It all adds up

March 1, 2013
My favorite seat on any plane is a window seat. It's fascinating to see the world from that vantage point, a perspective that makes it easier to digest ...

by Anne Nugent Guignon, RDH, MPH

My favorite seat on any plane is a window seat. It's fascinating to see the world from that vantage point, a perspective that makes it easier to digest complex landscapes and geological formations.

Several months ago, my husband and I were fortunate to spend a week in Kauai. A big highlight of the trip was the helicopter ride around the island. The pilot flew along the rugged Na Pali coastline, and we skirted the dramatic north shore, crossed over a coffee plantation, peered into the remnants of a dormant volcano, marveled at dozens of waterfalls, and delighted at the splendor of the Waimea Canyon, a geological gem, tucked in the middle of the island.

This was my first helicopter ride. It was an amazing experience, but left me exhausted. Helicopters are basically small, vibrating mechanical bubbles, designed for efficiency, not creature comfort. I spent the hour sitting like a pretzel trying to get the best view possible. Apparently, fatigue is a common outcome from exposure to whole body vibration, and the end result was an unplanned afternoon nap.1

While clinical dental hygiene does not involve whole body vibration, many of us employ awkward postures and static positioning. We also use vibratory tools such as ultrasonic dental scalers, slow-speed polishing devices, and high-speed handpieces. Ergonomists also consider factors such as repetition, force, grip, and duration when evaluating workers and their tasks. The goal is to reduce the risk for developing a workplace-related musculoskeletal disorder. Quite honestly, no one has yet come up with the total ergonomic solution for our profession.

Our profession is falling apart at a very rapid rate. In the fall of 2012, over 1,000 dental hygienists completed a survey that included questions about workplace-related demographics, practice activities, and injuries. Fifty percent of the respondents reported one or more injuries or disorders directly related to the clinical dental hygiene practice. The top five injuries were neck, shoulders, lower back, dominant hand, and mid to upper back.2

In October 2012, Dr. Alan Hedge, a world-famous ergonomist from Cornell University, delivered a paper at the Human Factors and Ergonomics Society Annual Meeting in Boston. The study looked at relationships between computer data entry and the frequency and severity of musculoskeletal disorders in physicians working in multiple outpatient diagnostic clinics. The most commonly reported repetitive strain injuries were neck, shoulder, and upper and lower back pain, with female physicians reporting more discomfort than their male counterparts, findings that parallel the 2012 dental hygiene survey.3

The report caught the attention of the lay press. According to Hedge, "These rates are alarming. When more than 40% of employees are complaining about regular problems, that's a sign something needs to be done to address it. In a lot of hospitals and medical offices, workplace safety focuses on preventing slips, trips, and falls and on patient handling, but the effects of computer use on the human body are neglected." Hedge further reflects, "We can't assume that just because people are doctors or work in health care that they know about ergonomics. With so many potential negative effects for doctors and patients, it is critical that the implementation of new technology is considered from a design and ergonomics perspective."4 In a 2011 study of physicians and nurse practitioners, Hedge and James concluded, "Ergonomic factors for musculoskeletal injuries are seldom considered. We cannot unknowingly afford to be exposing highly trained medical personnel to any increased injury risk."5

Before dismissing this discussion, consider the facts. Dental hygiene challenges every ergonomic principle. Our injury rates are significantly higher than the physicians' in Hedge's research. Alarm bells should be going off in your head right now. Based on the very nature of clinical practice, our bodies are getting stressed every moment we practice. The push for electronic health records means added keystrokes in the treatment room, often done in cramped spaces using miniature keyboards with poorly fitting covers.

Add in the keystrokes from our personal lives. Incessant use of handheld devices can lead to the early development of osteoarthritis and other potentially chronic joint conditions such as "BlackBerry thumb," a condition all too many hygienists know as de Quervain's tenosynovitis. According to Dolores Langford, a registered physiotherapist and certified hand therapist in West Vancouver, British Columbia, the thumb is responsible for 60% of the functioning of the hand. "If you're texting, the pressure at the tip of your thumb is amplified twelve times by the time it gets to the base of your thumb, so the basal joint has to absorb that shock with every keystroke."3

Factor in the physical stress of housework, childcare, cooking, and leisure activities such as needlework, gardening, playing a musical instrument, crafts, or sports such as tennis or biking. Don't forget time spent behind the wheel of a car, commuting to work, running errands, or taking the kids or other loved ones to sports activities, shopping, or church.

In addition to the multiple microtraumas that we face in our professional and personal lives, most of us don't factor in enough time for rest and recovery. On a cellular level, the body needs time to recover, but today's work and life demands make rest a precious commodity. We need to take individual responsibility for our own bodies. Perhaps it is time to restructure your workday and fit in more mini-breaks or to add Bethany Valachi's exercise regimen, especially designed to combat the effects of clinical practice, to your routine. (You can find that information on Would taking a day off in the middle of the week, rather than working three days in a row, work in your schedule? Each of these schedule changes could reduce your risk for developing a work-related musculoskeletal disorder (WRMSD).

Is this the year to begin investing in your own custom equipment or add to what you've already purchased? If you've been reading this column over the years, you know there are many choices with respect to equipment such as magnification loupes, auxiliary headlights, safe stools, sharpen-free hand instruments, sophisticated power scalers, more brilliant mirrors, specialty suction devices, hands-free documentation systems, and disposable supplies such as gloves and masks — and it doesn't always mean spending money. Solutions can be as simple as rearranging the location of your instrument tray.

If you've not already started down the path of creating a healthy workspace, make a promise to yourself that 2013 will be the year that you're going to start fitting your dental hygiene practice to your body and not the other way around. You're going to feel better, be more productive, and have a happier career. Your patients deserve a healthy clinician focused on their comfort zone. Your time has come. RDH

Consider reading:House of Cards: A fragile balance in our health
Consider reading:Get your alma mater involved
Consider reading:A Gift Only You Can Give


1. Noise and Vibration in Army Aviation. Accessed 1/15/2013.
2. 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.
3. Walkinshwa E. Thumbs up and down. CMAJ. 2011 August 9; 183(11): E711–E712.
4. Hedge A, James T. Gender effects on musculoskeletal symptoms among physician computer users in out patient diagnostic clinics. 56 Annual Human Factors and Ergonomics Society Annual Meeting. October 2012.
5. Hedge A, James T, Pavlovic S. Ergonomics Concerns and the Impact of Healthcare IT, International Journal of Industrial Ergonomics, 41 (4), 345-351. (2011).

ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biof lms, 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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