What should be taken into account when suffering from toothache during pregnancy?

Already during the diagnosis of toothache there are special features. During X-ray diagnostics, the radiation exposure in the pelvic area is only 0.1 – 1 pGy, if the radiation protection is correctly implemented. This corresponds to the normal background radiation, but in pregnant patients in the 1st trimenon, X-ray diagnostics should only be carried out if there is a compelling indication, in order to rule out any consequences for the embryo.

The pregnancy is divided into three trimenons.

The first trimester is considered the “vulnerable phase”. Here the embryo is the most sensitive, as this is the time when the organs are created.
The 2nd trimenon is considered the most stable phase and is best suited for dental treatments.
In the 3rd trimenon, a possible danger is the occurrence of premature contractions, which in this case mainly influences the choice of anesthetic.

Treatment

With regard to the prescription of medication by the dentist, the gynaecologist should be consulted in the case of longer prescription periods. Aspirin should not be taken during the 1st trimester, as it increases the risk of bleeding and can lead to premature closure of the ductus arteriosus Botalli in the embryo. Opioids may cause respiratory retardation and dependence of the newborn and are therefore contraindicated during pregnancy and lactation.

Antibiotics may be taken as long as the therapy requires it. In this case, antibiotics of the type penicilin, amoxicilin or cepahlospoein are considered safe during pregnancy. Toothache during pregnancy is best treated with paracetamol, which is considered the most tolerable during pregnancy.

In case of intolerance, ibuprofen is available as an alternative.Aspirin with the active ingredient acetylsalicylic acid (ASS 100) is contraindicated in pregnancy due to the side effects described above. During treatment for toothache in pregnancy, the patient should also be positioned correctly. In advanced pregnancy the patient should be treated in a left-side position if possible.

Since this is usually not possible on dental chairs, treatment should be carried out in a slightly right-hand position to avoid blood congestion. Amalgam fillings should not be removed during pregnancy if it is avoidable. If not avoidable, amalgam should be removed using a rubber dam.

Toothache during pregnancy is often triggered by pulpitis/tooth marrow inflammation if it was not foreseeable (e.g. prolonged caries, root remains). The therapy of choice here is a root canal treatment. This can also be carried out during pregnancy, so that in most cases pain relief can be achieved.

However, the dentist must take into account the patient’s particular situation and should therefore allow for breaks in the treatment if it is to be continued over a long period of time. The treatment should be as painless and stress-free as possible for the patient in order to achieve the least possible influence on the cardiovascular system. All larger or longer lasting treatments should be postponed to the time after pregnancy if possible.

Most painkillers should not be taken during pregnancy or during the subsequent breastfeeding period. The reason for this is possible damage to the child’s organism. Some painkillers are even capable of prematurely closing an important bypass of the embryonic blood circulation (Ductus botalli).

Inhibition of contractions is also a typical side effect of many painkillers. For toothache during pregnancy, paracetamol has been the painkiller of choice. From a medical point of view, the active substance may be taken throughout pregnancy.

The use of paracetamol should only be avoided in the last days before the calculated date of birth. Furthermore, a maximum daily dose of 500 to 1000mg should not be exceeded during pregnancy. In addition, doctors recommend that no more than ten days per month of pregnancy be taken.

Even though it is much less likely to affect the child’s organism while taking paracetamol than with other painkillers, each application should be discussed in advance with a doctor or pharmacist. The use of paracetamol is not completely harmless in case of toothache during pregnancy. According to the latest studies from Scandinavia, England and North America, the use of paracetamol for toothache during pregnancy should not be underestimated.

Higher doses of the active ingredient paracetamol are said to cause side effects such as high blood pressure. Furthermore, increased cases of liver damage and testicular malpositions could be linked to the use of paracetamol. As a consequence of testicular malposition, the child’s later fertility could be limited.

The risk of developing testicular tumors is also significantly influenced by the malformation. For this reason, patients should also be careful when using paracetamol in case of acute toothache during pregnancy. Ibuprofen is extremely controversial during pregnancy, as it may only be taken in the first and second third (trimester) of pregnancy.

Ibuprofen must not be taken in the third trimester, as it prematurely closes the ductus botalli of the unborn child. This is a vascular connection between the pulmonary artery and the aorta of the unborn child, which only closes after birth. Especially from the 30th week of pregnancy onwards, ibuprofen is not recommended as it has a contraction-inhibiting effect.

Furthermore, taking ibuprofen from the third trimester onwards can also lead to kidney damage to the baby. Paracetamol is the painkiller of choice during pregnancy. However, the use of any pain medication during pregnancy should be discussed with the treating gynaecologist.

Arnica is probably one of the best known alternative painkillers. Apart from its use for toothache during pregnancy, this alternative painkiller is also suitable for relieving back and joint pain. In addition, bruises and swellings can also be effectively treated by taking the alternative painkiller arnica.

The clear advantage of this homeopathic remedy is therefore its multiple applications.Arnica is suitable in the form of small balls for internal use, but can also be used externally as a solution. In case of slight toothache during pregnancy, it is often sufficient to rinse the oral cavity several times a day with a water-arnica solution. Severe toothache during pregnancy can be relieved by taking this alternative painkiller orally.

Arnica can be used without hesitation in children, adults and the elderly. The use during pregnancy is also completely safe. Another alternative painkiller that can be taken for toothache during pregnancy is ginger.

The effectiveness of ginger lies mainly in its anti-inflammatory properties. Especially during pregnancy, the use of painkillers should be reduced to a minimum, regardless of which active ingredient is involved. For this reason, the use of home remedies for acute toothache during pregnancy should be seriously considered.

The most popular home remedies for treating toothache during pregnancy are onions, salt solutions, cloves and chamomile. In addition, alcoholic solutions, tea tree oil, and herbal vapors have been shown to be particularly helpful for toothache during pregnancy. The choice of the most suitable home remedy depends mainly on the intensity and quality of the toothache present.

Also the cause of the complaints should not be ignored. While inflammation-related toothache can be effectively relieved by biting on cloves, for example, the symptoms of nervous pain usually increase. Homeopathy can be used during pregnancy without having to worry about damaging the unborn child.

For toothache, the globules Chamoilla, Calcium carbonicum and Creosotum in the strength D6 to D12 have proven to be effective. It is important to treat the specific complaints with the optimal globules. Consultation with the dentist and alternative practitioner can be helpful in choosing the appropriate medication and strength.