Avoiding the Danger Zone

Nov. 1, 2000
The Danger Zone exists just outside of the Comfort Zone. Understanding the boundaries will allow you to practice hygiene with ease.

The Danger Zone exists just outside of the Comfort Zone. Understanding the boundaries will allow you to practice hygiene with ease.

Anne Nugent Guignon, RDH, MPH

Have you ever found yourself in the Danger Zone? (Don?t worry if you don?t know what I?m talking about. The Danger Zone concept is my own invention!) Now close your eyes and imagine you?re in your treatment room. You?re relaxed and sitting all the way back in your ergonomic dental chair, ready to begin working with your next patient, when suddenly ... WARNING! ... STOP! ... the Danger Zone surrounds you! Any object in front of you, above you, below you, or to either side that causes you to strain or twist unnaturally is in the Danger Zone. Everything positioned behind you also is part of the Danger Zone. Every time your body has to strain, pull, or overcompensate to perform a task, you enter the Danger Zone.

Countless numbers of hygienists and other dental professionals suffer chronic and often career-disabling injuries that are a direct result of what we now call cumulative trauma disorders (CTDs) or repetitive strain injuries (RSIs). Whether you call them CTDs or RSIs, these often-complex conditions can strike without warning at any age and at any time. New graduates are just as much at risk as seasoned veterans. Plenty of part-timers have gotten hurt as well. In fact, a large number of hygienists have been forced to reduce their work schedules because of work-related injuries, and some even abandon dental hygiene entirely in favor of less physically demanding careers. What a waste it is to lose dedicated and educated dental professionals when these injuries often can be avoided or reversed!

Let?s put your imagination to work again by comparing your workplace with setting up a kitchen in your new home. For some folks, a kitchen is just a place to breeze through, pop a few hot dogs in the microwave, heat the buns in the toaster oven, grab a cold drink out of the refrigerator, and rip open a bag of chips. Other folks revere their kitchen as a sacred domain, a place to meditate, a place to unwind, a hallowed ground reserved only for the finest gourmet equipment and pristine ingredients. Hot dog chefs and gourmet cooks have one thing in common: They both need an efficient, well-organized, safe place to prepare food. Regardless of how you practice hygiene, you need a safe, efficient place to work.

It is important to position your equipment within easy reach of where you sit. For example, if you place your hand instruments on top of the cabinet behind you, you?ll be twisting and leaning backwards each time you need a new one. Eventually your shoulder, arm, or neck will be sore. What if the bracket table is positioned behind you? You might be tempted to use the napkin covering the patient?s chest as a temporary bracket table just to save your back. Perhaps you could solve these dilemmas with a mobile cart or an over-the-patient bracket table. These types of modifications also can make a treatment area more adaptable for a variety of clinicians. In the long run, a mobile cart or an after-market bracket table with an extension arm is cheaper than multiple visits to the physician, chiropractor, or massage therapist to treat pain originating from repetitive stress injuries!

Are you forever reaching over, under, or behind your patient for the saliva ejector, polishing handpiece, or air/water syringe? Are you dragging these hoses across your patient?s chest? If you were in the kitchen, you probably wouldn?t drag an extension cord across the sink, would you?

If you can?t reposition your existing equipment, consider installing handpiece brackets. These brackets allow items to be placed within your reach and are available with or without extension arms. Some brackets attach to existing cabinetry, and others to the dental unit or light pole. It may take a bit of searching and ingenuity to reposition these devices, but it can be done!

Not too many years ago, most hygienists used power scalers only on the most difficult patients. These scalers frequently were perched on a small sliding tray, hidden away in some lower part of the cabinetry. Units installed in these locations are often hard to reach, making it difficult for the clinician to make necessary adjustments in power, frequency, or water settings.

Also, if the unit is positioned below the countertop, gravity and the weight of the handpiece cord can tug on the operator?s wrist and hand. Imagine if the microwave oven in your kitchen were installed high above the stovetop, where the vent hood is usually located. Not only would you have to be very tall to reach the control pad, but you?d also risk a nasty burn from a boiling pot on the stove below.

Since automated scaling has become an accepted standard of care in today?s dental hygiene practices, these devices need to be readily accessible to the clinician. In most cases, the water lines and power cords can be rerouted easily, allowing the scalers and other frequently used automated devices to sit on the countertop.

If you are able to preplan your schedule and sufficient instruments are available, consider preparing tray setups or cassettes in advance for your day?s appointments, in the same way a chef assembles ingredients before starting to cook. Being well-prepared prior to seating patients makes our treatment rooms more user-friendly. Rummaging around for last-minute hygiene supplies is like searching for that elusive onion in the back of the refrigerator!

Not only will organization save time, but the appointment should proceed more smoothly. This strategy works well if you are familiar with the treatment room and the office, but it can be more difficult to implement if you are working there as a temporary dental hygienist.

One of my most frequent trips to the Danger Zone involves the overhead dental light! For some unknown reason, I always position the light handle too far away after dismissing a patient. Then, just as soon as I am comfortable and ready to begin with my next patient, I notice the light handle is outside of my easy reach. I suppose if I practice long enough, I?ll finally remember to position it closer!

Now, I know that this suggestion may get under the skin of the Oneat freaks,O but if you use a certain piece of equipment often, please don?t stash it out of sight in some impossible-to-reach location! Remember, if you are a hot dog chef, your microwave and toaster oven should be handy, and if you?re a gourmet cook, your cutting boards and food processor should be within close reach!

The Danger Zone exists just outside of the Comfort Zone. Understanding the boundaries will allow you to practice hygiene with ease.

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 [email protected].