House of Cards: A fragile balance in our health

Feb. 1, 2013
Many hygienists simply work with whatever is provided in an office, regardless of whether the equipment or workspace is conducive to wellness.


Many hygienists simply work with whatever is provided in an office, regardless of whether the equipment or workspace is conducive to wellness. For years I've tried to simplify the concept of dental hygiene workplace wellness. How we practice clinically is an incredible balancing act involving one's head, hands, and heinie. All three parts are equally important and involve the most common sites for cumulative trauma disorders or workplace-related injuries sustained by clinical dental hygienists.

Over two-thirds of hygienists report neck pain as the most common area of discomfort, closely followed by shoulder problems. More than one-third report pain or discomfort in the lower back and in the dominant hand. 27% have mid to upper back issues and 20% have problems with their nondominant hand or thumb. In addition, hygienists are plagued with elbow, hip, forearm, ankle, and venous issues. Basically, the majority of dental hygienists are like slow motion train wrecks; their bodies are ready to derail without much provocation.

The head/hands/heinie concept is like a house of cards: a dynamic and fragile balance that can mean the difference between a healthy career and one that ends abruptly due to an unforeseen injury. Clinical practice does not have to result in multiple surgeries, endless medications, or lost time from work, but we have to be willing to address how we are positioning our heads, how we are using our hands, and our core postures. Using neutral body postures and giving the body time to recover from stressors are keys to reducing musculoskeletal stress.

Neck pain is significantly more common among those that don't use magnification systems. It's nearly impossible to maintain a neutral posture, sit upright, and keep one's arms to the side without loupes. In a desperate attempt to see, the patient's oral cavity is at a high position instead of at our waist, where our forearms can be parallel to the floor. It's also impossible to have a neutral wrist posture if the patient is too high.

While our hands are not the primary source of pain, plenty are suffering. As science continues to enlarge the role of biofilm in both periodontal disease and caries, learn to rely on your power scaler to disrupt biofilm and remove tenacious deposits and stain. Stock up on some of the new, ultrathin inserts, keep your touch light, and work with lower power levels. Consider the size, diameter, and weight of hand instruments. Sharp instruments require less force and limit tight pinch grip, so invest in instruments that feature sharpen-free technology.

While polishing is only a portion of the appointment time, there are significant advancements that will reduce hand stress. Contemporary corded handpieces are lightweight and swivel. Straight hoses, made from ultra-light materials, reduce cord torque. Cordless handpieces are the ultimate in clinician-friendly design. Even prophy angles and cups play a role. Contra-angles keep the wrist straight, and soft cups adapt more easily to tooth anatomy, cutting down on hand pressure.

Gloves can have a huge impact on hand health. Everyone's hands are different. Compare the diversity in the size and shape of your coworkers' hands, palms, and fingers. It does not make sense for everyone in a practice to be wearing the same brand of glove. Newer, ultrathin nitrile products offer great tactile sensitivity without compressing delicate nerves and blood vessels. Some ambidextrous nitrile brands have received an ergonomic certification based on thinness and the ability of the thumb to stay in a neutral position.

Ergonomists recognize the negative impacts of traditional seating on the torso. While thighs parallel to the floor continues to be taught, that type of positioning creates havoc in the lower back, virtually eliminating the natural spinal curves, putting undue stress on the supporting muscles, tendons, and ligaments and fast-tracking clinicians into venous problems in their legs. Short clinicians are at particular risk when they are forced to sit on the edge of a traditional seat. Seating options based on sit/stand positioning eliminate these issues when clinicians use correctly-sized saddles that are properly adjusted to their bodies.

More and more hygienists are investing in their long-term health by purchasing their own equipment and supplies. This approach, long considered strange by many, is now becoming more mainstream for the following three reasons.

Decades ago students were required to purchase only hand instruments and uniforms. Today a growing number of students are expected to purchase their own equipment such as ultrasonic scalers, magnification loupes, and personal protective devices such as gloves and masks. It varies from school to school. Some schools select the equipment and negotiate lower prices with companies if there is a mandatory, exclusive arrangement with a company or supplier. Others merely expect students to supply the type of product, but do not require a certain brand.

In addition, more and more information is coming to light regarding workplace-related musculoskeletal disorders that plague a huge number of people in our profession. Hygienists wanting to prevent injuries or prolong their careers are purchasing everything from loupes to chairs to gloves. They have come face-to-face with the reality that, ultimately, we have to protect our own bodies from injury and not wait for a doctor to solve all of our issues.

Legislative changes all over the country are also driving sales. Hygienists who are fortunate enough to practice in states that allow more autonomy, such as those with an RDHAP license (e.g., California), routinely have all of their own supplies and equipment to enable them to care for patients outside of the four walls of a traditional dental office.

Simply put, if the head, hands, and heinie are not in equilibrium, our bodies end up bearing the brunt of never-ending multiple microtraumas. The human body is not built to take the demands of dental hygiene practiced as it was taught for many years. Let's embrace the science of ergonomics and accept what it is going to take to build our clinical comfort zone, rather than letting one more career topple like a house of cards. RDH

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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