by Anne Nugent Guignon, RDH, MPH
One hundred years ago, two social visionaries, Dr. Alfred Fones and Irene Newman, opened the doors to the first dental hygiene program in a converted carriage house in Bridgeport, Conn. One year later, 27 women posed for their graduation picture on June 6, 1914.1 Thousands of women and men have followed in their footsteps over the last century. The dental health of people all over the globe has improved.
Photos of early dental hygiene practitioners make us chuckle. It is interesting to note that our profession has always been at high risk for musculoskeletal disorders. At the beginning of my clinical training in 1968, my classmates and I worked standing up, using hand scalers with skinny handles and porte polishers to remove stain. Our hands suffered from tight pinch grips, awkward intraoral fulcrums, and forceful, repetitive motions. Patients sat upright. We worked with bent necks and arms abducted away from our torso. Our initial clinical experiences were identical to those of Irene Newman, hardly a progressive way to start one's clinical career.
Typically, anniversary celebrations include reflections on events, activities, or technologies that impact a profession. Our profession experienced very little change over the first 40 years. In 1952, Texas became the last state in the nation to license the practice of dental hygiene. According to Wilma Motley's History of the American Dental Hygienists' Association, the idea of a group disability insurance program was proposed at the ADHA Annual Session in 1952 and adopted in 1954.1 While there is no discussion about what prompted this action, one wonders if concerns about workplace-related injuries were surfacing in our profession so many years ago.
Two pieces of equipment that changed the dental hygiene practice came on the scene in the 1950s. Dentsply launched the first ultrasonic dental scaler in 1957;2 a device was originally designed to cut tooth structure, but the high speed handpiece quickly became the tool of choice for restorative procedures. While the Cavitron failed to meet its original purpose, it was quickly recognized as more efficient way to remove stain and calculus. From an ergonomic standpoint, properly used power scalers reduced pinch/grip and force issues, but increased our exposure to vibration, a known MSD risk factor. Our hands, elbows, and wrists were now expected to support heavy hoses for long periods of time.
In 1958, Des Moines inventor John Naughton collaborated with Dr. John Anderson to develop the first patient chair that fully reclined. The goal was to enhance patient comfort and reduce strain on the operator's neck and back.3 Dental professionals started sitting on small, round exam stools used by physicians, but our work habits are different from medical professionals, who sit for much shorter periods of time.
It is not uncommon for us to spend 30 to 45 minutes in a continuous seated posture, often with the seat pan parallel to the floor. This type of positioning flattens the lumbar spine, creating measurable strain on lower back muscles and increasing intervertebral disc pressure. The result is low back pain, an unintended consequence of sit-down dentistry.4 In a recent study 36% of all dental hygienists reported lower back pain, double the rate of the general population.5
Many stools have backrests to provide lumbar support but seat pan dimensions are often too big for petite clinicians forcing them to sit on the edge of the seat. Dr. Chuck Caplan's desire to practice dentistry pain free in 1981 led him to design the first ergonomic chair with arms to provide additional support. In the early 1990s, saddle seating was developed to maintain the spine and pelvis in a neutral posture while supporting one's trunk.4 Both western and modified English style saddles help clinicians sit higher and eliminate seat pan bulk, allowing clinicians to position closer to the actual worksite, creating safer reaching distances.5
Three years after introducing safer seating options, Dr. Caplan, a modern day ergonomic visionary, introduced surgical telescopes to the dental world. Auxiliary lighting was added at a later date. Sixty-three percent of hygienists suffer from neck pain, and 58% report shoulder injuries -- conditions associated with stressful, static working postures.6 Numerous studies have demonstrated that today's magnification systems are critical components for achieving neutral body postures,7-9 as well as improving visual acuity and reducing eye strain.
Through the years, concern about workplace safety in the dental office began to grow. As more states adopted mandatory continuing education requirements, word began to spread that there were new ways to practice dental hygiene -- ways that would lessen the impact of practicing like a pretzel hour after hour. We began to congregate at events and on line, telling our stories about getting hurt, eagerly exchanging information about how to prevent needless, career-threatening injuries.
