She Was 22 Weeks Pregnant and Needed a Root Canal

Quick answer: Root canal treatment during pregnancy is safe, and the second trimester is the ideal window. Local anaesthetic, a shielded dental x-ray and the treatment itself carry far less risk than leaving an infected tooth untreated.

The call

Rivka, 29, from RBS Gimmel, at 22 weeks with her third. She had been in pain for five days and had not phoned because she assumed the answer would be that nothing could be done until after the birth. Her mother had told her that dentists will not treat pregnant women, which is a piece of folklore that causes real harm.

By the time she called, she had not slept properly in three nights, which at 22 weeks matters for more than one person.

What we found

Lower right first molar. Deep decay under an old filling, cold pain lasting a minute or more, tenderness to tapping. Irreversible pulpitis with early spread past the root tip.

We took one periapical x-ray with a lead apron and thyroid collar. The dose from a single dental x-ray is a tiny fraction of natural background radiation, and the beam is directed at the jaw, nowhere near the abdomen. Declining to take a necessary x-ray is not a neutral act — it means treating blind.

What we did

Root canal treatment, first stage the same day, in a 45-minute appointment.

The specifics that matter in pregnancy:

• Local anaesthetic: lidocaine with adrenaline, which is well established in pregnancy. Adequate anaesthesia is important, because pain and the stress response are themselves a risk. Under-treating is not the safe option.
• Positioning: slightly on her left side with a cushion under the right hip, rather than flat on her back. From the second trimester onwards, lying flat can compress the vena cava and drop blood pressure. She was also given short breaks to sit up.
• Timing: the second trimester is the sweet spot. Organ development is complete, morning sickness has usually settled, and the physical discomfort of the third trimester has not yet arrived.
• Medication afterwards: paracetamol. We avoided ibuprofen, which is generally not recommended in pregnancy, particularly after 20 weeks. Where an antibiotic is needed, several are well established in pregnancy — that is a prescriber's decision case by case.
• Appointment length: kept short, in the morning, with a bathroom break planned.

We completed the canals, sealed the tooth with a durable temporary restoration, and deferred the crown until after the birth. There was no clinical reason to do crown work while pregnant.

The outcome

She slept that night. The tooth was crowned four months after her daughter was born.

The point she makes to friends now is that the alternative — an untreated infected tooth for eighteen more weeks — is the genuinely risky option. Untreated dental infection in pregnancy is associated with worse outcomes, not better ones.

What to do if this happens to you

1. Phone. Do not assume nothing can be done.
2. Say how many weeks you are at the first call, so the appointment can be planned properly.
3. Ask to be positioned on your side if you are past around 20 weeks, or say if you feel faint or dizzy lying back.
4. Accept the x-ray if it is needed. Shielded dental x-rays are low dose and directed away from the abdomen.
5. Ask specifically what painkiller is appropriate for your stage of pregnancy rather than reaching for what is in the cupboard.
6. Have a check-up in the second trimester even without symptoms. Pregnancy gingivitis is very common and worth catching.

Pregnant and in dental pain in RBS or Beit Shemesh? Ramat Beit Shemesh Urgent Dental Care treats pregnant patients every week. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.