In which trimester of pregnancy can emergency, challenging tooth extractions be performed, and what type of local anesthesia should be chosen?

The safest window for dental surgical procedures during pregnancy is the second trimester (weeks 14 to 27), because at this stage the baby’s organ development (organogenesis) is largely complete, and the expectant mother is still comfortable enough to avoid the risk of pressure on the inferior vena cava (supine hypotension syndrome) while lying supine in the chair, as is the case in the last trimester. If a difficult tooth extraction is necessary in emergency situations, “Lidocaine” or “Prilocaine,” which minimally cross the placenta and are pregnancy category B, should be preferred as local anesthetics; the epinephrine (adrenaline) concentration in the anesthetic solution should be kept to a minimum (1:200,000 or adrenaline-free forms) to avoid triggering uterine contractions, and written consultation and consent from the patient’s gynecologist must be obtained before the procedure.