How do you put a price on quality and your health?
By Anne N. Guignon, RDH, MPH, CSP
Two decades ago, most dentists did not use magnification. It was certainly not the norm, and it was even odder for a hygienist to wear loupes. Patients and coworkers laughed at me, but I didn't care. My neck and shoulders felt better, and it was easier to make it through the clinical day with an improved posture. It's been a journey to use loupes in the clinical setting since 1997, but one that I have never regretted.
Fortunately, I was fitted properly from the very beginning. Even though I have a short torso, I started with an 18-inch working distance, and my first loupes were a front-lens-mounted pair of flip-ups, which allowed me to set a steep declination angle that helped keep my neck in a more neutral position.
A year later, I bought my first headlight. When I shifted to my first TTL (through-the-lens system), I was again measured for the correct working distance and the right declination. When a reading prescription became a necessity, it was easy to have my loupes reconfigured to accept this accommodation, and my working distance was changed to account for my visual changes.
Six years ago, I transitioned to saddle seating, which allowed me to sit higher and closer to the patient. Since the positioning dynamics had changed, my loupes needed to be tweaked a bit to still properly accommodate a neutral posture. Two years ago, I changed from standard contact lenses to monovision. My left ocular was reworked to allow optimal visual acuity.
The Advice Seekers
So why my personal story? For starters, using equipment like loupes and a light is a process. Over time, there have been dramatic improvements in optical quality, frame comfort and design, and headlight and battery technologies. The shift by many to a sit/stand position over the last six years-coupled with magnification and illumination-has had a profound impact on overall postural health for many clinicians.
As more clinicians adopt these ergonomic tools, the number of questions on Internet forums has increased exponentially. While most advice is well meaning, much is based on personal anecdotal experiences, and some responses contain information that is just not accurate.
Certain questions come up very frequently. They are of obvious interest to clinicians who are interested in using these technologies in their clinical practice. While this is not an exhaustive list of questions, it may help clear up many misconceptions. In some cases, there may be a variety of similar questions grouped together that ultimately lead to the same answer.
Here are some frequently asked questions about loupes, lights, and saddles
My friend has a pair of loupes that I'm considering purchasing. My doctor wants me to use his/her old pair of loupes. There are many used pairs of loupes for sale on the internet. My doctor wants me to share a pair of loupes with the other hygienist.
On the surface, using someone else's loupes might sound like a great way to save money. But this approach is full of problems. Your personal ocular measurements and frame size would have to be the same as the previous owner.
High quality loupes are custom-made devices. It is rare to be able to use another person's TTL loupes. Flip-ups are more forgiving, but the frame size and working distance much match that of the new user. Using a device not made with your measurements can lead to poor posture and/or eye fatigue.
Loupes (substitute lights or saddles) can be so expensive. I just want to order something inexpensive off the internet to see if it really works for me.
Inexpensive products sold online are typically made with less durable materials that will not deliver the same experience as higher quality custom-fitted products manufactured to your body's needs. Most so-called bargain loupes can't be personalized, and many bargain saddles have no seat pan tilt adjustment or are only sold with a standard cylinder height, which may be too low or too high.
Low priced TTL loupes that are not made with your measurements can create more postural issues than not wearing loupes at all. The most important benefit from using loupes is creating a neutral body posture. The enlarged image is a bonus.
I am finally old enough to need loupes. I can't see what I am doing any more.
If you're old enough to put your hands in someone's mouth, you're old enough to wear loupes. Magnification is all about posture and providing better visual acuity. Cheaters are a poor option. The optical quality is not great, and there will be postural compromises.
I just can't afford the expensive products. I don't want to make a mistake and be stuck with a product that does not work for me.
Everyone has personal budget limitations. People make choices about where they spend money. Companies that offer more customized products generally have generous trial periods with a money-back guarantee. They also offer interest-free payment plans that reduce the strain on the monthly budget.
Make sure you understand all of the time limits and who is responsible for shipping costs if an order is returned for a refund.
Warranty plans are meant to protect both the company and the purchaser. Sometimes a product will have a lifetime coverage, but usually the warranty is for a specific time period or for a specific part, such as a frame or a hydraulic cylinder for a saddle.
I want the lightest weight frame possible for my loupes.
No one wants to use a heavy pair of loupes. While plastic frames are the most lightweight, the material does not lend easily itself to adjustment. Most people's ears are not positioned at the same position on their head. The temples on high quality titanium or carbon composite frames can be adjusted to fit one's personal facial geometry, including one's ears.
Adjustable nose pads also help position the loupes properly on the nose bridge. This is a very important feature for those with a flat nose bridge or those with long eyelashes.
I need reading glasses. Can my loupes be retrofitted for this change? My prescription changes all of the time. What are my options?
It depends. Some of the inexpensive loupes products can't be reworked to accommodate visual changes. Companies that manufacture custom loupes are well positioned to work with prescription changes.
The options include adding the prescription into the ocular only, putting the change to the carrier lens, or working with a prescription insert that can be taken in and out of the frame as needed.
To obtain optimal visual acuity, ask for high index plastic inserts. Removable inserts are a great option for those who experience frequent prescription changes. Depending on seasonal allergies, some clinicians alternate between using contact lenses and regular glasses. While inserts are perfect for those who need options, the actual insert adds more weight than inserting the prescription in the ocular.
My headlight battery is five years old and won't hold a charge any more. The cable on my headlight is shorting out.
All rechargeable batteries reach a point where they can't be recharged. Four to five years is the maximum for most. Both LED and battery technologies are improving at a rapid pace. Carefully weigh the cost of putting more money into an older product.
New cordless headlights offer exceptional lighting and use lightweight batteries, and the light bezels also weigh less than earlier models.
What is the best pair of loupes, best headlight, or best saddle? What is the best company to work with? How do I know if a company is good?
Everyone's needs are different. What works well for one, may not be the best product for the next person. While it is great to solicit opinions from your colleagues, remember that most comments are based on their singular, personal experience.
So take what you read and hear with a grain of salt. If you see a general trend of complaints about a company, there is probably some basis for the comments. The same holds true if there are a high number of satisfied customers.
Paul Simon's song from the 1970s "One man's ceiling is another man's floor" puts this whole discussion in perspective. RDH
ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].