Working as a dental hygienist during pregnancy: Safety considerations and symptom management

For those who are trying to expand their families, or even if it comes as a surprise, pregnancy is an exciting milestone. Navigating it for the first time can be overwhelming, fun, confusing, and at times frustrating. Our bodies are going through so many changes in such a short amount of time that sometimes we feel an onslaught of uncomfortable symptoms. My pregnancy journey may be different than yours, but I hope some of this information can be useful or tailored to fit your specific needs.

Occupational hazards and pregnancy

I told my employers that I was pregnant early on, at about five to six weeks. The reason I told them so early was because I wanted to reduce occupational hazards and exposures, and so they knew the reason why I could not see certain patients. Two of the most important factors to me were not seeing patients who needed nitrous oxide gas sedation and not taking x-rays.

While nitrous oxide can be used safely in a dental office setting with proper maintenance protocols and well-maintained scavenging systems, it is still not recommended for pregnant individuals to work near it. This is because even with the best protocols in place, trace amounts of nitrous oxide gas can escape the machine, the patient’s nasal mask, or even the hose. Breathing in nitrous oxide gas can potentially be toxic. According to the Centers for Disease Control and Prevention (CDC), possible side effects can include spontaneous abortion, more commonly known as miscarriage.1 Continued exposure to nitrous oxide during pregnancy can lead to increased risk of premature delivery, congenital abnormalities, and cancer, renal, and hepatic diseases.1

I am not taking x-rays on patients while I am pregnant because I do not feel comfortable doing so. However, many pregnant dental hygienists do feel comfortable and make the personal decision to continue to do so. As long as universal precautions are followed, it will ensure the safety of you and your unborn baby. Additional precautions can be taken, such as wearing a lead apron while taking x-rays or wearing a radiation dosimeter, which can constantly be monitored to give you peace of mind. Most offices have lead-lined walls, which helps to reduce further radiation exposure.

Managing the symptoms

Dealing with first trimester symptoms, all while you may not be physically showing, is challenging. Many women deal with morning sickness and nausea—even though we all know that the nausea is not really just in the mornings! I had days where my nausea would last 12 hours, and I still had to see a full day of patients. What helped me and brought me some relief during the day and night, were three main things: staying hydrated, eating saltine crackers or another bland food, and ginger.

Dehydration is never a good state to be in for anyone, but especially for pregnant women. According to the American Pregnancy Association, “Dehydration during pregnancy can lead to serious pregnancy complications, including neural tube defects, low amniotic fluid, inadequate breast milk production, and even premature labor.”2 Since our work as dental hygienists is so physically demanding, we should always make sure that we are drinking an adequate amount of water during work hours.

I will be the first to admit that I have terrible water-drinking habits. I usually go the entire day at work with only a few sips of water, and not because I do not have the time to do so, but because I just forget to. It is only when I start feeling parched or dizzy that I remember that I need to drink more water. Since becoming pregnant, this is a habit that has been at the top of my priority list to finally break. Not only have I been feeling more “overheated,” but I also feel more tired throughout the day than I previously did.

Now I have made it a habit to go to the break room and drink a lot of water when the doctors are performing exams, in my downtime when I do not have a patient, during lunch, and basically any time I have a free minute. I also bring a very large water bottle with me and refill it when I finish it. Not only has it helped keep my energy levels up during the day, but I know that I am doing the responsible thing for both me and my baby’s overall health.

Constantly snacking throughout the day has also helped me keep my energy levels high and my stomach acids at low levels. I used to eat three big meals a day with an occasional snack to tide me over. Instead, I started bringing healthy snacks to work, such as my favorite trail mix, string cheese, and fruits. I noticed that I would get really hungry after seeing about two patients. Again, when the doctors were performing exams, I would go to the break room and eat a few bites and immediately feel better.

