I have been working in clinical practice for almost 5 years. I am starting to experience pain in my hands, arms, and shoulders. I use loupes and a headlamp. My dentist wants to improve the ergonomics of my operatory. What should I suggest?
Congratulations on having an employer who values your health and is willing to consider suggestions to change the work environment. In addition, you are already on the right path with the wearing of loupes and a headlamp. These are two of the most crucial tools in promoting good ergonomic practice.
Adapting the work environment to your personal needs is a necessity for attaining proper body mechanics. A meta-analysis of 30 studies reports 10.8% to 97.9% of oral health professionals experience musculoskeletal disorders and pain, with most articles reporting the prevalence at 60%.1 Static and awkward postures and repetitive motions are the most common dental risk factors for musculoskeletal disorders.1,2 Other dental work risk considerations include psychosocial factors such as stress, work schedule with long days, and multiple repetitive days.2 Biomechanical and psychosocial risk factors lead to a higher rate of musculoskeletal disorders and pain.3
You can begin with evaluating operatory equipment to determine whether it can be adjusted to meet your needs to attain optimal posture. First, adjust your clinician stool/chair so that your hips are higher than your knees and the seat is titled forward 5° to 10°. Your ears, shoulders, and hips should be positioned in a straight vertical line and an anterior pelvic tilt should be maintained. Researchers have found that a saddle stool is more helpful in maintaining optimal posture than a conventional clinician chair.4,5 Additional systematic analysis noted that combining loupes with a saddle stool improves posture.5 If you cannot adjust the clinician chair up and down or tilt the seat pan, consider purchasing a saddle chair.
The next factor to consider is the patient’s chair. There should be ample room around the patient’s head with the chair reclined (approximately 24” away from the wall or cabinets). You should be able to adjust the height of the patient chair, so your legs fit comfortably under the chair with your arms by your sides with correct positioning. The patient’s headrest should be adjustable and preferably a double-articulating, gliding model.6 Instruments should be within your reach; avoid twisting to access your instrument tray. Loupes can promote a neutral posture with a correct declination angle, and, with a light, the clinician does not need to reach overhead to adjust the light. Clinicians’ visual acuity may decrease over time, so you may need to adjust your loupes accordingly. Clinician and patient positioning can be a protective factor for the dental hygienist; therefore, review patient and clinician positioning to reduce the risk of awkward postures.2 If possible, ask a co-worker to take photographs throughout the day to assess your posture.
Instrument quality, including ultrasonic inserts/tips (UITs), can also impact ergonomics. Manual instruments need to maintain their original design. UITs need to sustain their effectiveness according to the manufacturer’s directions for use. Force applied during instrumentation as well as repetitive motions contribute to musculoskeletal disorders and pain. Stretching prior, during, and after work can reduce musculoskeletal disorders and pain in the hands and wrists.7,8
Lastly, consider psychosocial factors such as balancing home and work responsibilities. Working long days and multiple days in a row contributes to increased musculoskeletal disorders and pain. Make sure you have time to stretch throughout the day and, when possible, alternate types of patients (calculus, periodontal, adult, child) throughout the day. If pain continues, seek treatment from a healthcare professional.
- Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in western countries: a systematic literature review and meta-analysis. PloS One. 2018;13:E0208628.
- Hayes MJ, Taylor JA, Smith DR. Predictors of work-related musculoskeletal disorders among dental hygienists. InJ J Dent Hyg. 2012;10:265–269.
- Warren N. Causes of musculoskeletal disorders in dental hygienists and dental hygiene students: a study of combined biomechanical and psychosocial risk factors. Work. 2010;35:441–454.
- Ramsay JRE, Gandavadi A, Burke FJT. Assessment of dental student posture in two seating conditions using RULA methodology—a pilot study. Br Dent J. 2007;203:601–605.
- Plessas A, Bernardes Delgado M. The role of ergonomic saddle seats and magnification loupes in the prevention of musculoskeletal disorders. a systematic review. Int J Dent Hyg. 2018;16:430–440.
- Valachi B. The 4 ergonomic ‘must-haves’ in a patient chair: dentists often only think of their patients’ comfort when choosing a patient chair–but the choice of chair could have a much greater effect on the dentist than the patient. Dental Products Report. 2016;50(5):62.
- Nye, Whitni H, Partido, Brian B, DeWitt J, Kearney RC. Prevention and reduction of musculoskeletal pain through chair-side stretching among dental hygiene students. J Dent Hyg. 2021;95:84–91.
- Valachi B. Stretching your way out of pain: frequent stretching throughout the workday can have big benefits for dental professionals. Dental Products Report. 2015;49(10):94.
From Dimensions of Dental Hygiene. September 2021;19(9):12.