Harmony in Hygiene

Dec. 1, 1996
Dental hygienists live in a labor-intensive world of stress and strain. The daily schedule is demanding. The needs of the dentist and patient generally come first. Jan Haun, a dental hygiene consultant specializing in periodontal concepts, says that many of the hygienists she meets at workshops or during on-site consultations complain of experiencing physical pain throughout their work day.

The right balance to nutrition and exercise can prolong your career

Mary Martha Stevens, RDH

Dental hygienists live in a labor-intensive world of stress and strain. The daily schedule is demanding. The needs of the dentist and patient generally come first. Jan Haun, a dental hygiene consultant specializing in periodontal concepts, says that many of the hygienists she meets at workshops or during on-site consultations complain of experiencing physical pain throughout their work day.

"They`re so interested in their patients, they have forgotten about themselves," Haun said.

An article in the April 1996 issue of RDH adds, "Disability caused or aggravated by hygiene practice has prompted nearly one-fifth of hygienists to leave the profession permanently."

If you are concerned that the physical demands of the profession may shorten your professional career, maybe it`s time to develop a plan to create a healthy work environment which will enable you to practice and enjoy dental hygiene for many years to come.

A work environment that fits your needs

Haun noted that one source of discomfort for the hygienist comes from using old and outdated dental operatory equipment. Rob Accurso agrees. The branch manager and dental equipment and supply specialist from Patterson Dental Company said that, after 21 years in the business of designing healthy work environments for the dental office, he is adamant about the importance of a delivery system that serves the health needs of the operator.

"The hygienist spends hours in the operatory each day, while the patient is only there for minutes," Accurso said. "The first thing dental hygienists should have is a good operating stool, and they should know how to use it."

He recommends sitting slightly forward on a well-constructed, contoured chair, allowing the operator`s thighs to be parallel to the floor. The chair should have a four-way adjustable, locking lumbar support and adjustable locking seat tilt to support the hygienist`s own unique physical needs.

Accurso also recommends either an over-the-patient or side-delivery system. Newer systems are equipped with light, easy-to-disinfect cording which allow the hygienist to handle the air, water, and handpiece with ease. Both systems require minimal twisting and reaching if the hygienist is working in the 10 to 12 o`clock position.

Sherry Burns, a dental hygiene instrument specialist with Hu-Friedy Manufacturing Co., points out, "There are a number of things that hygienists can do to prevent cumulative trauma disorders and other physical maladies. To avoid excessive bending when attempting to see clinical work areas clearly, I would highly recommend hygienists wear magnifying loupes. These visual enhancers relieve eye strain as well as body strain. That`s why dentists have been using them for years. Of course, along with this, good lighting is essential."

Burns, a periodontal concepts consultant who works internationally with hundreds of hygienists and dentists each year, adds, "But the most important thing is being mindful of sitting in the correct working posture and selecting the instrument specifically designed to provide optimal access to each area of the dentition."

The importance of posture

Even if you are fortunate to have equipment that fits your body`s needs, you will still have to be mindful of a working posture that allows you to serve your patients without straining your body. It`s easy to forget about your own needs when you`re trying to get that last bit of calculus on the distal of the upper left molar. Don`t hesitate to ask your patient to turn or tilt their head to enable you to maintain a healthy posture.

Positioning the patient for your comfort will increase the overall quality of your work. If you feel good, your patient is more apt to feel good, too.

In fact, posture is so important to Dr. Scott Donkin that he wrote a book about it. Dr. Donkin comments in Sitting On The Job, that the ligaments and connective tissues holding your bones together exhibit both "elastic" and "plastic" properties. The elastic-like tissues spring back to their original form after a stretch or movement. However, the plastic-like tissues respond like putty, eventually remaining in the position most often taken in one`s daily routine.

"If you spend the majority of your work day slumped at your desk with your head flexed forward," says Dr. Donkin, "or are always turning in one direction, the connective tissues will allow the body to eventually conform to those abnormal positions. Unknowingly, you are `training` your body to become unbalanced."

This constant instability can produce symptoms such as pain, burning, numbness, and tingling in the affected parts of the body.

