Give me a break!

Aug. 1, 2001
Are you ready to bring up the concept of a "true break" to your dentist-employer? Initially, this may sound useless, but remember that your physical and emotional health are at stake!

Are you ready to bring up the concept of a "true break" to your dentist-employer? Initially, this may sound useless, but remember that your physical and emotional health are at stake!

Hygienists practicing clinical dental hygiene, even for a short period of time, are high-risk candidates for many types of repetitive stress injuries or cumulative trauma disorders. One of the major factors leading to the development of RSIs and CTDs is working all day without a break. If you are the typical hygienist, you may be saying to yourself, "Are you kidding? What is a break? You mean there should be something more than my lunch break?"

Notice I said lunch "break," not lunch hour! Actually, I believe that many dental offices today have what I have dubbed "lunch minutes." In a few stolen moments, the hygienist may be able to inhale a couple of mouthfuls of cold, soggy leftovers, a handful of cheese and crackers, or other "gourmet repast" washed down with lukewarm, canned soda pop. Often, we are expected to accommodate an extra patient or procedure that no one remembered to tell us about! Now don't get me wrong, I'm not griping about an occasional change in the schedule, but many hygienists barely get a chance to get to the restroom, much less stop for lunch during the workday. This is not hearsay. I have seen it; I have experienced it; and I have heard it for many years from my colleagues in practice.

Contemporary society is moving at record speed. Cell phones, faxes, and the Internet all have improved our efficiency. Has this focus on connectivity and immediacy eliminated our last hope of a break? Many hygienists, just like the patients we care for, suffer from myofacial pain, TMJ dysfunction, and fractured tooth syndrome. Has this often self-imposed fast pace created an environment where we feel that we cannot afford to take a break? Have we overloaded ourselves with personal debt so that we are compelled to work more and more hours, seeing more and more patients, just to bring in more and more dollars to feed our credit card debt? In this regard, I doubt that many hygienists are very different than other people in today's "buy now, pay later" society.

Earlier this year, I conducted an informal poll of dental hygienists who participate in the e-mail group. The questions pertained to whether or not they had scheduled breaks during the day. Fifty-four of the 500-plus hygienists answered questions about their work environments that ranged from the number of days they practiced to the number of hours per day and per week. Hygienists who graduated in the years from 1960 to 2000 participated in the poll. They averaged 17 years of practice, working an average of 28 hours per week, eight hours per day.

There were also questions about a scheduled lunch break and any additional officially scheduled breaks. Only one hygienist reported that she worked eight hours straight each day, five days per week, without any breaks. This hygienist graduated two years ago and was totally exhausted physically and mentally; however, she recently took another position with adequate patient time and a real lunch break. The remaining hygienists all reported lunch breaks that ranged from 30 to 90 minutes, averaging 55 minutes. Many reported that even though a lunch break was scheduled, they were rarely able to take the entire break. Only one hygienist had another officially scheduled break during the day. Most respondents felt that there was no time to take a physical or mental timeout — a time to regroup. Does this constant treadmill of patient after patient lead to complacency, boredom, feeling drained physically, and, worst of all, emotional burnout or repetitive stress injuries?

The results of this poll substantiated my three decades of observations on clinical dental hygiene practice. By now, I'm sure you're thinking, 'Well, that's just the business of dentistry." And the business of dentistry is classified as a small -business enterprise, often exempt from state statutes covering workplace practices. Except for rare circumstances, hygienists are not working in an environment subject to breaks negotiated in a union contract, for example. So if you are employed in a typical dental office, maybe you should be the one to bring up the concept of a 'true scheduled break," not just downtime away from patient care, yet performing some other office task.

Are you ready to bring up the concept of a "true break" to your dentist-employer? Initially, this may sound useless, but remember that your physical and emotional health are at stake! Find out what your state workplace regulations mandate. Oregon and Nevada statutes require that employers provide scheduled breaks, while Wisconsin exempts certain businesses such as dental offices. Each state has different laws. Know what you are entitled to as an employee.

Before you use the big legal hammer, why not have a discussion with your employer about the serious risks for RSIs and CTDs that face dental workers? Dentists are responsible for the entire practice, and we can elevate ourselves as professionals when we can bring important information to the table. Let them know that you enjoy being a part of their practice and want to continue on a long-term basis; therefore, you would like to work in the safest environment possible, just as you would want to be protected from infectious diseases. If your dentist is a wise businessman and values what you bring to the practice, he is sure to listen to your ideas.

Another way to consider this situation is that Mother Nature has set the rules for all of us. If you try to fool Mother Nature, it won't work. Jet lag is a perfect example. Our internal time clock is not made for such an abrupt subtraction in rest. No matter how much we try to beat the odds, nature will always force us to take some type of periodic rest. Consider our need for daily sleep, how the seasons change, or how dogs and cats just naturally understand how to conserve energy! Can we fool Mother Nature? For a brief time perhaps, but not over the long haul.

Hygienists are premier nurturers, but often the one person we forget to take care of is ourselves! Each one of us can find a variety of opportunities to put everything on the back burner for an hour or two during the week. If you cannot take an entire hour for physical, emotional and spiritual enrichment, then consider using half- or quarter-hour time segments. Just don't forget to schedule some downtime during the workday.

We are so much more than "efficient cleaning machines" — we are valuable health-care providers. We are also human beings who need time out for physical rest and emotional rejuvenation so we can continue to give our best day after day, year after year. If you do not respect Mother Nature's rules, she may reward your diligence with some type of stress-related injury, or you could simply suffer from varying levels of burnout, complacency, or boredom — hardly the way to practice in the comfort zone.

Eight hygienists who took a break to talk
These comments about work breaks came from all over the country, and the message is universal — we need a break!

"I would like to have scheduled breaks, scheduled time to service my dental unit, etc. This is done if I have a patient fail, but broken appointments are very stressful to me."

"My co-workers came to an awareness of the importance of 'free time' and how we are not given the appropriate breaks ... especially when patients are squeezed in on short notice!"

"Often, I am fatigued at the end of the day because there is not enough time between patients to stand, stretch, get a drink, take a bathroom break, etc., unless I am willing to sacrifice and run behind, then shorten my lunch time."

"Dentists tend to hyperventilate if they see their dental hygienist relaxing. If a patient no-shows, I stay busy by helping ... It is very, very rare that I actually take a break."

"I think that this needs to be discussed and brought out into the open. I know hygienists who work 10 hours without a break ... it's rush, rush, rush. The other hygienist uses a breast pump 10 minutes twice a day and feels like she is stealing or wasting time. Comments have been made about this! Even potty breaks are looked at poorly. I have resolved to take breaks this coming year, but, as a coward, I will take them in my operatory. We work in a society that allows every other worker to have a break; why not us?"

"In all my years of practicing dental hygiene, I have never been offered any type of break. The dentists I have worked for the past three years have a fit if they see an RDH without a patient. Do you know of any other job/profession where you are expected to work like that? In one office, I was expected to work eight hours without a break. Needless to say, I left."

"Breaks just aren't scheduled into the day; oh well — better have the bladder of a camel ..."

"I guess break time is when I am waiting for the doctor to do an exam! No matter where I have worked, permanent or temping, this is the way it has always been."

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].