Creating awareness and enhancing visual acuity

Feb. 1, 2010
Twenty years ago a smattering of articles began to show up in the dental hygiene literature about musculoskeletal pain.

by Anne Nugent Guignon, RDH, MPH
[email protected]

Twenty years ago a smattering of articles began to show up in the dental hygiene literature about musculoskeletal pain. A random sample of 493 dental hygienists surveyed by Osborn et al. revealed that 68% of the respondents reported having musculoskeletal pain. Thirty–four percent stated that musculoskeletal pain had affected their clinical practice, and the researchers concluded the pain was related to clinical postures.1 Several years later a small four–year longitudinal study demonstrated an increase in musculoskeletal–related complaints from the beginning of clinical dental hygiene education through two years of clinical practice.2

Lack of education

During the same time, a survey of all the dental hygiene programs revealed that the majority of dental hygiene programs provided little ergonomic education. Study results revealed two perceived reasons for not including advanced ergonomic education — lack of time in the current curricula, and this type of education was never discussed as a possibility. The authors' concluding comments indicated a need for ergonomic education to increase awareness of MSDs and good ergonomic work habits.3 At the same time, several authors began to encourage the use of magnification loupes in dental hygiene practice to enhance musculoskeletal health, improve visual acuity, and provide optimal patient care.4,5

While reports of work–related musculoskeletal diseases (WRMSD) among the dental hygiene population continues, it is clear that the hazards of dental hygiene practice are being taken more seriously in the academic environment. Five years ago, Branson et al. published the first scientific report demonstrating the positive effects of magnification on clinical postures in dental hygiene students.7

A more recent study conducted in Nova Scotia assessed chairside work posture among dental hygiene students who used Branson's Posture Assessment Instrument. The authors concluded that there was significant postural improvement when wearing loupes, and that students who began their clinical careers using magnification had significantly better posture than students who started using loupes in their second semester.8 Ergonomics, beyond the basics, is now considered a critical part of clinical training, and properly fitted magnification loupes are the foundation for musculoskeletal health.9

During a 2002 visit to the Fones School of Dental Hygiene to meet with the faculty and students, I announced I would never let anyone work on me without loupes and a light. A little voice piped up that students were not allowed to wear loupes. Since I couldn't imagine not encouraging students to use magnification, her remark led to an awkward silence. I regained my composure, finished the presentation, and later learned that the discussion had just never come up. While the faculty could have taken offense at my remarks, they enthusiastically embraced the students' curiosity about magnification. This experience was the catalyst for their senior class student project, and many began using magnification the next semester.

Student–led survey

The students conducted an Internet–based survey of 868 clinical practitioners and reported 85% of the respondents felt magnification would have been beneficial during their clinical training. However, only 38.7% thought loupes should be a requirement while in school, in contrast to 59.7% who thought magnification should be an option for students. Respondents who always wore loupes were more in favor of loupes being required and introduced early in clinical training. This study clearly indicates a dramatic shift in acceptance of loupes in both the academic setting as well as clinical practice.10

On a much lighter note, I conducted a recent poll to learn how hygienists used their loupes to solve issues other than poor posture. Those who wear loupes and lights have come up with some very ingenious “off label” uses for these valuable devices, including removing splinters, threading needles, tying fishing flies, reading small print and expiration dates on crimp labels, replacing nose pads on another pair of loupes, making and fixing jewelry, needlepoint, cross stitch and quilting, identifying and removing facial hair, and personal pedicures. One dental hygienist provides canine care to retired rescued racing greyhounds. She has cleaned, sutured, and stapled their wounds, removed corns from their feet, and scaled their teeth. Husbands have used loupes to repair computers and sort wildflower seeds.

My hat is off to all of you who have committed to wearing magnification loupes in your clinical practice. For those of you who are still on the fence, make plans this year to commit to magnification and create a more comfortable personal clinical comfort zone.


  1. Osborn JB, Newell KJ, Rudney JD, Stoltenberg JL. Musculoskeletal pain among Minnesota dental hygienists. J Dent Hyg. 1990 Mar;64(3):132–8.
  2. Barry RM, Woodall WR, Mahan JM. Postural changes in dental hygienists. Four–year longitudinal study. J Dent Hyg. 1992 Mar–Apr;66(3):147–50.
  3. Beach JC, DeBiase CB. Assessment of ergonomic education in dental hygiene curricula. J Dent Educ. 1998 Jun;62(6):421–5.
  4. Syme SE, Fried JL, Strassler HE. Enhanced visualization using magnification systems. J Dent Hyg. 1997 Fall;71(5):202–6.
  5. Pencek L. Benefits of magnification in dental hygiene practice. J Prac Hyg 1997;6(1):13–15.
  6. Morse T, Bruneau H, et al. Musculoskeletal disorders of the neck and shoulder in dental hygienists and dental hygiene students. J Dent Hyg. 2007 Winter;81(1):10.
  7. Branson BG, Bray KK, et al. Effect of magnification lenses on student operator posture. J Dent Educ. 2004 Mar;68(3):384–9.
  8. Maillet JP, Millar AM, et al. Effect of magnification loupes on dental hygiene student posture. J Dent Educ. 2008 Jan;72(1):33–44.
  9. Sunell S, Rucker L. Surgical magnification in dental hygiene practice. Int J Dent Hyg. 2004 Feb;2(1):26–35.
  10. Thomas J, Thomas FD. Dental hygienists' opinions about loupes in education. J Dent Hyg. 2007 Fall;81(4):82. Epub 2007 Oct 1.

About the Author

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston since 1971. You can reach her at [email protected] or (832) 971–4540, and her Web site is