Running head: FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES

The Risk of Reproductive Outcomes among Female Dentists

Summary

In most professions, there are hazards that the professionals in that field are exposed to.

This is the same in the field of dentistry, whereby the dentists are exposed to hazards that

emanate from the use of chemicals in the practice. One of these occupational hazards is the

exposure to the anesthetic, Nitrous Oxide. This gas has an effect on the female gender and in this

case the female dentists and assistants.

The chronic exposure to this gas is more dangerous than the acute exposure, and since

the female dentists and assistants use the gas continuously, chronic exposure occurs. This

Nitrous Oxide has an effect of disrupting the reproductive system, whereby the gas oxidizes

vitaminB12, which is vital in the formation of the necessary amino acids. This in turn hinders the

formation of adequate amino acids, and also disrupts the activeness of an enzyme that is

necessary in the synthesis of DNA.

With these biological processes disrupted, the female practitioners experience

spontaneous abortions/miscarriages, and also reduced fertility. This has been reported in

different parts of the world, and therefore is a common phenomenon. This then has a huge

impact on the field of public health whereby these chemicals are being used on a daily basis, and

the practitioners are exposed to them for long periods. This is due to the possibility of the female

students abandoning their careers on this field due to the fear of not being able to conceive and

raise families.

This hazard has also had a huge impact on the society, through the breakup of

relationships and homes due to the inability to conceive and raise a family. The women
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 2

practitioners have also experienced anger, anxiety and even the post traumatic disorder as a

result.

Introduction

In any profession, there are the environments that the professionals working in them

experience, and some lead to occupational hazards. It is the same thing when it comes to

dentistry, whereby the uses of chemicals are necessary for the profession. In dentistry, this

chemical is Nitrous Oxide, which is used in the different aspects of dentistry. This chemical

poses an occupational hazard for the dentists, especially those of the female gender (American

Dental Hygienists' Association, 2009). Several studies have been carried out on the same in an

attempt to investigate the issues that result from the exposure to the different types of chemicals

in the workplace. This included the study on the effects of the exposure to Nitrous Oxide on the

female dentists. This chemical is used by dentists to reduce the anxiety of patients, as a sedative

(Olfert). These studies have revealed that the use of Nitrous Oxide exposes the dentists to diverse

side effects, which includes the reduced mental performance, fetal malfunctions, audiovisual

ability reduction and liver diseases (Gambhir et al., 2011).

Another effect of Nitrous Oxide is the environmental pollution, whereby during the

exposure, the levels that the dentists are exposed to are beyond the limits they would be exposed

to during practice. The environmental pollution causes the limits of exposure to be in excess

since the exposure accumulates over time. This gives rise to the chronic exposure, which is more

dangerous than the acute exposure which is in high concentration. This type of exposure

therefore becomes a risk to the female dentists as it brings about the disruption of their

reproductive system. Specifically, the exposure to Nitrous Oxide reduces the fertility and can

also cause abortions if the female dentists exposed to it are pregnant (Dosch, 2009). This essay
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 3

therefore looks at these issues that the female dental workers face as a result of exposure to the

Nitrous Oxide.

History

There has been evidence of the effects of handling chemicals in the workplace by the

employees. For example, the effects of these chemicals on nurses, or in the case of the female

employees working in pharmaceutical companies, have been studied. The evidence acquired

from these epidemiological studies have proven that the exposure to different chemicals in the

workplace have an effect on the female employees handling them, which leads to spontaneous

abortions and also infertility (Masters, 2011).

Studies have been carried out in an attempt to investigate the occupational hazards,

especially due to the exposure to different chemicals. These chemicals include all forms, from

solvents to the gases. In relation to this essay, the same has been done on the chemicals that the

practitioners in the healthcare industry are exposed to regularly in their practice (Lindbohm,

1995). This included chemicals like the disinfectants, drugs and anesthetic gases. Exposure to

these chemicals leads to different side effects to be experienced by the practitioners who handle

them in their day to day work (Figa-Tamalanca, 2006). In the dentistry, there is a vast use of

Nitrous Oxide, which is an anesthetic. Studies were carried out in the years between 1980 and

1990, which showed that there was toxicity when it came to the reproduction system. This

brought about risk of spontaneous abortion and also cases of delayed pregnancies (Arkhipoff et

al, 1985).

Etiology

The scientific explanation behind this is that the chemical, Nitrous Oxide has been known

to oxidize a certain type of Vitamin, termed as vitaminB12. This in turn impairs the formation of
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 4

adequate amino acids, and also Thiamine. Another effect that Nitrous Oxide has is the

inactivation of Methionine Synthase Enzyme, which is useful in the synthesis of DNA. In the

female dentists therefore, Nitrous Oxide can cause the disruption of all the processes that require

mitosis like the folliculogenessis. All the biological processes requiring this element will

therefore not function normally (Rowland et al, 1992).

