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What are you willing to risk?

Jan. 1, 2010
Teenagers typically think they're invincible. The vast majority become adults with few permanent health issues.
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by Anne Nugent Guignon, RDH, MPH
[email protected]

Teenagers typically think they're invincible. The vast majority become adults with few permanent health issues. However, many encounter a fair number of bumps and bruises along the way, depending on how many times they've tested fate.

Through the years, I've seen way too many dental professionals approach their careers with the same type of reckless abandonment. Eventually, most dental hygienists admit their bodies cannot withstand constant workplace-related microtraumas without some type of protective strategy. This strategy includes using equipment that prevents dangerous postures, sufficient breaks and periods of relaxation, adequate appointment times, and an exercise program with stretching and strength training.

While workplace safety may not be a jazzy subject, it does set the stage for a healthy, productive, and satisfying career. It's impossible to provide good care and feel good about your profession if your back and neck muscles are screaming in pain, or your hand hurts every time you pick up a mouth mirror.

Recent research about both dental hygienists and dentists indicates clinical dental professionals are at high risk of developing neck, back, shoulder, wrist, and hand pain.1-5 Factors contributing to pain among dental professionals include poorly designed workstations, inadequate equipment, inappropiate work patterns, repetitive work, neck flexion, upper arm abduction, prolonged static postures, awkward positioning, and precise motions.1-3, 6-8 According to ergonomists, the end result of working with abnormal postures and positions over prolonged time periods is nerve compression, shorter muscles, and muscle imbalance.8,10

Recent studies support anecdotal observations about the rigors and risks of clinical practice. Two different studies of dental students indicate that musculoskeletal pain among the students increased in frequency and duration over time with 70% to 75% reporting pain by their third year of study.5,11 Female students reported that the most significant pain was in their shoulder and neck regions, while the males experienced their worst pain in the mid and lower back. Females reported a higher intensity of overall pain.5 These findings closely parallel other studies that indicate 64% to 93% of dental professionals experience general musculoskeletal pain. Reports of back pain range as high as 60%, neck pain at 85%, and hand and wrist pain at 69%.2-4 Another study concluded that alterations in tasks did not reduce the musculoskeletal load on the neck and shoulders.3

Research conducted by Marquette University measured the occupational postures of dentists and dental hygienists by using videos taken over a four-hour period of time to record postural data of the neck, shoulders, and lower back. The postures were classified by 30-degree intervals to the respective joint and included neutral, 30, 60, and 90 degrees. Both dentists and dental hygienists flexed the trunks of their bodies at least 30 degrees more than 50% of the time, flexed their necks at least 30 degrees 85% of the time, and raised their shoulders at least 30 degrees more than half the time. The neck, shoulder, and back postures were primarily static.12

A more recent study compared practicing dental hygienists to dental hygiene students. The student group was further subdivided into two groups: those with no prior dental office experience as compared to those who had been dental assistants. Ninety-six percent of the practicing dental hygienists worked with a bent neck, 63% had static posture, 90% used precise motions, and 98% reported repetitive procedures. Seventy-two percent of the practicing hygienists reported neck symptoms and 35% shoulder symptoms — findings that correlated with reported postures. Students with a history of dental assisting had much higher rates of musculoskeletal disorders in the neck and shoulder.1

In February 2000, I called Mark Hartley, RDH magazine editor, expressing concern about the increasing number of fellow professionals who were getting hurt on the job. A decade ago, the silent epidemic of workplace-related musculoskeletal disorders among dental professionals was rarely acknowledged, but we both believed that no one would ever be paid enough to sustain a workplace related injury. With these concerns in mind, the Comfort Zone column made its debut in July 2000.

Over the past ten years, the column has addressed many topics. But columns in 2010 will be devoted to the core message of protecting and extending your professional career by preventing needless workplace-related musculoskeletal disorders. For some, the next 12 months will affirm that you have taken positive steps to ensure a happy, healthy career. For those of you who are on the fence about taking active steps to prevent injuries, the information will be a foundation to help build a professional comfort zone that suits your career goals. Remember, you spent long hours and many dollars gaining your academic credentials. It doesn't make sense to ignore ways to protect your investment.


  1. 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.
  2. Hayes MJ, Smith DR, Cockrell D. Prevalence and correlates of musculoskeletal disorders among Australian dental hygiene students. Int J Dent Hyg. 2009 Aug;7(3):176-8.
  3. Hayes M, Cockrell D, Smith DR. A systematic review of musculoskeletal disorders among dental professionals. Int J Dent Hyg. 2009 Aug;7(3):159-65.
  4. Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord. 2004 Jun 9;5:16.
  5. Rising DW, Bennett BC et al. Reports of body pain in a dental student population. J Am Dent Assoc. 2005 Jan;136(1):81.
  6. Ohlsson K, Attewell RG, et al. Repetitive industrial work and neck and upper limb disorders in females. Am J Ind Med. 1995 May;27(5):731-47.
  7. Mani L, Gerr F. Work-related upper extremity musculoskeletal disorders. Prim Care. 2000 Dec; 27(4):845-64.
  8. Yamalik N. Musculoskeletal disorders (MSDs) and dental practice Part 2.Risk factors for dentistry, magnitude of the problem, prevention, and dental ergonomics. Int Dent J. 2007 Feb;57(1):45-54. Review.
  9. Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. Arthritis Rheum. 2007 Apr;56(4):1355-64.
  10. Novak CB. Upper extremity work-related musculoskeletal disorders: a treatment perspective. J Orthop Sports Phys Ther. 2004 Oct;34(10):628-37.
  11. Thornton LJ, Barr AE, et al. Perceived musculoskeletal symptoms among dental students in the clinic work environment. Ergonomics. 2008 Apr;51(4):573-86.
  12. Marklin RW, Cherney K. Working postures of dentists and dental hygienists. J Calif Dent Assoc. 2005 Feb;33(2):133-6.

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, as well as presented seminars. She is a recipient of the 2004 Mentor of the Year Award and the 2009 Irene Newman Award and has practiced dental hygiene in Houston since 1971.