Out of the Blue

A wake-up call for every hygienist who is beginning to feel neck strain,arm or hand pain, or any other work-related muscular pain.

by Anne Nugent Guignon, RDH

A wake-up call for every hygienist who is beginning to feel neck strain,arm or hand pain, or any other work-related muscular pain.

Kelly is not a complainer. Until two years ago, she had never been sick a day in her life. Her sobering account is not an isolated episode. Every year, thousands of hygienists are blindsided by workplace-related injuries. Their careers are sidelined, their financial futures are on the brink, their bodies are wracked with never-ending pain, and they feel isolated. Their stories are nearly impossible to comprehend.

Kelly's husband and two children were very supportive of her educational goals. She was 26 years old when she graduated from her dental hygiene program. She spent the next 13 years practicing two days a week in a very low-key dental office that offered no benefits. At that time in her career, she was content to work with wonderful patients who cared about their oral health.

As her children grew older, she felt the need to plan for the future, so she accepted a position at a dental insurance company that offered a reasonable salary and benefits. For the next four years she enjoyed her new position, which allowed her to work four days a week and often involved visiting dental offices in several states. Soon the unexpected happened; a corporate acquisition forced her company to relocate to another state, resulting in the termination of more than 200 employees, including Kelly.

Now Kelly was back at the drawing board. She had heard about a full-time position in a large dental practice - an opportunity to work as a clinical hygienist with benefits (a 401(k) plan, vacation time, holidays, and personal days) at an office close to home. She was offered a position for four days a week. Eventually, a couple of Saturday mornings were added to the schedule.

The office atmosphere was like a pressure cooker. She felt the stress all day, every day. She never had a minute to catch her breath, stretch her aching body, or run to the restroom. Kelly never considered that she might become injured; she had never had any problems practicing dental hygiene. However, the doctor in sisted that she carry disability insurance and offered to pay for her coverage.

Several months later, Kelly learned that five or six other hygienists had become disabled with musculoskeletal disorders while practicing hygiene in this office. The list of injured hygienists even included the doctor's wife. These hygienists suffered from a variety of ailments: chronic neck pain, carpal tunnel syndrome, and fibromyalgia.

Within 18 months, Kelly had developed severe neck pain, and both hands became numb. Rather than seeking medical advice or treatment, she attempted to control the escalating aches with over-the-counter pain medications. She desperately tried to practice clinical dental hygiene despite the increasing pain.

Her neck pain became excruciating, making it impossible to sleep through the night. Kelly had not slept well for months. She tossed and turned, hoping the pain medications would allow her some rest. Her arms were sore all the time. The chronic pain affected her body's metabolism. She gained weight without changing her diet and became hypersensitive to even the slightest noise. Sitting in one position for more than 20 minutes practically disabled her legs.

Finally her body shut down. She was in so much pain that she could no longer practice. An EMG revealed carpal tunnel syndrome in both hands. Her physician told her she had to stop working immediately. Doctors had trouble understanding her pain. They couldn't imagine how practicing dental hygiene could cause such terrible shoulder and neck pain. As a result, they could not offer any advice on how Kelly could regain her health. Her once-productive life became a nightmare centered on pain. She consulted with a long list of doctors and therapists, and she was prescribed medication every night to sleep. To date, she has been given a variety of vague diagnoses along with a handful of prescriptions. Her long-term prognosis appears bleak.

Did Kelly gamble her career and physical health for a paycheck and benefits? Here are her observations.

"There were never any cancellations that weren't filled immediately. Clinically, the patients were very difficult. They all had bleeding gums and needed extra care.

"In hindsight, I wish I had taken a position in a lower stress office. I probably wouldn't have ended up with all of these physical problems. Who you work for is so much more important than how much money you make.

"Although I am very close to my husband of 30 years and have two grown children, after about six months of complaining about my neck, hand, and arm pain, I stopped saying anything. Even though my family wanted to help me, there was nothing they could do. I have always been a happy person and very optimistic. So often, the medical profession thinks there is an underlying emotional problem. That is maddening.

"If we do not keep ourselves healthy, it is not only bad for our patients, but it is horrible for us and very hard on our families. This is very scary. If you are not aware of ergonomics and your posture, you can dig a dental hygiene grave for yourself. The sad thing is that your family has to endure it. They also must see the look of pain on your face."

After nearly two years, Kelly's pain has stabilized. She no longer needs prescription pain medications to sleep, and her most recent EMG still shows an abnormal carpal tunnel. At this point, it appears unlikely that she will ever practice again. Now, she focuses on wellness; she takes yoga, and is considering the Alexander technique. Her goal is to do whatever it takes to get well.

Kelly has now lost more than a year's worth of dental hygiene income. Her disability coverage softens the blow somewhat, but it was never meant to replace all of her lost income. This makes her story even more serious, for she was at a place in her career where her hygiene income would have made her future more secure.

Kelly's story should be a wake-up call for every hygienist who is beginning to feel neck strain, arm or hand pain, or any other work-related muscular pain. Pain is your body's cry for help. If you ignore your body's warnings, continue working the way you always have, and take pain pills to keep going, you're asking for trouble. No one can ever pay us enough money to become disabled. Once repetitive-stress injuries become apparent, it is often too late. It can mean an end to your career, not to mention life-long pain and a mound of medical bills. Kelly's suffering - and that of countless other hygienists - deserves a brighter legacy.

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 (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at anne@ergosonics.com.

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