by Anne Nugent Guignon, RDH, MPH
While I’m certainly not a math whiz, I love collecting data and analyzing trends. At the beginning of my speaking career, I designed an ergonomic survey for my course attendees about how we practice, and the products and type of equipment we work with in our clinical settings. The information is fascinating and the trends evident. Over the last decade, dental professionals have become more aware of workplace safety.
Twelve years ago it was rare for dental hygienists to use magnification, much less a headlight. An increasing number now use these devices, and have developed a growing reliance on ultrasonic scalers and new instrument designs. Customized operator seating is gaining traction, and many now consider buying their own equipment a basic survival strategy for a long and healthy career.
The end of my survey contains an open-ended question: “Are you having any physical pain, discomfort, or soreness related to hygiene practice? If yes, what steps have you taken to deal with these issues? Please explain.” A remarkable number of people take time at every program to share their stories. Last fall I presented a program at a major university annual alumni meeting. Other than having a large registration, this event was no different than dozens of others held over the years.
In the world of statistics, the data gathered from this group is classified as a convenience sample, and the information presented in this column is descriptive of the respondents who indicated they were experiencing pain or discomfort. Demonstrating causality requires a much more exacting survey instrument that is pretested for validity and subjected to more complex data analysis. Despite these limitations, the descriptive analysis of this group draws a very sobering picture of the physical health of those in our profession.
About 275 dental professionals attended the course, and 216 filled out the ergonomic survey. Sixty-three wrote that they were experiencing some kind of pain or discomfort, which represents 29% of the audience that returned the form. While the majority of those who reported pain were practicing dental hygienists, one dentist and four students also supplied data. The remainder of this discussion focuses on the cohort experiencing pain.
Eight respondents reported pain or discomfort but did not describe a specific area in their body. Many reported pain in multiple sites. The top three areas of pain or discomfort were clustered in the trunk. Twenty-two indicated neck pain, 18 experienced back discomfort, and 17 reported shoulder issues. Four reported hand, arm, or thumb pain. Three indicated headaches as an issue, and the same number stated they were having issues with their fingers. Two had problems with their elbows and two listed tingling and numbness. There was one mention each for the wrist, leg, and hip joint. Only 17% currently carry disability coverage, a commodity that is impossible to get for any pre-existing condition.
Chiropractic treatment was the top therapy of choice. Twenty-four respondents indicated one or more visits per month. Ten employ therapeutic massage techniques, nine engage in exercise/core strengthening activities, and seven work with physical therapists. Four reported regular stretching, and the same number take medication to deal with discomfort or pain. Four respondents have had a surgical intervention, and one reported using wrist splints, and another uses compression socks.
The most sobering piece of information gathered at this event was the fact that 42 of the 63 who reported pain are not using magnification loupes or auxiliary lighting systems. Numerous studies cite postural improvements in clinicians that use magnification systems. While I’m sure there are many reasons for not using loupes, the large number of attendees experiencing back, shoulder, and neck pain is disturbing. While massage, chiropractic treatment, exercise, and stretching may help decrease the severity or frequency of discomfort, it makes more sense to trade one’s health-care dollars for equipment designed to prevent or alleviate pain through better postural alignment.
The story does not end here. Four students were already experiencing pain or discomfort and they haven’t even graduated yet! Nearly 75% of the licensed clinicians, a total of 58, practice the equivalent of three or four eight-hour days a week, 39% and 33% respectively. The remaining 13 work an average of one to 24 hours a week. Clearly those experiencing discomfort put in more clinical hours.
Another startling fact came to light. Twenty-two respondents, including the four students, have practiced five years or less, meaning 35% of our new colleagues are already in trouble. Eleven have practiced between six and 10 years. Ten each were in the 11- to 15-year cohort and the 16- to 20-year cohort. Nine had 21 or more cumulative years of clinical experience.
It is impossible to read anything more into this data, but two things come to mind. First, a disproportionate number of those who have not spent years at the chair are hurt. Second, what does the drop in numbers starting in year six mean? One could speculate that clinicians may be leaving the profession or not practicing anymore. Through the years I’ve met hundreds of clinicians who no longer practice due to pain, injuries, and various surgeries.
The data gathered during the class parallels the findings of a 2007 survey commissioned by the ADHA. Over 11,000 dental hygienists were randomly selected to participate in the survey, which had an overall response rate of 44%. The executive summary, published in 2009, stated that more than half of all practicing hygienists (53.8%) worked more than 31 hours a week. One third of the respondents (33.8%) reported at least one workplace-related injury. Shoulder/tendonitis, neck injuries, and carpal tunnel syndrome were the most cited problems. Slightly over half of the dental hygienists (53%) who reported a workplace injury or illness indicated that they use medication to control the discomfort, and 49.5% indicated a reduction in work hours as a result of their injury or illness.
The remarks of two recent graduates at the fall CE made me pause. “Very sad. I’ve only been practicing 3.5 years and already I have trouble with my hands due to the poor equipment. The dentist has new handpieces, chairs, and equipment but denies my requests. I have soreness in my hands and back and am hoping my dentist will honor my request to update the equipment.”
The other attendee wrote, “The patient chair is old with no adjustment for the headrest. The chair height cannot be adjusted and the back is broken. We have talked to the dentist about the chairs and he says there is nothing wrong with them. The instruments are over three years old, and I’m experiencing hand pain.”
While I don’t have all the answers, I find the data from both surveys shameful. As a profession, we need to embrace the problem of workplace injury. Too many bodies are getting destroyed, which causes undue stress on family stability and financial health. Should a doctor be required to provide a safe workspace for all employees? The Pollyanna answer is yes. In the meantime, let’s each one become accountable for the health of our bodies and careers. We lose by expecting someone else to protect us. Harsh words? Yes, but ultimately we’re each responsible for our own comfort zone.