The Pogo syndrome

Sept. 1, 2001
Do you think that practicing hygiene is an exercise in pain? Think again. You can practice pain-free!

Do you think that practicing hygiene is an exercise in pain? Think again. You can practice pain-free!

We all have patients who cannot deal with the idea of receiving dental treatment. Some are stopped by fear of the unknown. Others know exactly what creates their anxiety. Some patients have lives so busy that a dental appointment will not fit in their schedule. Others feel our fees are way beyond their budget, and yet another group is in denial about the seriousness of their dental diagnosis.

Don't you just love the patient who performs self-diagnosis and/or self-treatment? You know the ones. They are the patients who place an aspirin on the tooth that is hurting and think that this will alleviate their pain! We've all seen the results of this type of treatment. So are hygienists any different if they automatically decide their wrist, finger or hand pain is carpal tunnel syndrome? Personally, I do not think that we have enough expertise to institute treatment measures without first consulting a licensed health-care professional who specializes in the medical diagnosis of hand disorders. Some hygienists self-medicate their hand pain with splints and anti-inflammatory medications. Others dismiss chronic body pains, chalking them up to the price they pay for practicing hygiene. Are these hygienists putting their bodies at risk for permanent damage? It seems they're practicing medicine without a license.

How do you feel when your patients give you a blank stare, or that smile that says "hurry up and change the subject," or the even more perplexing combination eyeball roll/shoulder shrug, indicating that you can move on to more fruitful topics any time? You're a hygienist through and through, and you are educated and trained to help patients understand, appreciate, and value good health — especially their dental health. We want our patients to value all of our expert information and observations. Otherwise, we might as well think of ourselves as "well-paid domestic goddesses of the oral cavity."

I feel the same type of frustration every time I meet or talk to a hygienist in pain. One episode is etched in my mind. This past February, I presented a lecture for the Greater St. Louis Dental Hygienists' Society. One hygienist made this comment at the bottom of the ergonomic survey: "I have repetitive motion problems. I have learned to live with them. I take Motrin 800 every day I work as a hygienist." She has been a hygienist for 27 years and currently practices three days a week. Her remarks still resonate in my mind every time I teach a class. Pain is your body's signal that something is drastically wrong. Hygienists want their patients to understand the importance of pain and get concerned when patients are in denial, or worse yet, have learned to tune out their pain or discomfort.

Dental hygiene practice is much more strenuous than many people imagine. Unfortunately, there are well-meaning health-care providers who do not understand what the average hygienist puts their body through day in and day out. For example, if a physician or physical therapist has never worked in a pair of gloves all day long, how could they possibly understand the discomfort of wearing ill-fitting gloves while performing intricate dental hygiene procedures? Does your best friend understand how hygienists twist their necks just to see the distal-buccal of number 15? How can we expect other health-care providers to understand the origin of our pain? Very little research exists to highlight or support the problems we face. Most of the evidence is anecdotal, but the aches and pains are a daily experience for many hygienists, dentists, and assistants. Here is a little secret: You can learn to practice without pain.

We can learn a great deal about cumulative trauma disorders (CTDs) surfing the Web. One of my favorite sites is www.medicalmultimediagroup. com/opectoc.html, which contains lots of information about a myriad of repetitive stress injuries (RSIs) as well as possible avenues of treatment. Unfortunately, reading about CTD's on a Web site does not make us qualified to diagnose or treat these conditions any more than a few quickie weekend courses can teach a preceptor about the complexities of real dental hygiene practice. We shouldn't be tempted to treat ourselves. It may be difficult to find the proper person to help prevent the onset of pain or deal with an existing condition, but knowledge about cumulative trauma disorders can bring us one step closer to the solution.

Okay, I'm stepping off of my soapbox now, but please, please value your health. Value your professional career. Respect the pain. Pain is a big red flag. Learn as much as you can from other dental hygiene professionals. Find out what other hygienists have done to get rid of the pain. Just remember it is not terribly wrong to attempt to solve your own pain problems, but if you do not get relief within a month or so, consider seeking a specific medical diagnosis. This advice is the same we would give to our patients. Seek a second opinion if you are uncertain. Your body will thank you and you will have a much happier, productive, and pain-free life.

