Antibiotic use in endodontic treatment during pregnancy: A narrative review

Submitted: 24 August 2022
Accepted: 26 September 2022
Published: 20 October 2022
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  • Tahere Aliabadi Department of Endodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of.
  • Eshagh Ali Saberi Department of Endodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of.
  • Amin Motameni Tabatabaei Department of Endodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of.
  • Ebadolah Tahmasebi Department of Endodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of.

More than half of pregnant women are usually affected by odontogenic pain affects. Pain often accompanies periapical or pulp infections and increases the risks to pregnant patients and their fetuses. The American Dental Association, in partnership with the American College of Obstetricians and Gynecologists, has offered a strong declaration reaffirming the significance of suitable and timely oral health care as an indispensable constituent of a healthy pregnancy. However, there is lack of knowledge about the use of antibiotics in endodontic treatment. Therefore, the present study would review the researches done in this area and tries to provide comprehensive and complete information about the use of antibiotics in endodontic treatment during pregnancy. Based on the results, it can be said that using antibiotics during pregnancy are allowed, and they can be used normally and safely by pregnant women.

Geevarghese A, Baskaradoss JK, Sarma PS. Oral Health-Related Quality of Life and Periodontal Status of Pregnant Women. Matern Child Health J. 2017 Aug;21(8):1634-1642. DOI:

Ibhawoh L, Enabulele J. Endodontic treatment of the pregnant patient: Knowledge, attitude and practices of dental residents. Niger Med J. 2015 Sep-Oct;56(5):311-6. DOI:

Cengiz SB. The pregnant patient: considerations for dental management and drug use. Quintessence Int. 2007 Mar;38(3):e133-42.

Buttino L. Principles & practice of medical therapy in pregnancy: McGraw-Hill Medical Publishing; 1998; 1998.

Hashim R. Self-reported oral health, oral hygiene habits and dental service utilization among pregnant women in United Arab Emirates. Int J Dent Hyg. 2012 May;10(2):142-6. Epub 2011 Oct 31. DOI:

Koyuncuoglu CZ, Aydin M, Kirmizi NI, Aydin V, Aksoy M, Isli F, Akici A. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications? Eur J Clin Pharmacol. 2017 Aug;73(8):1027-1032. Epub 2017 May 1. DOI:

Richards AG, Colquitt WN. Reduction in dental X-ray exposures during the past 60 years. J Am Dent Assoc. 1981 Nov;103(5):713-8. DOI:

Gibbs RS, Karlan BY, Haney AF, Nygaard IE. Danforth's obstetrics and gynecology: Lippincott Williams & Wilkins Philadelphia, PA, USA; 2008.

Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant patient. J Can Dent Assoc. 2009 Feb;75(1):43-8.

Gurbet A, Turker G, Kose DO, Uckunkaya N. Intrathecal epinephrine in combined spinal-epidural analgesia for labor: dose-response relationship for epinephrine added to a local anesthetic-opioid combination. Int J Obstet Anesth. 2005 Apr;14(2):121-5. DOI:

Enabulele J, Ibhawoh L. Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy. BMC Pregnancy Childbirth. 2014 Nov 25;14:388. DOI:

Little JW, Falace D, Miller C, Rhodus NL. Dental Management of the Medically Compromised Patient-Pageburst on VitalSource: Elsevier Health Sciences; 2007.

Khan SA, Hassan AU, Iqbal Z, Hassan MJJ. Endodontic Management of Acute Dental Pain Among Pregnant Patients. JPDA. 2021;30(01). DOI:

Silk H, Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. Am Fam Physician. 2008 Apr 15;77(8):1139-44.

Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Röbl-Mathieu M, Schiffner U, Vetter K, Weißenborn A, Wöckel A. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd. 2018 Dec;78(12):1262-1282. Epub 2018 Sep 25. DOI:

Sant'Ana AC, Campos MR, Passanezi SC, Rezende ML, Greghi SL, Passanezi E. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial. J Appl Oral Sci. 2011 Apr;19(2):130-6. DOI:

Wasylko L, Matsui D, Dykxhoorn SM, Rieder MJ, Weinberg S. A review of common dental treatments during pregnancy: implications for patients and dental personnel. J Can Dent Assoc. 1998 Jun;64(6):434-918.