Remember, no pain, every BODY gains ... especially yours!

Living with "less than ideal"

"Many times I find hygienists are using `less than ideal` instruments," Haun said, "ones from their dental hygiene school days or ones that were already in their operatory when they started work. Or their instruments are unbelievably dull, causing hygienists to use extra pressure during instrumentation which produces fatigue and strains the body."

Hu-Friedy`s Burns adds that hygienists should alternate using instruments with different handle sizes to reduce prolonged pressure exerted on specific muscles throughout the appointment time. She said, "Instruments should not be gripped tightly unless the hygienist is removing hard deposits. For exploring, probing, and deplaquing procedures, hygienists should use the same pressure and stroke an artist would use to paint delicate lines on a picture."

Burns said that using the correct size of protective gloves is another area of concern. "Among dental personnel, it has been documented that poor fitting gloves can contribute to carpel tunnel syndrome," says Burns.

Gloves that are too large may cause you to grip the instrument tighter. Gloves that are too small, on the other hand, can cut off circulation and alter your ability to use instruments correctly. Also, your right hand may be a different size than your left hand and should be sized accordingly.

Time is money and much more

Time management is highly valued in clinical practice. However, if you barely have time to breathe between patients, your body is more apt to feel tired and fatigued throughout the day. Excessive fatigue increases the possibility of work-related injuries. In order to prevent disability, Frances Wolfe suggested in an RDH article that you alternate heavy and light cases when scheduling patients, as well as allow sufficient time to stretch and flex between patients.

In her book, Carpal Tunnel Syndrome: How to Relieve and Prevent Wrist `Burnout,` Rosemarie Atencio recommends hand and wrist stretching and strengthening exercises to help prevent injury. The exercises are performed in a matter of a few minutes. An example of a stretching exercise is placing the hands at the side with thumbs facing out, pushing down with the palms to stretch the forearms. A strengthening exercise is squeezing a small ball in the palm of the hand with all fingers, including the thumb. For more information about the book, contact HWD Publishing, (800) 935-7323.

An exercise regimen also energizes the body, countering fatigue and work-related injuries. During workshops, Sherry Burns asks hygienists to comment on what they had found to be the most effective remedy for carpal tunnel syndrome.

"The remedy most often cited throughout the country was yoga exercises," Burns said. "Even after surgery, hygienists said doing yoga exercises gave them the most relief, which really surprised me."

It is not surprising that hygienists have found relief in yoga exercises from carpal tunnel syndrome. As Howard Jacobson writes in his book, Racewalk to Fitness, "The oldest recorded science of physical and mental health is that of yoga, which was developed in India over 5,000 years ago. The yogis discovered that certain physical postures would stretch, strengthen, and cleanse the muscles if done slowly, remaining in the posture for a period of time, and breathing deeply. The increased circulation due to the exercise and the oxygenated blood energize and purify the system."

A number of good videotapes can be purchased on yoga exercises. One of the most enjoyable is by television actress Dixie Carter and is called Dixie Carter`s unworkout. Take a few minutes before or after work to let Dixie`s southern hospitality take you comfortably through a few stretching and breathing exercises. Afterwards, you`ll feel refreshed and more self-assured.

Walking clears the mind and rejuvenates the body

Another way to enhance productivity and reduce fatigue is to begin a daily walking program. Walking is like breathing. It`s totally natural and essential to the health of the body. Walking has been shown to increase a whole range of mental and physical benefits, from improving digestion to preventing heart disease and osteoporosis.

Keep a pair of good sports shoes at your office at all times. After lunch slip on your shoes and head out the door for a go-at-your-own-pace walk. You`ll return to work with a smile on your face, better prepared to meet your afternoon challenges.

The U.S. Center for Disease Control and Prevention (CDC) and The American College of Sports Medicine recommend that we exercise 30 minutes a day at a moderate rate of intensity. Walking and yoga exercises are perfect ways to meet this recommendation. Also, research has shown that exercising in 10 minute mini-sessions improves fitness nearly as much as longer exercise periods.

