Can you have an implant or a tooth taken out while pregnant or breastfeeding?

The question that brings people to this page actually contains two separate questions, and they have different answers. The first: what should be done about a tooth that is painful, has formed an abscess or needs to come out? The second: should planned implant treatment be started while you are pregnant or breastfeeding? The American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA) give a clear answer to the first question: preventive, diagnostic and restorative dental treatment is safe at every stage of pregnancy and should not be put off. The second question is answered with a different logic; we will look at it separately.

The reason not to put off urgent treatment is simple: an untreated infection carries a greater risk than the treatment itself. An abscess or a painful tooth gets worse while you wait, the inflammation can spread, and for both your health and the health of your developing baby this is a far more serious situation than having the tooth treated. That is why procedures such as an extraction, root canal treatment or draining an abscess can be carried out whatever month of pregnancy you are in.

An implant, however, does not carry the same urgency. Replacing a missing tooth with an implant is a planned surgical process, spread over several sessions, that should not be rushed. The reason for postponing it is not that the anaesthetic or materials used are unsafe; it is that, when there is no urgent medical need, keeping the imaging, the long sessions and any medicines that may be needed outside pregnancy and breastfeeding is the simpler and more cautious approach. That is why the implant is planned not straight after the tooth is lost, but for after the birth and the breastfeeding period.

On anaesthesia, there is separate information for each of the two periods. The ADA considers local anaesthetics, including lidocaine with or without adrenaline, suitable for use in pregnancy. On breastfeeding, LactMed, the NIH's database on drugs and lactation, states that lidocaine passes into breast milk in very small amounts and is not expected to cause side effects in breastfed babies, so no special precautions are needed. In other words, the anaesthetic used when an urgent procedure is needed is not in itself a barrier, either in pregnancy or while breastfeeding.

Imaging is a slightly different story. The ADA states that dental X-rays taken when needed are considered safe in pregnancy; an image required for an urgent diagnosis is not put off. But the 3D CBCT scan needed for implant planning involves more radiation than a standard dental X-ray, and because the implant decision is not urgent, leaving this imaging until after the birth removes an unnecessary exposure entirely. In short: if it is urgent, it is taken; if it is not, it waits.

Changes in the gums are also normal in pregnancy. Higher hormone levels make the gums more sensitive to plaque, and this can lead to 'pregnancy gingivitis', which shows itself as bleeding and swelling. Less often, a benign swelling can appear on one area of gum that grows quickly, bleeds easily and usually shrinks by itself after the birth. Neither is dangerous, but both should be reported to your dentist; professional cleaning and gum treatment can be carried out safely in pregnancy.

The distinction below shows which situations should be dealt with without delay and which can be left until after the birth and breastfeeding.

The steps below help you deal safely with an urgent problem and also put the implant decision at the right time.

1. 1

   Tell your obstetrician

   Add how many weeks pregnant you are, any condition that carries a risk and the medicines you take to the information you will share with your dentist. Information passing between the two doctors makes the plan clearer.

2. 2

   Tell your dentist that you are pregnant or breastfeeding

   This directly affects the plan in terms of anaesthesia, imaging and any medicine to be prescribed; it should be mentioned at the start of the appointment.

3. 3

   Do not put off treatment in an emergency

   If there is pain, an abscess or a tooth that needs taking out, it is treated however many weeks pregnant you are. Waiting does not reduce the risk; it increases it.

4. 4

   Discuss the timing of a planned implant

   If there is no urgent need, when implant treatment should begin is decided together, depending on how the birth and the breastfeeding period go.

5. 5

   Imaging only when it is needed

   An X-ray needed for an urgent diagnosis is not put off; non-essential imaging, such as the CBCT scan needed for implant planning, can be left until after the birth.

6. 6

   While breastfeeding, have every medicine checked

   If a painkiller or antibiotic is to be prescribed, ask your dentist, your obstetrician or your baby's doctor whether it is compatible with breastfeeding; do not change or stop a medicine on your own.

If tooth loss or an extraction is on the cards, these are the routes discussed for the time up to the birth and afterwards.

These are the situations met most often during this period, and they are worth knowing about in advance.

For most families who put off the implant decision, the process after the birth goes like this.

1. Straight after the birth

   At this stage, the priority is for mother and baby to recover. The implant assessment is not rushed; if there is an outstanding problem in the mouth, that is dealt with first.

2. While you are still breastfeeding

   Dental treatment is possible while breastfeeding; if you want a planned implant, it can go ahead once the anaesthesia and any medicines that may be needed have been reviewed. Even so, many families prefer to put this decision off until breastfeeding has ended.

3. Once breastfeeding has ended

   The period with the fewest restrictions on medicines and imaging. Most dentists recommend starting the implant process at this point.

4. The long term

   Once implant treatment starts, it proceeds in the same way as for a patient who has never been pregnant or breastfed; that earlier period does not affect the plan.

Pregnancy or breastfeeding does not change the price of treatment; what it affects is the timing and the extra coordination. These are the items:

Urgent treatment

Pain, an abscess or a tooth that needs taking out is dealt with without waiting, as a separate item.

Postponement

Leaving the implant until after the birth and breastfeeding does not add any cost; the only thing that changes is the timetable.

Additional consultation

A short exchange with your obstetrician or, if needed, your baby's doctor may be part of the plan.

Reassessment after the birth

Your mouth is assessed again before the implant process begins; if anything has changed in the meantime, it is reflected in the plan.