Ather A, Zhong S, Rosenbaum AJ, Quinonez RB, Khan AA. Pharmacotherapy during Pregnancy: An Endodontic Perspective. J Endod. 2020 Sep;46(9):1185-1194. DOI:

George A, Shamim S, Johnson M, Dahlen H, Ajwani S, Bhole S, Yeo AE. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth. 2012 Sep;39(3):238-47. Epub 2012 Jun 27. DOI:

Marchi KS, Fisher-Owens SA, Weintraub JA, Yu Z, Braveman PA. Most pregnant women in California do not receive dental care: findings from a population-based study. Public Health Rep. 2010 Nov-Dec;125(6):831-42. DOI:

Santos F, Oraichi D, Bérard A. Prevalence and predictors of anti-infective use during pregnancy. Pharmacoepidemiol Drug Saf. 2010 Apr;19(4):418-27. DOI:

de Jonge L, Bos HJ, van Langen IM, de Jong-van den Berg LT, Bakker MK. Antibiotics prescribed before, during and after pregnancy in the Netherlands: a drug utilization study. Pharmacoepidemiol Drug Saf. 2014 Jan;23(1):60-8. Epub 2013 Aug 3. DOI:

Machowska A, Sihavong A, Eriksen J, Vongsouvath M, Marrone G, Sychareun V, Hanson C, Keohavong B, Brauner A, Mayxay M, Kounnavong S, Lundborg CS. Containment of Antibiotic REsistance-measures to improve antibiotic use in pregnancy, childbirth and young children (CAREChild): a protocol of a prospective, quasiexperimental interventional study in Lao PDR. BMJ Open. 2020 Nov 19;10(11):e040334. DOI:

Romero R, Gómez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim YM. The role of infection in preterm labour and delivery. Paediatr Perinat Epidemiol. 2001 Jul;15 Suppl 2:41-56. DOI:

Osunde O, Bassey G, Ver-Or N. Management of Ludwig's Angina in Pregnancy: A Review of 10 Cases. Ann Med Health Sci Res. 2014 May;4(3):361-4. DOI:

Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J. 2015 Feb;65(1):4-10. Epub 2014 Dec 16. DOI:

Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic Therapy in Dentistry. Int J Dent. 2021 Jan 28;2021:6667624. DOI:

Lodi G, Azzi L, Varoni EM, Pentenero M, Del Fabbro M, Carrassi A, Sardella A, Manfredi M. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev. 2021 Feb 24;2(2):CD003811. DOI:

Hussein RJ, Krohn R, Kaufmann-Kolle P, Willms G. Quality indicators for the use of systemic antibiotics in dentistry. Z Evid Fortbild Qual Gesundhwes. 2017 May;122:1-8. Epub 2017 May 16. DOI:

Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017 May 1;189(17):E625-E633. DOI:

Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol. 2017 Nov;83(11):2557-2571. Epub 2017 Aug 11. DOI:

Sá del Fiol F, Gerenutti M, Groppo FC. Antibiotics and pregnancy. Pharmazie. 2005 Jul;60(7):483-93. DOI:

Lin KJ, Mitchell AA, Yau WP, Louik C, Hernández-Díaz S. Maternal exposure to amoxicillin and the risk of oral clefts. Epidemiology. 2012 Sep;23(5):699-705. DOI:

Puhó EH, Szunyogh M, Métneki J, Czeizel AE. Drug treatment during pregnancy and isolated orofacial clefts in hungary. Cleft Palate Craniofac J. 2007 Mar;44(2):194-202. DOI:

Gottberg B, Berné J, Quiñónez B, Solórzano E. Prenatal effects by exposing to amoxicillin on dental enamel in Wistar rats. Med Oral Patol Oral Cir Bucal. 2014 Jan 1;19(1):e38-43. DOI:

Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev. 2003;(2):CD001058. Update in: Cochrane Database Syst Rev. 2010;(8):CD001058. DOI:

Czeizel AE, Rockenbauer M, Sørensen HT, Olsen J. Use of cephalosporins during pregnancy and in the presence of congenital abnormalities: a population-based, case-control study. Am J Obstet Gynecol. 2001 May;184(6):1289-96. DOI:

Ailes EC, Gilboa SM, Gill SK, Broussard CS, Crider KS, Berry RJ, Carter TC, Hobbs CA, Interrante JD, Reefhuis J; and The National Birth Defects Prevention Study. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res A Clin Mol Teratol. 2016 Nov;106(11):940-949. DOI:

