Stop the madness

June 1, 2011
Stories of abuse in the dental workplace come to light periodically. While the details may vary, the general theme remains constant.

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

Stories of abuse in the dental workplace come to light periodically. While the details may vary, the general theme remains constant. Every tale of worker exploitation makes my stomach churn, but the word has to get out. We have got to stop the madness. Here is a story I recently received, followed by my response.

"I've been practicing for 12 years and now I'm having health issues. After my first year I went to work for a big corporation. I use an ultrasonic scaler on every patient, use fat instruments whenever I can find them, do lots of hand exercises, and wear wrist braces every night.

"We are always heavily booked, with lots of last minute additions – anything to get the numbers up. My production is never enough. When another hygienist is off, we are expected to see their patients as well as our own, generally without any extra help.

"This week the pain became ridiculous. A hand specialist diagnosed tendonitis, arthritis, and primary carpal tunnel in both hands. He put me on light duty, to be determined by my employer and myself, until he could do neurological testing and determine if surgery is necessary.

"My boss and I agreed to one patient per hour in lieu of 11 plus a day, but he would not let me off the next day for testing even though I was in pain, and the next available appointment was a week later. Loyalty means nothing nowadays. Hygienists in this company have become a dime a dozen, and we are told that the company has so many applicants that replacing any of us would be no problem.

"I don't plan to file workers' compensation so I guess I thought the company would indulge me a little to get the help I need. That didn't happen. Thanks for letting me vent."

Not only does your story describe abuse to your body,1-4 it also describes the barriers to a prompt diagnosis put up by your employer. You mention loyalty. The ultimate form of loyalty is taking care of yourself and your body. You can't possibly provide optimal care when your body is screaming in pain.

When you said the physician ordered light duty to be determined by you and your employer, I said wow. Now you have an hour? One hour per patient is NOT light duty; it is a standard appointment time in a sane setting. I would guess that your physician does not really understand the physical rigors of dental hygiene. Few do.

Workers' compensation cases are hard to win, and they take lots of time and create lots of stress. Years ago, Toni Adams, RDH, was successful in winning her case. She kept detailed records and persevered. Others get discouraged and drop their claims.

With respect to diagnostics, while your wrist and hand may be killing you, the problem could be in a different part of your body, or as you mentioned, there can be multiple conditions. Carpal tunnel syndrome is only one. Dental professionals suffer from many other syndromes, including tension neck, thoracic outlet, cubital tunnel, lateral epicondylitis, and arthritis.

There are thousands of other stories. Each has its own twists, but the results are remarkably similar – reduced physical function, pain, loss of clinical opportunities, frustration, reduction of income, and mounting medical bills.

You need to be your own best advocate. Find a physician who understands workplace-related injuries and the rigors of our profession, especially the demands of treating 11 patients per day. The physician may also be able to recommend good legal counsel experienced in workers' compensation.

Last December, over two dozen Ph.D. researchers from all over the world presented papers on the role of fatigue in the development of workplace-related musculoskeletal injuries (WRMSDs). Study after study demonstrated the human body needs time to recover from stress produced by repetitive, forceful movements. Without adequate recovery time, fatigue sets in, beginning on a cellular level. Lack of adequate rest reduces the body's tolerance for fatigue while increasing the risk for injury. Lack of sufficient recovery time is epidemic in clinical dentistry. In all too many practices, the predominant focus is on production, not on preventing needless injuries.1-4

While the conference findings were unsettling, several things were abundantly clear. There will never be a plethora of research studies on WRMSDs in dentistry. At most, studies will be limited and often based on anecdotal reports. This does not mean the reports are not legitimate, but it is impossible to have a double-blind, randomized clinical trial about potential or real WRMSDs because scientists can't control for all variables.

Every office has different equipment and time frames. Unlike assembly line workers, the size and shape of our widgets (patients) changes throughout the day. We go from treating barrel-chested Bob to big-bosomed Bertha to little Johnny-jump-up to old aunt Martha. Add a few tense patients to the daily schedule and our bodies are done.

Without a serious investment in creating a safe working environment and a significant focus on building strong core muscles in our own bodies, we can't withstand the multiple microtraumas we face in clinical practice.5 We need to build and protect our own comfort zone.

We can learn from other groups who perform similar types of tasks. Ultrasound sonographers use awkward hand and body positions and force on handheld sensors to capture images.6-7 Workers in the garment industry who work at sewing machines have many postural challenges that mimic dental hygiene. They sit hunched over, with a bent neck, and hands in compromised positions guiding fabric through the shuttle.8-10

There is a bright spot to your story. In some states doctors do not have to carry workers' compensation insurance, but you're working for a large company that carries this coverage. Be fair to yourself and file a claim.

Keep excellent records, don't let your employer bully you, and find the best medical and legal advice possible. No one is ever going to pay you enough dollars to get hurt. And there are ways to practice safely, even if you get injured, but that is another discussion entirely. Adequate disability coverage is critical, but impossible to get once there is a documented injury or condition.

The insinuation that you are a throwaway commodity is not only callous, it is insensitive and insulting.1-4,10 While it is little comfort at this point, the economy will not always be in the dumps.

Good luck getting an accurate diagnosis and appropriate care. Sooner or later, you will find a safe, sane practice that appreciates and values your skills and talents and does not expect you to work under injurious conditions.

Anne Nugent Guignon, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.


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  2. Celik SS, Celik Y, Agirbas I, Ugurluoglu O. Verbal and physical abuse against nurses in Turkey. Int Nurs Rev. 2007 Dec;54(4):359-66.
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  5. Armstrong TJ, Rempel D. Ergonomic interventions and research: Preventing musculoskeletal fatigue and injury. Dec 14-15, 2010. Oakland, CA.
  6. Schoenfeld A, Goverman J, Weiss DM, Meizner I. Transducer user syndrome: an occupational hazard of the ultrasonographer. Eur J Ultrasound. 1999 Sep;10(1):41-5.
  7. Friesen MN, Friesen R, Quanbury A, Arpin S. Musculoskeletal injuries among ultrasound sonographers in rural Manitoba: a study of workplace ergonomics. AAOHN J. 2006 Jan;54(1):32-7.
  8. Kaergaard A, Andersen JH. Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occup Environ Med. 2000 Aug;57(8):528-34.
  9. Wang PC, Rempel DM, et al. Self-reported pain and physical signs for musculoskeletal disorders in the upper body region among Los Angeles garment workers. Work. 2009;34(1):79-87.
  10. Wang PC, Harrison RJ, et al. Follow-up of neck and shoulder pain among sewing machine operators: The Los Angeles garment study. Am J Ind Med. 2010 Apr;53(4):352-60.
  11. Kivimäki M, Vanhala A, et al. Team climate, intention to leave and turnover among hospital employees: prospective cohort study.BMC Health Serv Res. 2007 Oct 23;7:170.
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