Spring cleaning

Despite the predictions of your favorite local-weather forecaster, spring arrives on March 21 — the vernal equinox — a time when daylight and nighttime are equal; everything is in balance. This reminds me of ergonomics. When workers are performing tasks ergonomically, the body is in balance. Muscles, nerves, tendons, and other body parts aren't straining to compensate for career-destroying behaviors. Now hold this thought about balance, and let's head to another scenario.

As soon as the first whiff of spring arrives, serious gardeners — heads filled with all kinds of plans — make a beeline for their prized beds. Before anything new can be planted, piles of winter debris have to be raked away. Naked plants become subject to scrutiny. Did the forlorn subjects survive Mother Nature's ill-tempered blasts of cold air with gracious resignation, or did they succumb to the change in seasons and become instead a mass of deadwood?

Gardeners have all kinds of tricks to revive their beds. Some schemes are literally dirt cheap, like composting kitchen vegetable waste, turning a castoff into valuable "black gold." Other ideas might include selecting plant varieties hardy to the particular climate.

Serious gardeners (or hobbyists of any kind, for that matter) soon become experts in the strategies and gadgets that make spending time tending to the earth a pleasure, rather than a chore. Should dental hygiene practice be any different? Why not take some time to look at how you are working?

Is your body comfortable, or have you fallen victim to the pervasive idea that pain is just part of the price you pay to be a dental hygienist? Is your body in balance when you are working, or do you go home at the end of the day with every muscle in your back and neck aching, full of knots? How are your hands? Do you dread looking at the schedule every morning only to see patient after patient listed who will tax your fingers beyond human limits?

One "Comfort Zone" column cannot begin to address the solutions to all of our practice problems, but it is possible to begin changing how you practice the next time you walk into your treatment room.

Here are some ideas about products and positioning that I have found very useful through the years, ideas that can keep you on the road to health or help put you back on the path if you've wandered down the lane marked "Dental Hygiene Aches and Pains." Some of the changes are free, others involve a product change, a few suggestions mean a minimal cash outlay, and, of course, there are the biggies that can have a major long-term impact on improving your health and how you practice dental hygiene for years to come. In other words, there is something for everyone.

The freebies

Elevate your operator chair so that your hips are one or two inches above the knees. This will take tremendous strain off the lower back.
Place frequently used equipment and instruments in an easy-to-reach location.
Quit fighting gravity. Raise the bracket table to elbow level. Bring it closer to your work area.
Clean dust and smudges from the overhead dental light cover.
If you work in a "dental hygiene closet," unlock and reposition the patient chair so you can move in closer.
Once reclined, ask your patient to scoot up to the top of the chair or ask little tykes to come closer so you won't have to bend over with hunched shoulders.
Have patients close their mouths halfway to make it easier to retract the buccal mucosa. Now you'll be able to see the facial surfaces of the molars.
Remove most surface stains with power scalers rather than hand instruments.
Wipe the mouth mirror frequently with a piece of gauze that has been dampened with mouthwash. This will give you a defogged, droplet-free view.
Bend the saliva ejector so it becomes a hands-free helper that hangs in the corner of the patient's mouth.
Get rid of your "airplane posture" by positioning the patient chair at elbow or waist level so that you can keep your arms at your side.
Stop perching on the end of the operator chair like a bird ready to take flight. Sit on the entire seat for good leg support and use the chair back for lumbar support.
Keep your hand instruments sharp. Dull instruments aren't effective and require more hand pressure.