If you want to know how to start a walking program, Rob Sweetgall, fitness walker, offers these incentives and more in his book, Walking Off Weight:

- For every minute you walk, you can extend your life as much as two minutes.

- The difference between sitting or striding a few minutes after every meal can make a two-inch difference on your waistline after a year of 1,000 meals.

Wet your appetite with these facts

By the end of each day, the average person is dehydrated which is the cause of fatigue, headaches, and irritability. A 120-pound woman, living in a temperate climate, uses up to 21/2 quarts of water a day simply by breathing. So, you need to drink plenty of water throughout the day to:

- Prevent heart attacks, strokes and blood clots.

- Keep your skin smooth.

- Keep your body temperature regulated.

- Keep your bowels running smoothly.

Food researchers have long been aware that plants can protect us from disease, but now they`re beginning to understand how.

"Plants contain hundreds, maybe even thousands, of different substances called phytochemicals that may shield us from disease," said Clare Hasler, PhD, a leading phytochemical researcher who oversees the Functional Foods for Health Program at the University of Illinois.

Phytochemicals (plant chemicals) are found in many of the fruits, vegetables, legumes, and grains that you eat. Dr. Hasler said, "We may reap the same benefits from phytochemicals as do plants. Just as these chemicals act as a defense mechanism in plants by fending off viruses, they may react the same way in our bodies."

Dr. Jerianne Heimendinger, MPH, ScD, of the National Cancer Institute adds, "There are so many ingredients in plants that may fight disease. And we haven`t been able to discern if it`s just one ingredient working alone that protects us, or if it`s all the ingredients acting together."

For maximum protection from disease, both the American Dietetic Association and the cancer institute would like to see you eat at least five to nine servings of fruits and vegetables each day.

"That may be tough for some people, but it is achievable," said Dr. JoAnn Manson of Harvard Medical School. "One apple, one pear, even a glass of orange juice counts as a serving. If you fill up on fruits and vegetables, you are less likely to eat fatty foods. And the fewer fatty foods you eat, the better. The weight of the evidence strongly suggests that if you increase your consumption of fruits and vegetables, you decrease your risk of cancer, heart disease and stroke."

Eating well should not be thought of as an act of deprivation but a way to nourish the body to better health.

Obeying the law of the jungle

"Your work station and environment may seem like a man-made jungle that can feel as imposing and stressful as living in a natural jungle," wrote Dr. Donkin in Sitting on the Job. "One can survive and thrive in a natural jungle, if its rules or laws are understood and obeyed. If these rules are ignored, one is sure to perish. Less life-threatening, but every bit as important to you, is knowing and understanding the laws which govern the physical and mental demands of your work. Your ability to survive and thrive in your chosen occupation is directly dependent on your knowledge and understanding of these laws and your ability to make them work to your advantage."

In order to enjoy a long and healthy dental hygiene career, the first step is to prevent problems from happening in the first place. It is, by far, cheaper to prevent disorders than live with the painful consequences. So, first of all, don`t be afraid to approach your dentist with a plan on how to create a healthy work environment that will meet your unique needs. Highlight the fact that such an environment would allow you to meet your long-term career goals in his office.

Secondly, it is vitally important to get into a routine that includes these four health-enhancing habits:

- Engage in an enjoyable, daily exercise routine.

- Drink six to eight glasses of fluids per day.

- Include more fruits, vegetables, and grains in your diet.

- Get seven to eight hours of rest each night.

As a dental hygienist, you deserve to enjoy each work day. You also deserve a long and healthy professional career. Take time now to make this desire a living reality.

It`s time to thrive instead of survive!

Mary Martha Stevens, RDH, PhD, is clinical associate professor at the University of Missouri at Kansas City School of Dentistry. For more information on benefits of walking as described in this article, contact Rob Sweetgall at (800) 762-9255. For more information on cumulative trauma disorders (CTD), contact the Hygienists` Pain Network. Send inquires with a SASE to: Carol Coady, Hygienists` Pain Net-work, P.O. Box 25, Paradise, CA 95967 or e-mail: carolcoady @aol.com.