Various physiological and pathological changes, including changes in oral health, often manifest during pregnancy. Hormones (gonadotropins) are largely responsible for sex drive, puberty, menstruation, pregnancy, and menopause, with progesterone and estrogen instrumental in sexuality and fertility.1
These two hormones cause enhanced vascularity, making pregnant women susceptible to periodontal diseases. Data from classic studies suggest that ovarian hormones alter the microenvironment of the oral bacteria, promoting bacterial growth and causing shifts in their populations.2 Periodontal status may deteriorate during gestation but generally improves postpartum.3
Increased incidence of caries and dental erosion have also been reported.4 Documented in 0.3%–2% of pregnant women, hyperemesis gravidarum is excessive vomiting, intractable nausea, and dry heaves.5 While initially the erosive lesions are not visible, the lesions caused by repetitive vomiting are often permanent and eventually become clinically observable.6 Table 1 provides tips for managing hyperemesis gravidarum.
Gestational diabetes (GDM), affecting 2%–7% of pregnant women, is high blood glucose levels during pregnancy and usually resolves postpartum.7 Meta-analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis. Further, periodontal disease causes a systemic inflammatory state, making diabetes control more difficult.8
Laws governing pregnancy
For workers in large organizations and practices, three primary laws oversee pregnant workers: the Family Medical Leave Act (FMLA),9 the Pregnancy Discrimination Act (PDA),10 and the Pregnant Workers Fairness Act (PWFA).11 Table 2 describes each law. However, since many practices have fewer than 15 employees, they fail to offer the average dental worker protection under the law.
The PUMP for Nursing Mothers Act, or the PUMP Act, was enacted in December 2022.12 This law requires all employers to provide a reasonable break time for a mother to express milk. It acknowledges that the time necessary for pumping will vary per employee. Employers must provide a private place that is not a bathroom and is free from intrusions. Rights under this act are available for up to one year after childbirth and all employers must comply, regardless of the number of employees.
Occupational hazards in the dental office
General considerations: To reduce occupational hazards, notify your employer of pregnancy as early as possible for self-protection and to put safety measures in place. According to the CDC and the National Institute for Occupational Safety and Health (NIOSH), changes in metabolism during pregnancy increase how quickly chemicals are absorbed, especially metals.
Physical changes may result in ill-fitting personal protective equipment (PPE), and there can be changes in the immune system and lung capacity. Even ligaments can be altered, which can increase risk of injury due to workplace hazards.13 Early in pregnancy, the fetus may be more vulnerable to some chemical exposures during its rapid growth and development.
Nitrous oxide: NIOSH states that dental workers are exposed to nitrous oxide during its administration to patients.14 Exposure to nitrous oxide has been associated with reduced fertility, spontaneous abortion, and development of neurological, renal, and liver diseases.15
The ADA states that special consideration should be given to pregnant dental personnel whose duties involve direct exposure to nitrous oxide.16 They should be selective when using it and wear a monitoring badge (25 ppm is the recommended exposure limit for workers). There should be a written monitoring system and a maintenance plan. Use scavenging systems, and ensure that masks fit and are worn properly by patients. Perform system maintenance every three months, including appropriate ventilation, leak testing, and monitoring the air in the room.
Radiation: The ADA suggests that pregnant dental providers taking radiographs have a barrier strategy and wear a dosimetry badge to track radiation exposure. This may include self-shielding while standing two meters from the primary beam of the tube head.17
Exposure to infectious diseases and bloodborne pathogens: Proper use of PPE and following infection control policies are critical in protecting dental workers.18 The most concerning bloodborne pathogens in dentistry are hepatitis B and C and human immunodeficiency virus (HIV).19 The major risks of HIV infection in health-care settings are through percutaneous injuries (needlesticks) and mucous membrane/skin contact, rather than, as previously believed, through aerosols generated by rotary and surgical instruments and air water syringes.20 As mentioned, there can be changes in PPE fit during pregnancy,9 so the provider must ensure proper fit and adherence to OSHA guidelines for maximum protection.
Chemicals: Mercury may cause damage to the lungs, kidneys, nervous system, eyesight, and hearing.21 According to the CDC, women planning to become pregnant, who are currently pregnant, nursing women, and infants are at risk.22 The ADA suggests that developing neurological systems in fetuses cause more susceptibility to adverse effects, such as sensitivity to the neurotoxic effects of mercury vapor. However, they recommend that amalgam restorations be removed only if no longer intact as removal increases exposure to the mercury vapor.23
Pregnant dental workers should be aware of other chemicals that pose risks. Disinfectants, such as glutaraldehyde and sodium hypochlorite (bleach), are commonly used to sterilize instruments and surfaces. These chemicals can irritate eyes, skin, and respiratory system, and some studies suggest a possible link to birth defects.24,25 Additionally, certain solvents such as acetone and xylene, used for cleaning or removing dental materials, may be harmful if inhaled in large quantities and can cause developmental problems.26,27
Pregnant workers should be especially vigilant with disinfectant use, as research suggests a possible association with miscarriage and preterm birth.26 Consulting the Safety Data Sheets (SDSs) for these chemicals provides crucial information on their specific hazards, recommended safety precautions, and first aid measures.28 By understanding the information in the SDSs, pregnant dental workers can take steps to minimize their exposure and protect their health.
Protecting oral health and worker safety during pregnancy
Pregnancy brings significant physiological changes that can impact a dental worker's health and safety. We highlighted the increased risk of periodontal disease, cavities, and dental erosion during pregnancy. We also addressed potential hazards in the dental workplace, including exposure to nitrous oxide, radiation, infectious diseases, and chemicals such as mercury, and disinfectants.
To maintain good oral health, pregnant dental workers should prioritize regular dental checkups, practice meticulous oral hygiene, and be mindful of dietary changes. In the workplace, early communication with the employer is crucial. Pregnant workers can benefit from laws such as the Pregnant Workers Fairness Act (PWFA) and the PUMP Act, which ensure reasonable accommodations and breaks for nursing mothers.
By following safety protocols and minimizing exposure to hazardous materials, pregnant dental professionals can protect themselves and their developing babies while providing excellent patient care.
Editor's note: This article appeared in the Aug/Sept 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
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