No one-size-fits-all solution

Nov. 1, 2005
The popularity of Extreme Makeover, has resulted in many people wanting a quick fix.

The popularity of Extreme Makeover, has resulted in many people wanting a quick fix. Extreme Makeover promotes the “overnight” wonder concept that is designed to resolve a lucky recipient’s physical problems and shortcomings.

With ergonomics, there is no quick fix. Practicing safely involves taking a good hard look at everything you do and every tool you use. If you’ve already analyzed how you work, you understand this concept. But if you’re suffering from musculoskeletal aches and pains and don’t understand why, then examining your work habits could bring relief.

Hygienists often ask me what they should do first to improve ergonomics. There isn’t one answer to this because it depends on how you practice and what equipment you use. But there are many things you can do right away to create a safer working environment.

First, take a close look at your treatment room. A friend, preferably another hygienist, can help with this analysis because he or she will be able to see things you’ve grown accustomed to. No one understands the unique demands of dental hygiene practice better than another hygienist. Take pictures of how you work, candid shots that reveal how you really practice.

Are all of the instruments and devices used regularly within easy reach? If not, reposition items so they become easy to access. Get rid of the clutter and free precious space for frequently used items.

Sometimes repositioning the patient chair can give the hygienist room to move into different working positions. Most chairs tied into fixed plumbing have a swivel built into the chair base. After-market bracket tables and mobile carts can help transform a 50-year-old room into a safe and contemporary working space.

Next, sit all the way back in your operator chair. The seat pan is designed to support the weight of your upper torso, and the back should be positioned to support the lumbar area. Chairs with arms provide additional support and reduce stress to the hips, shoulders, and neck. Position the seat so your hip joint is a couple of inches higher than your knees. Contrary to conventional wisdom, sitting like this decreases lower back strain.

Poor fitting gloves should be replaced by ones that have adequate finger length, fit the width of the palm, and are not too tight around the wrist. Hand specific gloves keep the thumb in a natural, relaxed position and the fingers in a natural curl. Surface texture lessens pinch grip, especially in a moist environment, because it is more difficult to hold an instrument with a wet glove.

Clinicians who want to reduce their exposure to natural rubber latex will find that the new nitrile gloves are more flexible than those made a decade ago. The fit of many newer synthetic fabrics decreases compression on susceptible nerves and muscles, resulting in greater hand comfort.

Modern instruments are designed to help alleviate hand, wrist, forearm and neck stress. Large diameter, textured handles reduce pinch grip. Some instruments come with padded grips that provide comfort as well as color-coding. If you’ve inherited a drawer full of skinny instruments, consider adding after-market autoclavable, textured grips to increase diameter and improve ergonomics.

Power-driven scalers not only tackle heavy stain and calculus deposits, the force produced by a scaler’s ultrasonic vibrations disrupts biofilm more effectively than hand scalers. To improve effectiveness and increase tactile sensitivity, hold the handpiece with a light pen grasp and use a light touch when adapting the insert tip to the tooth surface. Using a power scaler correctly can minimize hand fatigue.

In recent years, swivel mechanisms have revolutionized power scaling and polishing apparatus. When a swivel is incorporated, the weight of the hose is distributed differently, which allows the hand and wrist to function freely. Swiveling ultrasonic inserts as well as scaling and polishing handpieces are also available.

Cordless devices are portable, reduce clutter and eliminate unnecessary wrist stress. Consider the weight of the ultrasonic cord, and experiment with different ways to redistribute the cord weight. Some clinicians drape it around their neck, over their forearm, through their palm or between their ring and pinky finger.

To provide continuous, hands-free fluid evacuation, some suction devices are configured with intricate bends and others can be bent. Mirrors that attach to suction hoses can do double duty as mirrors as well as suction devices.

Contrangled prophy angles have a special bend to help access posterior teeth. Soft cups require less pressure and reduce hand fatigue, and smaller prophy cups are easier to fit into crowded or limited access areas.

Sitting up straight is another key to preventing a variety of injuries. While it may seem impossible, being a dental hygienist should not mean leaving work with an aching body. Properly fitted magnification loupes can help, and an enlarged clinical image is the bonus for being able to sit up straight all day.

Practicing in safety and comfort does not have a one-size-fits-all solution. Each technique, strategy or product may help hygienists prevent workplace-related musculoskeletal disorders.

Whether or not the solutions are simple, it is important to get started. Remember, it is your career. You are in charge of designing your own personal safe comfort zone.

Anne Nugent Guignon, RDH, MPH, is an international speaker, 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, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web site is