Purposely choosing to not invest in myself (regardless of whether or not the employer could afford) became the ultimate career killer.
By Dee Humphrey, RDH, BHSc
A dental hygienist's job is strenuous and has the potential to cause serious musculoskeletal injuries, but this does not slow us down from providing treatment services. As a young dental hygienist who graduated over six years ago, my clinical career is now hanging on by a thread (literally). With a previous minor injury to my upper neck and lower back, clinical dental hygiene-combined with a few bad choices-has become the ultimate career killer.
With limited knowledge about ergonomics, technology, and the specialized equipment to further the longevity of my career, I jumped into the "hygiene world" as superwoman trying to save the world one mouth at a time. My mentality was to pay off those bills, not worry about my health or body aches, and just earn a pay check without actually investing in myself or my career. For that matter, who actually has the money for those loupes with the little fancy light? Or that luxurious ergonomic chair that aids in better support for one's neck and back? Forget about those high quality instruments that stay sharp longer. The dentist would rather spend the money somewhere else. Liability insurance: who cares? I am not going to get hurt. How about spending my money on a designer handbag to take on an expensive vacation that I can actually enjoy?
Although this is not the mentality of some, it tends to be the mindset of most clinicians, especially new hygienists. Why do we intentionally choose to make bad choices that affects our careers and livelihood? The average hygienist does not invest in the longevity of his or her career and continues to work in unnecessary pain. It is vital to understand that the choices we make impacts more than one area in our lives, and it does change our future for the better or worse.
After graduating hygiene school, I couldn't wait to get a job and get my fingers wet. I felt the urgency to get started and was willing to work anywhere. So I took the first offer I was given in a local community dental clinic and worked Monday through Friday, eight hours a day. It seemed like the ultimate dream job for a new grad like me. Being in public health, I didn't have to modify treatment to accommodate for limited funding, and there was unlimited access to debridements and full mouth SRPs on any given day. Soaking up all the experience I could get my hands on, I learned much about the public health sector, oral pathology/diseases, and how to remove calculus quickly, yet proficiently. Taking a time off was put on the back burner, and I would occasionally stretch my hands and wrists to compensate for whenever I felt an ache or two.
1st bad choice: Failure to prevent risk factors for potential body injury and compromising the overall body health by not taking time off to alleviate muscle fatigue.
After a few years, I began to notice that my neck, left arm, and lower back started to bother me. I thought it was part of the job. As long as I had an ultrasonic scaler and decent instruments (three to five years old), I had everything under control (or so I thought). I wore loupes with no attached light and knew my ergonomic practices were not the best. But I blamed it on the 15-year-old dental chair that I kept sliding out of on a daily basis.
My dominant hand was removing calculus just like it always did, but my opposite mirror-holding hand started to have some major issues. I would occasionally drop things on the floor, but I thought it was no big deal while I kept trucking along. After all, repetitive work is what we do! As I would reach over to pick up items from the assisting table, the burning pain became a constant indicator that my career was starting to wear on me. However, as long as I continued to religiously stretch and do ergonomic exercises, I thought I had nothing to worry about. I didn't have the time to take off to go to the doctor, and I didn't think this was some issue to cause worry. After many months of the "neck tingles" protruding down my left arm to the tips of my fingers, I began to notice that the use of ice packs, a 10s-unit, and stretching for my hands, shoulders, and arms was not alleviating symptoms anymore. Terrible stress headaches and chronic muscle fatigue in the upper and lower back were somewhat countered with ibuprofen, but it continued to escalate beyond my control.
Compromising your own health due to lack of knowledge or limited funds is the remedy for a short-term career. It is vital to know your limitations and listen to your aches or pain in accommodating appropriately. Ignoring the body's natural warning signs only cause future problems. It wasn't until I was diagnosed with cervical radiculopathy and had two herniated discs located in the lumbar region, which needed surgery in the C5-C6 and L4-L5 regions that I was really doing a disservice to myself and my patients. If I was hurting on a daily basis, was I truthfully taking care of them to the best of my potential? The answer was no.
2nd bad choice: Failure to reduce potential for overexertion and ignoring results to injury, causing serious musculoskeletal damage.
Over the years, numerous dental hygienists were asked by researchers if they experienced similar musculoskeletal problems, and they were common issues. To make it more relevant to my years of practicing, I asked a few classmates if they were experiencing similar issues. It was no surprise to learn that four out of the five hygienists were already on a regular regimen for chiropractic care and/or received multiple deep massages per month to compensate for any denoting pain or aches.
