Dear Dianne,
I just received the wonderful news that I am pregnant! My husband and I are thrilled at the thought of having our first child!
The problem is that my employer expects me to continue taking radiographs. I am aware that radiation can do great damage to a developing baby, and I just do not want to take any chances. The two dental assistants have agreed to help me when they can, but I am certain there will be times when they won't be able to come when I need them.
The doctor does not understand my feelings of concern, and he has been adamant that patient care is not to be interrupted by my pregnancy. His attitude has been one of indifference. In fact, he said if I refuse to take X-rays, I could be terminated. This both angers and hurts me.
My husband and I bought a new house last year, so I need to work. The office is close to my home and I am fond of my patients and co-workers. However, no amount of money or all the new houses in the world are worth compromising my baby's health. Is there any workable solution to this problem?
Scared in Silver Springs
Dear Scared,
Congratulations on your pregnancy! This is indeed an exciting time for you and your husband.
Your concern about X-ray safety and implications for the developing baby is understandable. It is prudent to be aware of potential hazards.
However, as with many first pregnancies, it is possible to be overly anxious. Let's look at what you need to do to ensure safety.
If you remember from your hygiene school radiology education, the one material that X-rays will not penetrate is lead. Therefore, we drape our patients with a lead shield to protect vital organs from both primary and secondary radiation. With dental radiographs, the primary beam is directed to the head and neck area. So, the uterus is not exposed to primary radiation from dental radiographs.
According to the latest edition of Radiology for Dental Auxiliaries, by Harold Frommer, uterine doses of radiation from a full-mouth series without a lead shield have been shown to be less than 1 millirem. The average uterine dose from other environmental sources is about 225 millirems. So, with the uterine dose only a small fraction and no reported birth abnormalities linked to background radiation, there is no scientific reason to preclude X-rays during pregnancy for our patients. We typically defer radiographs for our pregnant patients purely for psychological reasons.
Several well-designed and well-monitored studies have been carried out to check the occupational exposure for dentists and auxiliaries. The documentation is clear, and the occupational risk is zero. There is no danger of radiation exposure to the developing baby if proper radiation hygiene is practiced. The courts have held there is no reason to change chairside or other duties during pregnancy because of concern about radiation exposure (Plunket, L: "When an Employee Becomes Pregnant," N Y State Dental J 62:9-11, 1996).
In our school clinic, we require students who are pregnant to don a lead apron while exposing any radiographs. The apron covers both front and back, and falls to the upper-thigh level. No student is excused from taking necessary radiographs on her patients because she is pregnant.
The best way for dental auxiliaries and dentists to know the amount of occupational exposure they receive is to wear film badges. These badges are worn in the office for a three to four-week period and then returned to the company for processing. The density on the film is compared with standards to determine if the operator has been exposed.
Auxiliaries should be careful not to wear the badge out of the office or in bright sunlight, since this could give a false reading.
Please keep in mind that although you are thrilled about your pregnancy, the doctor may be not be so thrilled. He or she may be concerned about the interruption to the practice during your absence. It sometimes is very difficult to find a temporary hygienist to work during a maternity leave. Your anxiety over taking radiographs may only heighten the doctor's concern about the business.
I hope I have given you reason to relax and not worry about your baby's safety or about caring for your patients when they need radiographs. Take the proper precautions, wear your lead shield, and look forward to cradling that new little one in a few months!
Best wishes,
Dianne
Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor's degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at [email protected], phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at http://www.professionalden talmgmt.com
Basic guidelines fors radiation hygiene
What is proper radiation hygiene? Here are some basic guidelines:
- Never stand in the path of the primary beam.
- Do not hold film in the patient's mouth - ever!
- Do not hold a drifting tube head when making an exposure.
- The operator should be a minimum of six feet from the tube head and behind a wall. At this distance and behind a wall, the occupational exposure is zero.
- Wear a lead apron that drapes over your shoulders and covers the abdominal area completely.
