nitrous oxide as an adjunctive analgesic, or oral sedatives with nitrous oxide.

Its pharmacological considerations table is the part most offices need, and it opens with its own condition: the agents listed are to be used only for indicated health conditions and with appropriate supervision by a health professional. Analgesics: acetaminophen may be used during pregnancy, and the table adds that oral pain can often be managed with non-opioid medication, and that if opioids are used, prescribe the lowest dose for the shortest duration, usually less than 3 days, and avoid issuing refills to reduce risk for dependency. The same entry covers acetaminophen with codeine, hydrocodone or oxycodone, and codeine, meperidine and morphine. Low-dose aspirin may be used after 12 weeks for women at high risk for preeclampsia. Aspirin, ibuprofen and naproxen otherwise carry a trimester schedule: first trimester avoid use; second trimester from 13 up to 20 weeks may use for short duration, 48 to 72 hours; second trimester from 20 up to 27 weeks limit use; third trimester avoid use. Antibiotics: amoxicillin, cephalosporins, clindamycin, metronidazole and penicillin may be used during pregnancy; ciprofloxacin, clarithromycin, levofloxacin and moxifloxacin are to be avoided; tetracycline is never to be used during pregnancy. Anesthetics: consult a prenatal care professional before using general anesthesia, intravenous sedation, oral-inhalation sedation or enteral-inhalation sedation, and limit duration of exposure to less than 3 hours in pregnant women in the third trimester; local anesthetics with epinephrine, listing bupivacaine, lidocaine, mepivacaine and prilocaine, may be used during pregnancy; articaine is to be avoided pending consultation; nitrous oxide is to be avoided pending consultation. Antimicrobials: use alcohol-free products, with cetylpyridinium chloride mouth rinse, chlorhexidine mouth rinse and xylitol usable during pregnancy.

ACOG's Committee Opinion 569, published August 2013 and reaffirmed in 2025, reaches the same conclusions from the obstetric side and was reviewed by an advisory committee of ACOG, ADA and HRSA representatives. Its recommendations include conducting an oral health assessment at the first prenatal visit; reassuring patients that prevention, diagnosis and treatment of oral conditions, including dental X-rays with shielding of the abdomen and thyroid and local anesthesia with lidocaine with or without epinephrine, are safe during pregnancy; and informing women that conditions requiring immediate treatment, such as extractions, root canals and restoration, amalgam or composite, of untreated caries, may be managed at any time during pregnancy, because delaying treatment may result in more complex problems. On periodontal disease it is careful in both directions: recent meta-analyses and large trials have not shown benefit of periodontal therapy during pregnancy in reducing preterm birth and low birth weight, and despite the lack of evidence for a causal relationship, treatment of maternal periodontal disease during pregnancy is not associated with any adverse maternal or birth outcomes, while prenatal periodontal therapy is associated with improvement in maternal oral health. Its conclusion: ample evidence shows that oral health care during pregnancy is safe and should be recommended.

The ADA's Pregnancy oral health topic page, last updated July 14, 2025, adds three things. First, the list of medications it considers safe: local anesthesia with or without epinephrine, and the antibiotics penicillin, amoxicillin, cephalosporins, clindamycin and metronidazole; for other medications, including analgesics, it points to consultation with the obstetrician, noting the FDA's 2015 statement that the published research is too limited to make recommendations on pain reliever use in this population. Second, nitrous oxide: the page classifies it as a pregnancy risk group Category C medication and recommends that pregnant individuals, patients and staff, avoid exposure, citing NIOSH's recommendation of a scavenging system and holding nitrous oxide concentrations in dental operations to approximately 25 ppm during analgesia administration. Third, and where it parts company with the older ACOG text, radiographs: radiographs are considered safe for the pregnant patient at any stage during pregnancy, and shielding, abdominal or thyroid, is no longer recommended, citing the American Academy of Oral and Maxillofacial Radiology's 2023 recommendations and the 2024 JADA recommendations on optimizing radiation safety in dentistry. See ada-radiation-safety-recommendations-2024 for that change, and aapd-nitrous-oxide-pediatric-2023 for nitrous oxide in the operatory.

Who it applies to#

Every pregnant patient on the schedule, and every stage of the pregnancy. Nothing in these documents supports the habit of pushing a pregnant patient to the second trimester or to after delivery; the closest thing to a timing rule is the consensus statement's third-trimester anesthetic exposure limit and its positioning advice, and the trimester schedule for aspirin and the NSAIDs. It also reaches the prenatal side: the consensus statement asks both professions to build formal two-way referral relationships in which the other agrees to see the referred patient in a timely manner, for example that day or the following day.

It reaches your own team too. The ADA's page asks pregnant dental personnel who take radiographs to inform their employer in writing as soon as they know, to adhere to the facility's shielding procedures and to use dosimeters, noting it is unlikely a dental health care worker will approach the exposure limit of 1 mSv per year, and asks for special consideration where job duties involve direct exposure to nitrous oxide.

What changed#

The core message has not moved since 2012, which is the point of a consensus statement. What has moved around it: ACOG reaffirmed Committee Opinion 569 in 2025 rather than rewriting it; the ADA adopted a Comprehensive Statement on Oral Health Services During Pregnancy in 2024, which encourages regular examination and treatment as needed throughout all stages of pregnancy and calls for dental coverage to extend one year postpartum; the FDA replaced the lettered pregnancy categories for prescription drugs with narrative labeling, phased in with a full compliance date of June 2020, with the letters surviving for over-the-counter products; and patient shielding during dental radiography is no longer recommended, which leaves the ACOG text and the ADA page describing the same procedure differently. The consensus statement's own revised edition carries a 2026 copyright and an updated pharmacological table.

Where the source is#

The link under the title is the ADA's Pregnancy oral health topic page, free on ada.org, last updated July 14, 2025, which carries the medication list, the nitrous oxide and radiograph sections, the ADA policy text and a reference list that names the other two documents. The national consensus statement is a free PDF from the National Maternal and Child Oral Health Resource Center at Georgetown University, supported by HRSA, and its own notice gives permission to save, print and forward it in its entirety and to photocopy the pharmacological table. ACOG's Committee Opinion 569 is readable in full on acog.org and marked reaffirmed 2025. All three were read in full for this entry, and every drug name, threshold and date above is copied from one of them and attributed in the text. This entry reports guidelines; the treating dentist and the patient's obstetrician or prenatal care professional decide what any individual patient receives.