Occasionally, I would be asked the question from other Hygienists about practice management within our office and if I was keeping current with beneficial ergonomic equipment. Our office did not have current plans in place, nor was researching for purchasing ergonomic equipment a priority. Was I using the most beneficial equipment that decreases muscle strain and tension on the body? The answer was no.
3rd bad choice: Failure to learn about ergonomics and not using the most beneficial equipment.
I continue to research and educate myself over what I could do to change this dynamic, learning that proper treatment planning, time management, and investing in myself is vital to my career. After two surgeries, multiple changes were needed, and extensive equipment research was completed.
Upon returning back to clinical hygiene, I began using a light that attached to my loupes. Then I was encouraged to record with video how many times my arms were raised during an hour appointment using loupes without a light attachment and with it. To my surprise, during the first two minutes of the video (without the light attachment), I raised my arm over 13 times to adjust the overhead light. In collaboration with my neurologist, I learned that raising my arm that much in an eight-hour work day would cause musculoskeletal issues. After months of using a light attached to my loupes, it tremendously decreased the muscle fatigue and stress I was having. I was amazed at these findings and can't image the damage being done to those hygienists who choose to not use a light attachment or purchase loupes altogether.
My next purchase was to examine my instruments, which were ordered for me by another hygienist. Questions were asked as to why we chose this brand and if these were the best ergonomically for our practice. The answers given were "That's what I always used" and "Why bother using something different? They're all the same." This forced me to research and contact local reps to further educate myself.
Upon talking with a rep, I was given a new commercial brand instrument and then purchased a different kind that he suggested was not as good. I was asked to use it, and compare my findings to determine which was more beneficial to my patient and me. After a month of this testing, the results totally sickened me. I had used multiple instruments for the past five years (new ones and old ones), and continued to experience fatigue and muscle strain as always. While switching to other instruments with a different type of metal, I immediately felt a difference and so did my patients. The sound was different, and I did not experience hand fatigue or pain in my upper extremities.
When I relayed these findings to the local rep, I was told that I was sadly mistaken about which instruments were better and needed to continue using the same instruments for better calculus removal. This made me question: If I had switched sooner, would I be having the musculoskeletal problems that I was experiencing. Like every patient is different, so is every hygienist. What works for one, may not work for another.
4th bad choice: Don't be afraid to try something new; educate yourself about products regardless of what others use or tell you.
The evaluation of the ultrasonic and prophy handpiece was my next focus, considering they both are necessary to my job performance. I was taught in school and through various CE courses that using a larger diameter ultrasonic handpiece helps ease hand fatigue, and a cordless prophy handpiece eliminates strain on the wrist. But I was too scared to ask for better equipment. Therefore, I worked for years with hand cramps just because of being too afraid.
I finally got the nerve up to ask and switched over to a cordless handpiece and a different ultrasonic machine. The equipment I was using was over 10 years old, and they were waiting for me to say something.
I immediately noticed that I was not fighting against, or felt the strain from the cord, or having hand cramps for grasping the smaller diameter of the handpiece. Why didn't I do this much earlier? It was instant freedom for my wrist and was ergonomically valuable for my expertise.
5th bad choice: Don't be scared to ask for better equipment, working in pain for years; all they can say is "no" or "not right now."
These self-discoveries along with many others dramatically changed the way I practice. The experiments to make better choices continues (an evaluations of the dental chair, for example, was also taken into consideration). What I have learned along the way is priceless, but maybe too late for my clinical career.
Purposely choosing to not invest in myself (regardless of whether or not the employer could afford) became the ultimate career killer. I could have purchased the things I needed if my career depended on it, and it did.
Reducing the risk factors to one's overall body health should be the utmost important resource in the life of a hygienist, and there needs to be more awareness in how to extend the life of your career. I encourage all hygienists, young or not, to stop making bad choices and continuing to work in unnecessary pain. Educate yourself and take ergonomics seriously. It's only a matter of time before one choice will negatively affect your future forever. RDH
Raise ergonomic awareness on product research and practice management trends among hygienists to further the longevity of your career.
Dee Humphrey, RDH, BHSc, has worked as a clinical dental hygienist and prevention specialist since 2010 in a tribal community dental clinic in northeast Oklahoma. Dee is an author and speaker, and she sits on the board of directors for the National Cancer Network, is on the Crest & Oral B Smile Council, and an educator for the Delaware Community Cooperation Partnership in Oklahoma. She is also a clinical educator for American Eagle.