Magnitude of the Problem

Although generally, as compared to other medical fields, dentistry has been considered as

one of the least hazardous practices, the female professionals in this field still face challenges.

Studies on the side effects posed by the chemicals being used in the dentistry were conducted in

the year 1980 and onwards (Figa-Talamanca, 2006). These studies have included information

regarding the relationship between the fertility rates and the exposure to the Nitrous Oxides. This

was done by collection of information on the female employees who intend to become pregnant,

whereby the number of active menstrual cycles were taken. Control groups were established

whereby they were to be used for comparison purposes. The information that was collected

pertaining the active menstrual cycles of the female employees was then compared against that

of the established control groups. The results showed that the female employees working as

dentists and were exposed to Nitrous Oxide were not as fertile as the ones in the control group. It

was also found out that these female professionals were less likely to conceive, and some of the

participants were found to be infertile, while most of the other participants were nearing

infertility (Rowland et al., 1992).

The same trend was found in the U.K, whereby the results found that there was even a

higher rate of abortions as compared to the established control groups. In America, a study was

carried out on the female dentists. The results showed a higher percentage of spontaneous
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 5

abortion on the female workers who were exposed to Nitrous Oxide a year before their

conception, than that of the female workers that were not exposed to Nitrous Oxide before their

conception (Cohen, 1980).

In Canada, the exposure that was found in the year 2003 was greater than the rates that

had been recorded in the previous years (Centre, n. d.). This was linked to the continuous

exposure to Nitrous Oxide (AM, 2003). In Funen, a Danish country, the research carried out on

the pregnant female dentists and their assistants showed that they were at a high risk of

experiencing abortions, whereby the rates of spontaneous abortions stood at 74 percent (Heidam,

1984). There have been developments in this area where some preventive measures have been

innovated and implemented to prevent or rather reduce the risks that arise from the exposure to

the Nitrous Oxide (CDC, n. d.).

Impact of the Reproductive Outcomes on the Society

The two outcomes of the female operator’s exposure to the anesthetic include the

spontaneous abortions and also the miscarriages. Although these unfortunate events can be

considered to be normal, the impact it has on the women who experience it is very strong and

will interfere with their day to day functions. As aforementioned, the female practitioners have

desires of one day being able to raise a family. With the exposure of Nitrous Oxide which they

are exposed to however, this might not be possible. This therefore means that more and more

female dentists will not be able to give birth or raise a family. There are very many effects of the

spontaneous abortions and reduced fertility generally in the society. In the case of the

relationships that the female dentists have, they may be put in test when the spontaneous

abortions come about from time to time. This occurs when they will be strained, leading to

anger, depression, anxiety and even post traumatic stress disorder (Bowles, et al., 2000), which
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 6

often leads to broken relationships. This results in broken homes and may also lead to other

societal issues (Swanson, et al., n.d).

In addition to these, the women who have experienced these effects of exposure to

nitrous oxide do develop emotional damages. These psychological factors make the women who

have experienced it to develop fear of miscarriages and the spontaneous abortions, which will

affect the development of the fetus, hence complications. Another effect that arises is the

possibility of infertility by the female dentists, which is a very serious issue in the society. This

problem affects all the couples, with very serious impacts in the society to personal life and

relationships. The women who become infertile tend to develop psychological symptoms which

are comparable to those suffering from diseases like HIV, hypertension and cancer among

others. What makes it worse than the other serious conditions is because infertility caused by the

exposure to nitrous oxide is not a natural condition like the other diseases, but is an occupational

related condition (Harvard Health Publications, 2009).

Impacts of the Reproductive Outcomes on the Public Health

Any form of reproductive anomaly has an impact on the person experiencing it. These

anomalies include the spontaneous abortions and also the miscarriages. The two outcomes of the

exposure to Nitrous Oxide by the female dentists have an impact on the field of public health,

and more specifically, the dentistry discipline. The reducing rates of infertility brought about by

spontaneous abortions, or miscarriage has an impact on the choice of career by the female

students. The effects of this outcome on the women are lasting, and will take long for the female

practitioners to recover and to get back to work (Domar, Zuttermeister & Friedman, 1993).

These female practitioners have desires, just like any other woman, to raise a family by giving

birth and stabilizing a marriage. These desires are however hampered by the occupational
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 7

hazards that they are exposed to, since their chances of successfully giving birth are minimal.