Crider KS, Cleves MA, Reefhuis J, Berry RJ, Hobbs CA, Hu DJ. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med. 2009 Nov;163(11):978-85. DOI:

Dobiás L, Cerná M, Rössner P, Srám R. Genotoxicity and carcinogenicity of metronidazole. Mutat Res. 1994 Jun;317(3):177-94. DOI:

Rustia M, Shubik P. Experimental induction of hepatomas, mammary tumors, and other tumors with metronidazole in noninbred Sas:MRC(WI)BR rats. J Natl Cancer Inst. 1979 Sep;63(3):863-8. DOI:

Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006 May;107(5):1120-38. DOI:

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008 Jan 5;371(9606):75-84. DOI:

Marcos Z. Arriving too early. Lancet Neurol. 2013 Apr;12(4):332-3. Epub 2013 Feb 21. DOI:

Lawn JE, Kinney MV, Belizan JM, Mason EM, McDougall L, Larson J, Lackritz E, Friberg IK, Howson CP; Born Too Soon Preterm Birth Action Group. Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health. 2013;10 Suppl 1(Suppl 1):S6. Epub 2013 Nov 15. DOI:

Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, Lackritz EM, Lee SK, Mason E, Serazin AC, Walani S, Simpson JL, Lawn JE; Born Too Soon preterm prevention analysis group. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet. 2013 Jan 19;381(9862):223-34. Epub 2012 Nov 16. DOI:

Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003 Jan;101(1):178-93. DOI:

Soilly AL, Lejeune C, Quantin C, Bejean S, Gouyon JB. Economic analysis of the costs associated with prematurity from a literature review. Public Health. 2014 Jan;128(1):43-62. Epub 2013 Dec 18. DOI:

Burtin P, Taddio A, Ariburnu O, Einarson TR, Koren G. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):525-9. DOI:

Koss CA, Baras DC, Lane SD, Aubry R, Marcus M, Markowitz LE, Koumans EH. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob Agents Chemother. 2012 Sep;56(9):4800-5. Epub 2012 Jul 2. DOI:

Cohlan SQ. Tetracycline staining of teeth. Teratology. 1977 Feb;15(1):127-9. DOI:

Cohlan SQ, Bevelander G, Tiamsic T. Growth inhibition of prematures receiving tetracycline: a clinical and laboratory investigation of tetracycline-induced bone fluorescence. Am J Dis Child. 1963;105(5):453-461. DOI:

Wormser GP, Wormser RP, Strle F, Myers R, Cunha BA. How safe is doxycycline for young children or for pregnant or breastfeeding women? Diagn Microbiol Infect Dis. 2019 Mar;93(3):238-242. DOI:

Romøren M, Lindbæk M, Nordeng H. Pregnancy outcome after gestational exposure to erythromycin - a population-based register study from Norway. Br J Clin Pharmacol. 2012 Dec;74(6):1053-62. DOI:

Lin KJ, Mitchell AA, Yau WP, Louik C, Hernández-Díaz S. Safety of macrolides during pregnancy. Am J Obstet Gynecol. 2013 Mar;208(3):221.e1-8. Epub 2012 Dec 16.

Lin KJ, Mitchell AA, Yau WP, Louik C, Hernández-Díaz S. Safety of macrolides during pregnancy. Am J Obstet Gynecol. 2013 Mar;208(3):221.e1-8. Epub 2012 Dec 16. DOI:

McCormack WM, George H, Donner A, Kodgis LF, Alpert S, Lowe EW, Kass EH. Hepatotoxicity of erythromycin estolate during pregnancy. Antimicrob Agents Chemother. 1977 Nov;12(5):630-5.

McCormack WM, George H, Donner A, Kodgis LF, Alpert S, Lowe EW, Kass EH. Hepatotoxicity of erythromycin estolate during pregnancy. Antimicrob Agents Chemother. 1977 Nov;12(5):630-5. DOI:

Ziv A, Masarwa R, Perlman A, Ziv D, Matok I. Pregnancy Outcomes Following Exposure to Quinolone Antibiotics - a Systematic-Review and Meta-Analysis. Pharm Res. 2018 Mar 26;35(5):109. DOI:

Acar S, Keskin-Arslan E, Erol-Coskun H, Kaya-Temiz T, Kaplan YC. Pregnancy outcomes following quinolone and fluoroquinolone exposure during pregnancy: A systematic review and meta-analysis. Reprod Toxicol. 2019 Apr;85:65-74. Epub 2019 Feb 7. DOI:

