by Anne Nugent Guignon, RDH, MPH
Every couple of weeks, an email or phone call comes from a hygienist who is in trouble physically from either trying to practice in an unforgiving physical layout or who has gotten hurt from all the demands clinical practice places on our bodies. These frequent conversations make it clear that if clinicians looked at how they are actually working they could perhaps discover some valuable clues that would help them solve the puzzle of pain.
When I was writing the "See Yourself in Pictures" column for the March issue of RDH, I wasn't really sure what the response might be like from the readers. After introducing a contest in the March column, I kept my fingers crossed that hygienists from all over would take a more critical look at how they practice from an ergonomic standpoint or share ideas with others about how they solved an ergonomic issue. Since hygienists are generally good sports (and there were noteworthy prizes at stake), it seemed logical that we could learn from each other and have some fun in the process. Click here to view photos from Ergonomic Contest.
Initially I worried that no one would participate, but suddenly the entries started coming in. Photos arrived from all over North America. While most were from hygienists in the United States, three Canadians joined in on the fun. By the deadline on April 15, more than two dozen hygienists had submitted entries. Some sent a single photo or idea. Others got really serious and sent pictures from every conceivable angle.
You also never know how people will interpret contest rules. Actually, this was a contest without a lot of rules. An entry made you eligible for a drawing for some great prizes: magnification loupes, ergonomic handpieces and prophy angles, a cordless polisher, and special exercise and stretching videotapes. The contest was simple and fun.
Most hygienists sent pictures of how they work and often commented about what they saw or how they would correct the situation. Several submitted photos of their co-workers complete with comments about the dangerous postures that they were observing. The treatment room designs ranged from state-of-the-art setups to equipment that was clearly decades old. But all of the photos give us a peek at how we practice everyday.
While the majority of the pictures paint a very distressing picture of what we put our bodies through day after day, there were a few hygienists whose entries demonstrate how to practice in safety and comfort. Nearly all the hygienists with good posture are wearing magnification loupes. The good posture group also fully utilized the operator chair lumbar support. Some also use chairs with arms or have operator headlights which provide additional illumination. Interestingly, many of these clinicians have purchased their own loupes, lights, and chairs throughout the years and consider this type of investment a cornerstone in building a long healthy career.
Two dental hygiene educators sent some of the most astonishing pictures. Diane Kandray, RDH, from Youngstown State in Ohio and Kathy Sockett, RDH, from Mississippi Delta Community College submitted photos that will make you say ouch! While the student postures were amazing to behold, it is gratifying to know that there are instructors working hard to turn the tide on the rising number of workplace musculoskeletal disorders. Their students may think they are picky at this point, but in the long run these hygienists will be grateful that they learned about these issues early in their career.
Continuing in the arena of formal education, Esther Conolly, RDH, presented a table clinic in 2001 at Lamar University in Beaumont, Texas, that demonstrated dangerous working postures and poor equipment positioning. Students now receive more information about this subject as a result of her efforts.
Connie Pries, RDH, a veteran hygienist of 34 years, feels that a part-time schedule in addition to year-round exercise and sports are the reasons that she is pain-free after so many years. She has recently discovered the many benefits of yoga and now wonders why it took her so long to try a technique that benefits both her strength and concentration. Along with their magnification systems, Karen Stueve, RDH, and Dee Vecchione, RDH, credit the stretching and exercises recommended in the Peter Egoscue book Pain Free.
Vecchione's last office had a rear delivery system that forced her to constantly twist around to swap instruments, and her ultrasonic scaler was even lower so she had to twist more every time she used it. In addition, the rear delivery system added weight and drag to the saliva ejector and handpiece, and the patient chair would not go low enough to accommodate proper operator positioning. Like so many other hygienists, Jody Phillips, RDH, is aware of her posture but always feels sore and tired at the end of the day and now realizes that her chair, which is actually an office task chair, is a big part of the problem. Kasha Lower, RDH, works out of two different treatment rooms in her dental office. Even though she purchased loupes and a chair she notices the improvement in her posture when she uses the chair with the lumbar support versus a stool without a back.
Sherri Bush, RDH, and Robin Moye, RDH, love using ultrasonic scalers. They realized, however, that the handpiece cords were heavy and created a lot of unnecessary drag on their hands and wrists. Their solutions were practical and inexpensive. Sherri placed her scaler on a shelf and attached the cord to the bracket table arm. Robin threaded the cord through an ironing board cord support located next to the unit.
Some hygienists are able to practice with a dental assistant, but this can still lead to ergonomic problems. Shirley Cross, RDH, entered a photo of how she worked with her assistant, which showed Shirley's position was compromised since the patient chair was too high. In an attempt to correct the situation, the doctor gave the assistant an old pair of loupes. Since the loupes did not match the assistant's working distance, her posture was now compromised. The final solution was that both Shirley and her assistant needed loupes that allowed them to have proper posture.
Typically, dental hygienists don't want to upset or inconvenience patients. Michelle Jackson, RDH, reflects on why this type of thinking leads us into all types of problems: "It's all about having the patients adjust for you. Many people get the Mommy syndrome, which is that you'd rather hurt yourself than bother someone else.
I thought I had good posture until I read your article and really started thinking about everything that I do. Now I realize that loupes would probably really improve my posture."
The hygienists who worked with each other on this project gained even more out of the photo exercise. They were able to analyze and critique each other's posture and discuss solutions. That type of collaboration and dialogue has its own set of rewards.
Creating awareness of the environment that we practice in was the goal of this project. This exercise accomplished that goal for every hygienist who either participated secretly or for those who sent in photos and ideas on how to make our environment safer. Let's give a round of applause for all hygienists who had fun with this and our corporate sponsors that donated such generous prizes!
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].
Commentary in captions were written by Anne Guignon, RDH, who is the author of RDH's Comfort Zone column, and Bethany Valachi, PT, a physical therapist who is the author of the "Chairside Stretching" article that appeared in the March 2004 issue.