A number of important studies over the past few years have demonstrated the benefits of using magnification, auxiliary illumination, safer seating options, and properly fitted gloves.7-13 While the potential for getting injured on the job was never discussed while I was in school, this has become a hot topic in schools all over the country. Hygienists who have graduated in the last five years are five times more likely to have received information about potential workplace injuries than those of us who graduated over 30 years ago.6 Clearly dental hygiene educators are taking part in helping to prevent needless MSDs.9,1 6
In this year of celebration, it would be fun to dream about what Dr. Fones and Irene Newman would have to say about the turning points in the profession they helped create. Imagine strolling through the exhibits at this year's ADHA's annual session in Boston or RDH Under One Roof in Las Vegas with those two pioneers! Certainly their comfort zones would be challenged by how far we've come and how much work still lays ahead in creating a safer workspace. RDH
1. Motley WE. History of the American Dental Hygienists' Association 1923-1982. Chicago: ADHA. 1986.
2. Cavitron history. Accessed at http://www.prevent.dentsply.com/cavitron/history.cfm on April 13, 2013.
3. J Chair. Accessed at http://www.dentalez.com/about on April 13, 2013.
4. Valachi B. Practice dentistry pain-free. Evidence-based strategies to prevent pain and extend your career. Portland, Oregon. Posturedontics Press. 2008.
5. Mandal, A.C.: The Seated Man (Homo Sedens), Applied Ergonomics, 12.1, p. 19. Oxford 1981.
6. Guignon AN, Purdy CM. Dental hygiene 2012 - workplace demographics, practice habits, injuries and disorders, academic awareness and professional attitudes. Unpublished data collected October/November 2012. https://www.surveymonkey.com/s/5K87Z25.
7. Sunell S, Rucker L. Surgical magnification in dental hygiene practice. Int J Dent Hyg. 2004 Feb;2(1):26-35.
8. Branson BG, Bray KK, et al. Effect of magnification lenses on student operator posture. J Dent Educ. 2004 Mar;68(3):384-9.
9. Maillet JP, Millar AM, et al. Effect of magnification loupes on dental hygiene student posture. J Dent Educ. 2008 Jan;72(1):33-44.
10. Pope MH, Goh KL, Magnusson ML. Spine ergonomics. Annu Rev Biomed Eng. 2002;4:49-68. Epub 2002 Mar 22.
11. Tiedeman J. New concepts in seating. Accessed at www.scif.com/pdf/sftySeatingConcepts.pdf on April 13, 2013.
12. Mandel AC. Balanced seating posture on a forward sloping seat. Accessed at http://www.acmandal.com/ on April 13, 2013.
13. Willms K, Wells R, Carnahan H. Glove attributes and their contribution to force decrement and increased effort in power grip. Hum Factors. 2009 Dec;51(6):797-812.
14. Dianat I, Haslegrave CM, Stedmon AW. Short and longer duration effects of protective gloves on hand performance capabilities and subjective assessments in a screw-driving task. Ergonomics. 2010 Dec;53(12):1468-83.
15. Dianat I, Haslegrave CM, Stedmon AW. Using pliers in assembly work: short and long task duration effects of gloves on hand performance capabilities and subjective assessments of discomfort and ease of tool manipulation. Appl Ergon. 2012 Mar;43(2):413-23.
16. Congdon LM, Tolle SL, Darby ML. Magnification loupes in US entry-level dental hygiene programs – Occupational health and safety. JADHA. 2012 Summer; 86(3):215-222.
COMPANIES ARE WORKING HARD TO CREATE PRODUCTS THAT HELP REDUCE OUR PHYSICAL STRESS and allow us to provide patient care outside of the four walls of a traditional dental office. In comparison to the early years of dental hygiene, we now have the option to work with:
- Nitrile gloves that are kind to our hands and keep the thumb in a neutral position
- Sharpen-free hand instruments
- Ultra-thin ultrasonic inserts
- Saddle-style operator stools that create healthy spinal alignment
- Swivel mechanisms integrated into ultrasonic inserts and polishing and power scaling handpieces
- Contra-angled prophy angles that keep our wrists straight
- Scalers that have safer, lighter-weight handles
- Ultrasonic dental scalers that operate in low power ranges
- Cordless polishing devices
- Portable headlights attached to magnification systems
- Hands-free suction devices
- Charting systems that don't require any keystrokes
Editor's Note: The staff at RDH magazine, DentistryIQ.com, and RDHmag.com would like to wish your profession a happy celebration of its 100th anniversary too. At RDHmag.com, DentistryIQ.com, or on RDH magazine's Facebook page, you will find links to register for prizes given to magazine readers and website visitors.
Look for the RDH logo below for a quick link to a game based on this column. Play the game each month to enter a drawing for one of the 100 prizes given away that month. Play the game often to increase your chances of winning the grand prize -- registration, airfare, and three nights of hotel (or cash equivalent) to the RDH Under One Roof conference on Aug. 14-16, 2014 at the Hyatt Regency in Chicago.
Various sponsors in dentistry will be participating with RDH in handing out several hundred prizes through the course of the 100th anniversary.
For a chance to win go to http://www.rdhmag.com/contest.html to play the contest.
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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