Switch to more ergonomic products

Polish with a Young Dental Contra-Angled disposable prophy angle to keep your wrist in a neutral position. Disposable prophy angles also reduce the overall weight of the polishing apparatus.
Use soft prophy cups because they require less hand pressure.
Improve the access in tight-fitting or hard-to-reach areas with smaller, petite prophy cups.
Textured gloves improve "traction," allowing you to have a lighter grasp, especially when the glove is moist. Microflex makes many varieties of latex and synthetic gloves that have good texture.
If you have hand pain or thumb discomfort, consider right- and left-fitted gloves rather than ambidextrous models.
Improve your sealant application and reduce the need for adjustments by using Clinpro Sealant with its easy-to-see pink color and ultra-thin syringe tip.
Learn the special technique of polishing with Clinpro, the self-adjusting polishing paste, especially safe for shiny cosmetic restorations as well as effective for removing heavy stain.
Purchase some newer hand instruments that have more texture, larger diameters, and better grips. All major instrument manufacturers offer new designs.
Rather than relying on hand scaling for most patients, get in the habit of using the thinner ultrasonic insert tips at lower power settings.
If you have a magnetostrictive ultrasonic scaler, use the new Hu-Friedy Satin Swivel ultrasonic insert tips to reduce stress on your wrist, hand, and arms.
Use either the padded Otis Formajet saliva ejector or the Sof Stop saliva ejector pillow. Now the saliva ejector can be a patient-friendly retraction tool.
Replace those nightmarish scratched, worn-out mirror heads — a bargain way to improve visibility.
A scaler or curette with a broken end is unbalanced. American Eagle Select instruments are designed so that a new tip can just be screwed in the original handle.
Try using the smaller #3 and #4 mirror heads to access tight areas more easily.

Spend a few bucks

Chub-Eze, Acushy, and ErgoGrasp instrument grips give new life to skinny instrument shafts by increasing the diameter and reducing pinch/grip.
"Pillo' Beans" washable headrests and lumbar supports customize your patients' position, letting them get closer to you.
Replace old, curly, heavy air hoses to reduce the stress on your wrist.
Get a new, longer, pliable saliva ejector hose with a flip-switch control.
Add a shelf, rolling cart, or bracket table so that instruments and supplies are within easy reach without stooping or bending.
Replace the scratched light cover to increase the volume of light.

Make some big changes

Make the commitment to work with precision, custom-fitted magnification, so you can have better posture in addition to improved visibility. Orascoptic Research is a very dental hygiene-friendly company.
Use an ergonomic operator chair with arms so you stay relaxed all day.
Add a fiber-optic light to your magnification system and eliminate the blind spots.
Purchase a more sophisticated power-driven scaler and learn to use it correctly.
Add an electronic diagnostic periodontal probe such as the Diamond Probe to improve early disease detection and help patients take ownership of their disease.
Use an intraoral camera more often as an educational and diagnostic tool.
Change to the Midwest RDH or the Taskall cordless polishing handpieces to reduce stress to your hand and wrist.
Cure sealants with the new cordless 3M ESPE Elipar curing light.

Just like a gardener has to decide which plants simply get a bit of pruning and which ones are headed for the compost pile, you, too, have to decide where to make adjustments in how you practice. Once you've done some spring-cleaning, you will see where you need to make changes.

Often, hygienists do not believe that they are entitled to make a change in how services are delivered. It is not wrong to want or ask for the best for either ourselves or those whom we treat. Remember, we need quality tools and products to practice hygiene and provide quality services to our patients.

Now, if you think my ideas above run the gamut, just imagine what my list of garden goodies looks like every year! Spring is a time for renewal, a time for re-evaluation, and a time for change. Clean away the debris and start afresh this year — practicing dental hygiene in the comfort zone.

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]

How to find these nifty products

Acushy™ Instrument Grips – (800) 292-9140 – www.acushy.com

American Eagle Instruments – (800) 551-5172 – www.am-eagle.com

Chub-Eze Grips – (800) 665-6764 – www.handtech2000.com

Clinpro™ Paste and Sealant – (800) 634-2249 – www.3MESPE.com

Diamond Probe® – (888) 737-4620 – www.perio2000.com

Elipar™ Freelight Curing Light – (800) 634-2249 – www.3MESPE.com

ErgoGrasp® – (866) 209-ERGO – www.ergograsp.com

Hu-Friedy Manufacturing – (800) 483-7433 – www.hufriedy.com

Microflex – (800 ) 876-6866 – www.microflex.com

Orascoptic Research, Inc. – (800) 369-3698 – www.orascoptic.com

Otis Formajet – (800) 854-1045