Hello, A severe toothache brings up the concern of an infection. You need to treat an infection. Please check with your OB-GYN physician and update your doctor on this condition. Any complications with your pregnancy or allergies may affect your choice of dental treatment. This needs to be discussed with your treating dentist and your dentist would be glad to discuss any findings with your doctor. Minimal treatment would be to numb the tooth without epinephrine, establish drainage and put temporary medication covered with a sedative filling. An abscessed tooth could then be treated with a roor canal or extraction at a later date. Medications for painful and symptomatic infections usually include Amoxicillan and pain or anti-inflammatory medications. Tylenol is usually ok with OB-GYN doctors. Amoxicillan is prescription and should be discussed. I advise my patients to limit dental treatment and if needed try to do treatment during the middle trimester. Routine cleanings are advised to reduce inflamed gums. Dealing with an infection is a stress on your pregnancy and needs to be treated. X-rays give information about your tooth not seen with a clinical exam. This is a personal choice you will need to make about being exposed to a small amount of radiation while pregnant. I suggest an exam with a dentist to get a proper diagnosis and determine a safe treatment option. I wish you luck on your pregnancy. You need plenty of rest and to maintain a healthy diet for yourself as well as your baby.