by Anne Nugent Guignon, RDH, MPH
When ergonomists study a workplace, they look at everything that affects how a task is performed, including worker posture, forces used in a task, repetition, lighting, equipment location, room temperature, and the size and layout of the work field.
Workers who make the tools or equipment such as dental scalers, magnification loupes, or toothbrushes typically perform the same or similar procedures throughout the entire day in a defined workspace. The dental treatment room is a much different kind of workstation. Our assembly line widgets are people, who come in all different sizes and shapes and emotional states that range from mellow to wound so tight they’re ready to snap at the slightest change in plans.
Last year I was invited to present at the Applied Ergonomics Conference. This was the first time a dental professional had been invited to speak at the conference. The primary focus of the conference was on identifying and preventing workplace injuries among health-care workers.
I didn’t know if anyone would show up at the session, and I was curious to see if our workspace woes would catch anyone’s attention. I was given 30 minutes on the afternoon of the last day to talk about how dental health-care workers cope with postural challenges, and the presentation received high marks.
Two things became abundantly clear as I attended other conference programs. Health-care workers everywhere are challenged by the size of their patients and their patients’ ability to either assist or hinder care. Second, it is nearly impossible to conduct serious scientific studies when there are so many variables. Our workplace assembly line changes with every patient, unlike the risk for a cumulative trauma from performing the same task the same way in a manufacturing assembly line.
Anxious patients are generally ergonomic nightmares. Their tense, rigid bodies assume positions that make it nearly impossible to deliver care without great pain to our bodies. Patients with limited mobility or who can’t lie back in the patient chair are also challenging. What about patients that have involuntary twitching, or whose bodies are twisted by arthritis or bent over with osteoporosis? Working with the homebound, bed-bound, or wheelchair-bound requires the utmost ergonomic creativity.
While it’s not easy to get a tense patient to relax, it is worth the effort to find out what is bothering the person. If the problem is dentinal hypersensitivity, there are a number of products that provide immediate and long-lasting relief prior to instrumentation. It is a good idea to have several different products on hand since there is no one purpose chemistry that works on every patient.
Pastes that contain arginine bicarbonate, calcium sodium phosphosilicate, or stabilized amorphous calcium phosphate are easy to apply, and they reduce sensitivity to varying degrees. Most of these pastes are very creamy, so consider acquiring a contrangled prophy angle with external ribs on the cup. The angle and cup geometry help keep the wrist in neutral and reduce unnecessary splatter. Fluoride varnish and glass ionomer surface protectant products are also appropriate choices in the war against sensitivity.
Dental chairs with built-in massagers, or inexpensive massage pads with or without heaters, are great tools to distract patients and provide soothing vibrations to tense muscles. U-shaped neck pillows filled with polystyrene beads support and comfort patients with osteoporosis or arthritis of the neck. This type of pillow can subdue or eliminate spontaneous tremors in patients who have Parkinson’s disease or other uncontrollable neck movements.
The temperature in many treatment rooms may be just perfect for those providing care, but way too cold for patients. Simply covering them up with a soft, washable cotton thermal blanket or soft fleece throw can soothe a jittery patient. Sunglasses eliminate glare from the lights, earplugs or headsets reduce annoying noises, and cordless polishers eliminate the sound of a traditional drill.
Patients can also experience anxiety from flavors and odors or insufficient evacuation methods. There is a paste-free prophy angle for polishing that eliminates that gritty feeling and slows down the salivary flow stimulated by flavored products. There are also mild polishing pastes free of flavor or fluoride for those situations that require polishing.
Consider standing while treating patients whose physical restrictions make reclining impossible, or when faced with patients who are so large that you can’t reach their oral cavity without extending your arms straight out. Another option is to use a saddle stool, a seating design that uses a sit/stand position, which allows a clinician to not only sit up eight to 12 inches higher, but position more closely to the patient.
It is important to do everything possible to create a relaxed environment for patients, but not at the expense of our comfort zone. Addressing patient anxiety, adapting our workspace by using products that create patient comfort, and working with postures that limit how we compromise our musculoskeletal system are all integral aspects of dental hygiene workplace safety.
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.