What do you do when you are feeling nauseated? The last thing I wanted to eat was trail mix or fruit, and I had always heard that pregnant women and saltine crackers go hand in hand. Well, I can confidently say that is true! A big mistake pregnant women can make is to keep their stomachs empty when they are feeling nauseated—especially if that nausea is coupled with vomiting. Then not only are you constantly emptying out your stomach, but now all the acids that are left in your stomach are going to wreak more havoc since they have nothing to actively digest. Saltine crackers are bland and they have a high starch content. The starch absorbs excess stomach acids and in doing so can help to relieve the nausea you are feeling. Of course, if the nausea is too much for you to handle and you’re constantly vomiting with no relief, speak to your physician about possible medications or other treatments.

The second trimester proved to be a little easier than the first trimester. My overall energy levels were definitely higher, and I did not feel as if I were in a constant fog of exhaustion. I was not showing physically yet, but I started to tell my patients that I would be on maternity leave when they were to come in for their next recall visit, so they would not be caught off guard when they came in for their next appointment.

Despite feeling better overall, what started around four and a half months of pregnancy were the restless and sleepless nights. I could not find a comfortable position to sleep in, which of course impacted my day-to-day life. I had constant back pain, and on top of going to work and trying as much as possible to stay in ergonomic positions, my back pain would be burning and truly aching in so many spots that it was unbearable at times. I took some advice from a good friend and started going to physical therapy sessions regularly during the week to help with my lower back pain. They gave me tools I could use at home and at work to help alleviate and lighten the aches and pains I was feeling. As my pregnancy progressed, the exercises I was doing changed as well.

Prenatal massage therapy sessions proved helpful around five months. A prenatal massage session is slightly different than a traditional massage therapy session. First, you are instructed to lie on your side, so you do not have to put additional pressure on your stomach, since that would be very difficult for us mamas-to-be! Even though I was not showing at five months, it was still very uncomfortable for me to lie on my stomach. Second, the massage therapist will avoid certain areas that are not safe to massage during pregnancy. For example, there are certain pressure points around the ankles that are contraindicated because, according to the American Pregnancy Association, they can cause pelvic muscles and the uterus to contract, which can in turn lead to premature labor.3

A good rule of thumb before proceeding with any type of outside therapy is to make sure that the professionals who are going to work on you are licensed in prenatal therapy. There are licensed prenatal massage therapists who know which areas to avoid as well as what types of massages will benefit you the most.

Another great product that can lead to a more restful sleep is a pregnancy pillow. Depending on what type of sleeper you are, you can find specific pillows to fit your needs. There are pillows that support your back and your stomach when you sleep on your side. Some act like as a small wedge if you just want support under your belly when you sleep, and some pillows give you all-around body support and can be placed between your knees to alleviate pressure on your lower back.

The last and most important piece of advice I can impart is to find an obstetrician who you absolutely trust and feel comfortable with. You will be seeing your physician at least once a month and sometimes more, so it is very important that you find an office where you are happy. Not only does the physician matter, but the office staff does as well since you will be speaking and keeping in touch with them frequently. I ended up leaving my previous obstetrician almost four months into my pregnancy for another, so I can understand the stress and discomfort you may feel switching in the middle of your pregnancy. You should feel comfortable relying on your doctor or his or her staff, especially if this is your first pregnancy and you need extra guidance navigating this new journey of yours.

Everyone has their own experience during pregnancy, and I wish you the best of luck! Remember that you are in control of the decisions you make or need to make, and ultimately you know what is right for you and your baby.

References

1. National Institute for Occupational Safety and Health. Controlling exposures to nitrous oxide during anesthetic administration. Centers for Disease Control website. https://www.cdc.gov/niosh/docs/94-100/default.html. Updated June 6, 2014.

2. Dehydration during pregnancy. American Pregnancy Association website. http://americanpregnancy.org/pregnancy-complications/dehydration-pregnancy/.

3. Massage and pregnancy. American Pregnancy Association website. http://americanpregnancy.org/pregnancy-health/prenatal-massage/.

Datevig Tegeleci, MA, RDH, has been a practicing clinician for three years. She received her master’s in biomedical sciences from Midwestern University and her bachelor’s degree in dental hygiene from West Coast University.