Hygiene Message in a Bottle Mailbag: Should pregnant dental hygienists continue to take x-rays?

THE HYGIENE MESSAGE IN A BOTTLE MAILBAG is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Colleen Olson, RDH, BBA, the editorial director of the Hygiene Product Navigator, will answer reader-submitted questions to help you navigate your dental hygiene product decisions (and more!).

This month, she discusses guidelines for radiographic exposure during pregnancy and shares the results of an exclusive DentistryIQ survey that asked dental hygienists if they continued to take x-rays while they were pregnant and, if so, if they made any changes to their protocol.

Question

Miriam wrote: I have a dental hygiene–related question. Are there any guidelines for pregnant dental hygienists about taking x-rays in the dental office? Should a pregnant dental hygienist continue to take x-rays? Or should a dental assistant take the x-rays during the hygienist's pregnancy? We have digital sensor technology, and I am unsure what the actual protocol is when that time comes for me (soon, I hope). Thank you!

Answer

Thanks for the question, Miriam! Let’s begin by discussing the American Dental Association recommendation concerning dental radiation and pregnancy. The ADA website states, “Concern exists for the safety of dental x-rays in pregnant patients and operators. The ADA recommends the use of aprons and thyroid shields for pregnant patients and dosimeters and work practice controls for pregnant operators.” (1) What are “work practice controls” exactly? To discuss these controls properly we should briefly review the guidelines for the two main types of x-ray units.

For wall-mounted units, operator protection measures should be in place; these include “education, the implementation of a radiation protection program, occupational radiation exposure limits, recommendations for personal dosimeters, and the use of barrier shielding.” (2) Barrier shields would ideally include a leaded glass window. If the situation makes it impossible for the operator to be shielded, she should stand “at least two meters from the tube head and out of the path of the primary beam.” (2)

Handheld devices require no additional radiation protection precautions when used according to the manufacturer guidelines. These guidelines typically include holding the device at mid–torso height, orienting the shield to protect the operator, and keeping the tube head as close as possible to the patient’s face. (2) It is important to note here that dosimetry studies indicate there is no greater radiation risk for the patient or operator when a handheld x-ray device is used instead of a standard wall-mounted unit. (2) However, the ADA recommendations on limiting radiation exposure suggest that “pregnant dental personnel operating x-ray equipment should use personal dosimeters, regardless of anticipated exposure levels.” (2)

As with many guidelines, there is a difference between what is recommended and what is actually happening in practice, so we decided to conduct a survey of dental hygienists who practiced while pregnant. We asked several questions to determine how the hygienists took x-rays, what kind of unit they used, and who they discussed their concerns with. More than 1,200 hygienists responded.

The first question asked, “When you were pregnant, how were x-rays taken for your patients?” Almost 78% of these hygienists continued taking x-rays the same way they had before learning they were pregnant. About one-fifth of respondents wore a monitoring badge, and 9% wore a lead apron for protection. About 11% of hygienists indicated that another dental staff member took their x-rays during their pregnancies. Many respondents who used traditional wall-mounted x-ray units replied that they felt safe continuing to take images as they had been. Others chose to wait a few seconds longer after exposure or to stand a little bit further from the room than they normally would have.

Another survey question asked hygienists about when began taking x-rays in a different manner. As discussed above, 78% of respondents had already indicated that they took x-rays the same way they had when not pregnant. A small percentage, 2%, began modifying their x-ray safety procedures when they began attempting to conceive, while the other 20% changed their protocol when they found out they were pregnant.

The results that surprised me most were concerned with the type of x-ray technology used in the office. Almost 88% of respondents selected “wall-mounted tube head with an exposure button at least six feet away or behind a wall with a digital sensor,” but the vast majority of the written-in answers indicated that many offices did not use digital technology. This could be due to a few offices still lagging behind in dental technology or, more likely, the variation in the number of years that respondents have been in practice. More veteran hygienists may have been pregnant decades ago, when digital and handheld dental x-ray technology was new or nonexistent. As one respondent wrote, “no digital x-rays in 1978 and 1981.” These results may have skewed the data since there was no option for a wall-mounted tube head with film x-rays.

We asked two questions about dentists' responses to any changes in radiation safety procedures adopted by their hygienists. Almost 92% of those surveyed responded that their employers did not influence the way x-rays were taken during their pregnancies, and they were allowed to make the decision on their own. Only a handful of hygienists (1.5%) felt their employers responded negatively to the way x-rays were taken during their pregnancies, while the majority (88%) felt their employers remained neutral on the topic.

Almost one-third of responding hygienists indicated that they discussed their profession and the potential for radiation exposure with their obstetricians and received their professional input.

The final question was open-ended and allowed hygienists to share anything they wished. Many respondents took time to say that they felt following universal precautions kept them and their unborn babies safe while exposing radiographs. Several hygienists indicated that they took an easy extra precaution, such as wearing a lead apron or monitoring badge, for more peace of mind. A few responses mentioned that their discomfort with exposing radiographs makes or made them feel like a burden at the office. Some dental practices had assistants who would take over x-ray duties, while other offices did not have extra staff available to help hygienists who either did not want to expose x-rays or were directed by their obstetricians to refrain from taking them.

The thing that stuck out to me in this survey was the fact that most hygienists who responded already seemed to be taking measures to minimize radiation exposure in everyday practice, so major changes were not necessary when they were pregnant. It would be interesting to follow up with a second survey solely for handheld x-ray units since the overwhelming majority of respondents in this survey used wall-mounted units. I am curious to see how the results would differ for handheld x-ray unit users. I am thankful for organizations such as the ADA because they can provide us with industry guidelines on topics such as these, but it is helpful to see what is actually happening with hygienists in practice.

References

1. X-rays: Key points. American Dental Association website. http://www.ada.org/en/member-center/oral-health-topics/x-rays. Updated October 26, 2017.

2. American Dental Association Council on Scientific Affairs; U.S. Department of Health and Human Services Public Health Service and Food and Drug Administration. Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. Chicago, IL: American Dental Association; 2012. http://www.ada.org/~/media/ADA/Publications/ADA%20News/Files/Dental_Radiographic_Examinations_2012.pdf?la=en.

Colleen Olson, RDH,BBA, is an editorial director for the e-newsletter, Pearls for Your Practice: The Product Navigator. She earned a bachelor's degree in business administration from Texas A&M University in 2008 and worked in sales for five years. She graduated from the Blinn College Dental Hygiene program in 2013. She is a full-time mom to Bonnie Grace and is currently a part-time hygienist in private practice in San Antonio, Texas. She enjoys spending time outdoors with her husband, Zach, and their families.