Gilbert WM, Nesbitt TS, Danielsen B. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol. 2003 Sep;102(3):488-92. DOI:

Takayama JI, Matsuo N. The enigma of spontaneous preterm birth. N Engl J Med. 2010 May 27;362(21):2032-3; author reply 2033-4. DOI:

Pararas MV, Skevaki CL, Kafetzis DA. Preterm birth due to maternal infection: Causative pathogens and modes of prevention. Eur J Clin Microbiol Infect Dis. 2006 Sep;25(9):562-9. DOI:

Gravett MG, Novy MJ, Rosenfeld RG, Reddy AP, Jacob T, Turner M, McCormack A, Lapidus JA, Hitti J, Eschenbach DA, Roberts CT Jr, Nagalla SR. Diagnosis of intra-amniotic infection by proteomic profiling and identification of novel biomarkers. JAMA. 2004 Jul 28;292(4):462-9. Erratum in: JAMA. 2004 Nov;292(19):2340. DOI:

Burdet J, Rubio AP, Salazar AI, Ribeiro ML, Ibarra C, Franchi AM. Inflammation, infection and preterm birth. Curr Pharm Des. 2014;20(29):4741-8. DOI:

Martinez de Tejada B. Antibiotic use and misuse during pregnancy and delivery: benefits and risks. Int J Environ Res Public Health. 2014 Aug 7;11(8):7993-8009. DOI:

Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R. Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Sep;205(3):177-90. Epub 2011 Apr 2. DOI:

Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. ORACLE Collaborative Group. Lancet. 2001 Mar 31;357(9261):989-94. DOI:

King J, Flenady V. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev. 2002;(4):CD000246. Update in: Cochrane Database Syst Rev. 2013;12:CD000246. DOI:

Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, Taylor DJ. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet. 2008 Oct 11;372(9646):1319-27. Epub 2008 Sep 17. DOI:

Mercer BM, Goldenberg RL, Das AF, Thurnau GR, Bendon RW, Miodovnik M, Ramsey RD, Rabello YA; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes. Semin Perinatol. 2003 Jun;27(3):217-30. DOI:

Acar J, Davies J, Buckley M. Antibiotic resistance: an ecological perspective on an old problem. 2009.

Rao GA, Mann JR, Shoaibi A, Bennett CL, Nahhas G, Sutton SS, Jacob S, Strayer SM. Azithromycin and levofloxacin use and increased risk of cardiac arrhythmia and death. Ann Fam Med. 2014 Mar-Apr;12(2):121-7. DOI:

Morales WJ, Dickey SS, Bornick P, Lim DV. Change in antibiotic resistance of group B streptococcus: impact on intrapartum management. Am J Obstet Gynecol. 1999 Aug;181(2):310-4. DOI:

Heelan JS, Hasenbein ME, McAdam AJ. Resistance of group B streptococcus to selected antibiotics, including erythromycin and clindamycin. J Clin Microbiol. 2004 Mar;42(3):1263-4. DOI:

Fetissov SO, Déchelotte P. The new link between gut-brain axis and neuropsychiatric disorders. Curr Opin Clin Nutr Metab Care. 2011 Sep;14(5):477-82. DOI:

Bedford Russell AR, Murch SH. Could peripartum antibiotics have delayed health consequences for the infant? BJOG. 2006 Jul;113(7):758-65. DOI:

Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008 Apr;121(4):689-96. DOI:

Tan S, Holliman R, Russell AR. Hazards of widespread use of erythromycin for preterm prelabour rupture of membranes. Lancet. 2003 Feb 1;361(9355):437. DOI:

Gygax SE, Schuyler JA, Trama JP, Mordechai E, Adelson ME. Detection of erythromycin and clindamycin resistance genes in Group B Streptococcal clinical isolates and cervicovaginal-rectal swabs. Microb Drug Resist. 2007 Summer;13(2):119-23. DOI:

Yadav NR, Jain M, Monga A, SharmaA. Management of Pregnant patient in a Dental Clinical Setting. Annals of the Romanian Society for Cell Biology, 2021;25(6): 18728–18736.

Aliabadi, T. ., Saberi, E. A. ., Motameni Tabatabaei, A., & Tahmasebi, E. . (2022). Antibiotic use in endodontic treatment during pregnancy: A narrative review. European Journal of Translational Myology, 32(4).


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