Pain: It Shouldn’t Be Part of the Job

From infectious and psychological hazards to allergic reactions and musculoskeletal injuries, dentists, hygienists and assistants put themselves in harm’s way every day. In fact, according to a 2012 Dental Research Journal article, most dental professionals and the general public believe dentistry is extremely hazardous. Fortunately, preventive steps can eliminate or reduce the chances of injury related to all the hazards present in dental practices. However, musculoskeletal injury is one area particularly difficult to overcome. Many clinicians believe that the eye strain, headaches and neck, shoulder, elbow, wrist, hand and back pain are just part of the job. But would you say that about a sharps injury or latex allergies? Probably not. You’d take preventive action by using safer sharps and switching to nitrile gloves.

What preventive steps can you take to protect yourself from repetitive and large movement injuries? Start with some education and self-awareness, then integrate tools that will support your musculoskeletal health.

Learn about your body and yourself

Have you ever noticed your body position when preparing a tooth or scaling and root planing? Where are your arms and legs? Are you severely leaning over with your neck bent? Do you frequently reposition the overhead light to get a better view?

When you’re completely focused on clinical work, sitting is best. A seated position helps to keep your body relaxed and your spine properly aligned while providing support. In addition to spine alignment, this neutral position allows you to flex your head at a 20-degree angle (or less) and direct your eyes down. The result is reduced eye and neck strain.

Of course, too much sitting also can be hard on your health. This means you have to find opportunities to take regular breaks and move around. And when you’re not at work, make physical activity part of your regular routine. Whether it’s walking, yoga, working out at the gym or gardening, make sure you’re moving your body on a regular basis.

Supportive tools

Emily Boge, CDA, RDH, MPA, dental administrative chair at Hawkeye Community College in Waterloo, IA, describes a heads-down approach to ergonomics that includes loupes, headlamps, stools, chairs and gloves. All of these elements are incorporated into the curriculum at Hawkeye for dental students. “I believe if you don’t create bad habits, you don’t have to break them,” Boge says. “For instance, if I never start smoking, then I’ll never have to stop.”

Loupes and headlamps

Ergonomic posture isn’t natural for most people. When you want to get a closer look at your work, you’ll probably tilt your head and twist your body. Loupes, when properly fitted, can help you maintain an ergonomic posture where you sit upright and rotate your eyes downward. To achieve a proper fit, you need to determine your individual declination angle and working distance so you don’t feel the need to lean forward and out of neutral alignment.

Headlamps help you visualize the oral cavity while putting an end to repetitive large muscle movement that occurs when you reach up to reposition the overhead light. This habitual maneuver can result in shoulder and neck injury. Boge said that when she first started using a headlamp, she would reach up to reposition the light simply out of muscle memory. But once that habit is broken – that is, when you have all the light you need attached to your loupes – you’ll eliminate that repeated strain.

Chairs and stools

The neutral seated position you want to maintain requires a supportive chair or stool. Dynamic seating options, such as saddle stools, encourage good posture and position your pelvis down and forward, with your hips above the knees. These seats make it easier for you to sit close to the patient. Look for saddle chairs with adjustment options, so you can customize the height and seat tilt to best conform to your body type.

Gloves

The personal protective equipment you wear has an ergonomic component, too. Gloves, when worn over a prolonged period, can contribute to musculoskeletal disorders. They can constrict the hands, damage nerves and blood vessels – especially during repetitive motions – and result in hand fatigue, tendinitis and carpal tunnel syndrome. To prevent these issues, manufacturers have developed gloves with materials that minimize muscle effort.

Evidence-based strategies

Boge described how, when she graduated from hygiene school nearly 20 years ago, the pain dental professionals experienced during clinical work was normalized. “If my neck hurt, it was seen as just part of the job,” she explained. “Now, there’s a shift – schools are finally catching up with the technology manufacturers have made for us and our health.”

The industry is beginning to recognize which positions and equipment best support dental professionals’ health during clinical work, yet it is an ongoing effort. A 2018 Cochrane review revealed the need for more randomized clinical trials with long-term follow-ups to assess strategies for preventing work-related musculoskeletal disorders. Dental professionals deserve evidence- based approaches to injury prevention so they can enjoy long, healthy, productive careers.

Selected references

Ayatollahi J, Ayatollahi F, Ardekani AM, et al. Occupational hazards and dental staff. Dent Res J. 2012;9(1):2-7.

Chang BJ. Declination angle: The key factor for custom loupes. OralHealth. July 1, 2014.

FDI World Dental Federation. Policy statement: Musculoskeletal disorders and dental practice. October 2007.

Mulimani P, Hoe VCW, Hayes MJ, Idiculla J, Abas ABL, Karanth L. Ergonomic interventions to prevent musculoskeletal disorders among dental care practitioners. Cochrane Database of Systematic Reviews. October 15, 2018.

– – –

This blog post originally appeared in Best Practice.