Which local anesthetic is considered the SAFEST choice for a pregnant dental patient?

Correct answer: B. Lidocaine with epinephrine (2% with 1:100,000)

• A. Articaine is a Category C drug in pregnancy — there is less evidence on its safety compared to lidocaine. While used in practice, lidocaine has a better-established safety profile.
• B. CORRECT. Lidocaine (FDA Pregnancy Category B) is the most studied and recommended local anesthetic during pregnancy. It crosses the placenta minimally at dental doses. Epinephrine is acceptable at dental concentrations (1:100,000) — it actually reduces lidocaine's systemic absorption. Lidocaine with epinephrine is the first-line LA for pregnant patients.
• C. Mepivacaine (plain, no vasoconstrictor) has a longer systemic half-life in neonates than lidocaine and is actually considered LESS safe during pregnancy — it is relatively contraindicated in obstetric anesthesia. Plain mepivacaine without epinephrine has higher peak blood levels due to faster absorption.
• D. Tetracaine is an ester-type anesthetic used primarily for topical anesthesia, not for injection in routine dental procedures.