If you believe Pogo, the comic strip philosopher whose sage observation is, "I have met the enemy and he is us," then you'll understand that pain does not have to be a part of dental hygiene. The moment that you accept that pain is not a natural, normal, or necessary part of being a hygienist, then you'll be vaccinated against the "Pogo Syndrome." You'll become a hygienist ready to confront the real enemy — pain. Imagine dental hygiene practice in the comfort zone, pain-free — what a glorious experience!

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics ( She can be reached by phone at (713) 974-4540 or by e-mail at [email protected]

From TiffanyMany hygienists feel isolated, feeling no one really understands exactly what we do and how we do it. Consider joining the 750 hygienists who are members of Amy Nieves' email group at www. The list is free. You can remain annomyous if you like, but this is a friendly group focused on helping hygienists enjoy hygiene! The comments scattered throughout this article illustrates how the email group responded to a query from "Tiffany in Utah." The comments provide a peek at how hygienists share information and nuture each other.

Tiffany in Utah: "I am a recent grad and try my best to watch my ergonomics. Every day I get home, my back and neck are killing me. I would just like to know if everyone experiences this. I am seeing a massage therapist regularly, but would like any advice. I try to sit up straight, yet I am still having problems. I can barely sleep at night my body aches so much. I work three days a week seeing about 8 to 10 patients per day."

From BethBeth from Pennsylvania: "I work five to six days a week and have a little more of a patient flow than what you are currently seeing. I, too, have many problems with my upper back and neck. I have been to massage therapy which feels great at the time and for awhile afterwards! I have gone to a chiropractor, family doctor, and neurologist, and had a series of tests — MRI, CAT scans, blood work, etc. I'm waiting for the results of this last MRI.

"So far, no luck with the diagnosis, other than fibromyalgia, which was just given to me as a possible diagnosis. I think that is because they can't figure out what really is wrong. I try to practice the very best ergonomics as well — feet shoulder-length apart, sitting straight, indirect vision, etc. — all the things we were taught in college.

"Some days are better than others. But for the most part, I want to rip my head off first, then have some one walk or just rub my back until the pain just disappears. I have been taking 800 mg of Motrin a few times a day and that works for awhile.

"I'm a little concerned with my liver at this point, but I don't know what else to do for the pain."

From CappyCappy from Texas: "Tiff, you wrote that you are experiencing a lot of back and neck pain. I have been practicing for 14 years, and about three months ago purchased a chair specifically designed for what we do. It took a little getting used to, but the results have been amazing. I no longer have the pain in my shoulders and neck. The chair has armrests, reducing the strain on the neck and upper back."From LauraLaura from Tennessee: "Dear sore and tired ladies, I have practiced for 23 years and work four-and-a-half days a week, seeing 10 patients a day. Many years ago, I went through testing for carpal tunnel syndrome. I was having a lot of pain in my right arm.

"What I actually have is thoracic outlet syndrome. The nerves and blood vessels are compressed in the shoulder region, rather than the wrist. What has helped me the most for the longest period of time is exercise!"

From AnneAnne Guignon: "A large number of dental professionals experience back and neck pain. It can begin while you are still in school or it can show up 20 years down the road.

"The first thing to consider is posture. Posture is the key to a healthy back and neck. Healthy muscle tone and a regular exercise routine are critical for good posture. It is quite difficult for most of us to achieve and maintain good posture without the help of properly fitted magnification loupes. Each clinician has a unique working range. Properly fitted loupes will force you to sit up straight. The added bonus is you will see more clearly. Loupes are not just for older dentists and hygienists; they are designed to help maintain your health

"Before you dismiss the idea of magnification, consider this tidbit of information: The average head weighs eight pounds. When someone leans forward and places their head in an unsupported position, the body must then provide support for a head that would weigh 40 pounds! No wonder our backs, necks and shoulders take such a beating!

"Your operator chair also contributes to proper posture. A wide variety of chairs are available today. Chairs with arms have helped many of us, and the newer armless saddle chairs have benefited others."