This causes several issues among them mental health issues including depression for women

(Harvard Health Publications, 2009). The females who have gone through the miscarriages and

the abortions have been found out through studies to be emotionally destroyed. They undergo

societal withdrawal as they get depressed, loose appetite, self blame, fantasize about the fetus

and also hallucinate about babies’ images, among others. All these issues on the female dentists

do interfere with their professional duties, and therefore affect the effectiveness of the public

health (Harvard Health Publications, 2009).

This influences all the aspiring female dentists to rethink their choice of career, and most

of them will not pursue their dentistry career. In the long term, the field of dentistry in the public

health will be characterized by very few female practitioners and a very large percentage of male

practitioners (Scarbecz & Ross, 2012).

Reference:

AM, C. (2003). Infertility evaluation and Management. Strategies for family physicians. Canada

Family Physician , 1465-1472.

American Dental Hygienists' Association. (2009). Survey of Dental Hygienists in the United

States. American Dental Hygienists' Association .

Arkhipoff, J. e. (1985). Pregnancy and Its Outcome among hospital personnel according to

occupation and working conditions. J Epidemiol Community Health , 129-134.

Bowles, S. V., James, L. C., Solursh, D. S., Yancey, M. K., Epperly, T. D., Folen, R. A., et al.

(2000). Acute and Post-traumatic Stress Disorder After Spontaneous Abortion. Retrieved

July 21, 2012, from American Family Physician:

http://www.aafp.org/afp/2000/0315/p1689.html

CDC. (n. d.). Controlling Exposures to nitrous oxide during anesthetic administration. Retrieved

July 21, 2012, from http://www.cdc.gov/niosh/docs/94-100/

Centre. (n. d.). What the census can tell us about Canada's dental workforce. Retrieved July 21,

2012, from http://www.cranhr.ca/pdf/focus/FOCUS08-A2.pdf

Cohen, e. a. (1980). Occupational Disease in dentistry and chronic exposure to trace anesthetic

gases. Journal of American Dental Association , 21-31.

Domar, A. Z. (1993). The psychological impacts of infertility: A comparison with other medical

conditions. J. Psychosom. Obtet. Gynaecol , 45-52.

Dosch, M. P. (2009). Scavenging and Waste anesthetic gases (WAGs). Retrieved July 21, 2012,

from http://www.udmercy.edu/crna/agm/10.htm
 FEMALE DENSTISTS AND REPRODUCTIVE OUTCOMES 9

Figa-Talamanca, I. (2006). Occupational Risk Factors and Reproductive health hazards in

current Dental Proffession. Occupational Medicine , 521-531.

Figa-Tamalanca, I. (2006). Occupational Risk factors and Reproductive health of women.

Retrieved July 21, 2012, from http://occmed.oxfordjournals.org/content/56/8/521.full

Gambhir, R. S. (2011). Occupational health hazards in current dental proffession. The Open

Occupational Health & Safety Journal , 57-64.

Harvard Health Publications. (2009). Psychological impact of infertility, from the Harvard

Mental Health Letter. Retrieved July 21, 2012, from

http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/May/

The-psychological-impact-of-infertility-and-its-treatment

Heidam, L. Z. (1984). Spontaneous Abortions among Dental Assistants, Factory Workers,

Painters and Gardening Workers: A follow up study. Journal of Epidemiology and

Community Health , 149-155.

Lindbohm, M. (1995). Effects of Parental exposure to solvents on pregnancy outcome. J Occup

Environ Med , 699-713.

Masters, J. L. (2011). Female Reproductive Hazards in the dental office. Retrieved July 21,

2012, from http://www.dentalaegis.com/ida/2011/08/female-reproductive-hazards-in-the-

dental-office-are-female-dental-assistants-at-risk

Olfert, S. (2007). Reproductive outcomes among dental personnel. Retrieved July 21, 2012, from

http://saiddent.org/literature/Reproductive%20Outcomes%20among%20Dental

%20Personnel-A%20Review%20of%20Selected%20Exposures.pdf

Rowland, e. a. (1992). Reduced Fertility of women employed as dental assistants exposed to high

levels of nitrous oxide. The New England Journal of Medicine , n/a.

Scarbecz, M. &. (2012). Women in Dentistry. Retrieved July 21, 2012, from

http://www.dentistryiq.com/articles/wdj/print/volume-3/issue-3/focus-on-career-

choices/women-in-dentistry.html

Swanson, K. M. (n. d.). Miscarriage effects on couples' interpersonal and sexual relationships

during the first year after loss:Women's Perception. Retrieved July 21, 2012, from

http://nursing.unc.edu/ccm/groups/public/@nursing/documents/content/

ccm3_032557.pdf