Practicing Dentistry While Pregnant

Pregnancy takes a different shape for everyone and every body. While each person experiences pregnancy differently, these tips and suggestions are intended to make it easier for you to take care of yourself and your baby while simultaneously caring for your patients, your staff, and your dental practice.

Consulting Your Physician

One of the most crucial steps in managing your health during pregnancy is maintaining open communication with your physician. Here are some key points to consider:

• Consult Your Physician Regularly: If you have questions or if something just doesn’t seem right, consult your physician. You know your body best, and there’s no such thing as an inconsequential question.
• Share Your Job Description: Provide a copy of your job description to your physician. Include a checklist that details the physical aspects involved in treating patients—sitting, reaching, leaning, holding small instruments and tools. The impact of these demands may change as your pregnancy progresses.
• Follow Medical Advice: Adhere closely to the advice and recommendations given by your doctor. If you have concerns about their suggestions or if you’re having difficulty following them, let them know.

Ergonomics and Physical Therapy

During pregnancy, a female dentist’s body undergoes significant physiological changes that can affect their ability to perform routine tasks. Increased body weight, altered center of gravity, and swelling may necessitate modifications in posture and workstation setup. Proper ergonomics are vital when practicing dentistry while pregnant:

• Ergonomic Practices: Pay attention to proper ergonomics while working. Stretch throughout the day to alleviate stress on muscles and joints. Place your feet on a small stool in between appointments. Ergonomic chairs with proper lumbar support and adjustable height can help mitigate discomfort.
• Physical Therapy: Participate fully in any prescribed physical or occupational therapy sessions.

Types of hazards at a dentists’ workplace

Some of the potential workplace hazards that dentists might face include:

• Infectious disease / bloodborne pathogens
• Laser/electrosurgery plumes
• Heavy metals (mercury)
• Nitrous oxide (waste anesthetic gases)
• Ionizing radiation (x-rays)
• Accidents (needle sticks, bites)
• Allergic reactions
• Physical strain
• Stress
• Chemicals (cleaning / disinfecting, dental sealants & tooth filling materials)

Although you may work around a potential hazard, it does not mean that you are exposed at levels that would cause a problem. There are safety measures that dentists can take to limit exposures.

X- rays: To be Exposed to Them or Not?

Properly maintained x-ray equipment that is used with proper techniques does not expose dental personnel to x rays, whether they are pregnant or not. The recommendation by some regulating agencies is that exposure should not be more than 0.05 rads in any one month of the pregnancy. X-ray exposure of less than 5 rads has not been associated with an increased chance for birth defects over the background risk. However, radiation doses greater than 5 rads in the first two weeks of the pregnancy, before the egg implants into the uterus, might increase the chance for miscarriage. For context, it has been estimated that it would take about 50,000 dental x-rays to build up a cumulative exposure dose of 5 rads. Exposure to high doses (more than 50 rads) of radiation could be harmful to a pregnancy. These high dose exposures have been associated with small head size and poor fetal growth. In addition, exposure to more than 10 rads of radiation between the 8th week and the 15th week of pregnancy might be associated with learning difficulties and intellectual disability in the child. Below are some general tips:

• Keep the time of exposure as short as possible.
• Maximize your distance from the source of exposure.
• Shield yourself from the source of exposure by:

--Using appropriate personal protective equipment (such as lead gloves and aprons); --Standing the appropriate distance from the machine, or be out of the room or behind the appropriate shielding walls; and --Not standing in a direct line from a machine’s beam source.

• Wear a personal radiation monitoring badge (dosimeter).
• Check to see if equipment is standardised as required; including machines and protective gear, such as lead aprons.
• Store lead aprons properly by hanging on an approved hanger (do not fold or crease).
• In extreme situations in which you cannot avoid being in the room while x-rays are being taken, use a mobile shield or wear a protective apron with appropriate thickness. Make sure the apron can wrap around the body and has full coverage of the abdomen. In addition, use lead goggles, gloves and shields.

Conscious Sedation Users and Pregnancy

Analgesia machines for dentistry are designed to deliver up to 70% (700,000 ppm) N2O to a patient during dental surgery, but in most cases, patients receive 30- 50% N2O. The most common route of N2O delivery and exhaust is through a nasal scavenging mask applied to the patient. If nitrous oxide is used properly, including use of scavenging equipment and correct technique, then it is unlikely to cause a higher chance of miscarriage or birth defects in a pregnant dental professional. In addition, nitrous oxide is not expected to get into breastmilk. Air monitoring can be done to evaluate staff exposure if there is a concern about air levels in the office. Some studies have found that exposure to anesthetic agents including halothane may cause adverse pregnancy outcomes in health-care personnel. But unless the procedure is performed under general anesthesia in an OR, halogenated anesthetics are not administered in dentistry.