Reconnecting Practicing Hygienists with the Nation's Leading Educators and Researchers.

Incorporate Loupes Into Your Practice

Loupes offer a wide variety of benefits to oral health professionals, so why aren’t more clinicians using them?

Clinical practice places tremendous pressure on the body and vision of dental professionals.1 During a single dental appointment, an oral health professional must thoroughly examine the oral cavity, move various parts of the upper body, and stay in a static, consistent position for prolonged periods. To maintain appropriate sight of the oral cavity, clinicians may compromise the practice of proper ergonomics, such as inclining the back or twisting the neck, leading to musculoskeletal stress.2

In order to address potential musculoskeletal disorders (MSDs), clinicians should focus on the practice of appropriate ergonomics and better patient positioning. Alternatively, using magnification devices, such as loupes, provides the clinician with enhanced visual acuity and may improve ergonomics, reducing strain on joints and muscles.

Visual Acuity

Effective delivery of dental hygiene care requires adequate eyesight and vision. Early detection and diagnosis of oral diseases depend on the accuracy of visual assessment during patient examination. Loupes are recommended to increase the sight of the working field and magnify the oral cavity.3,4

Visual acuity is the preciseness of vision from a distance where the perception of intricate details varies based on angulation.4 Perfect vision only defines the sensitivity of vision and the distance from the object.5 Visual acuity is most commonly measured using the Snellen Eye Chart, where sharpness is tested one eye at a time to determine the capacity of each eye to identify shapes.6

A clinician’s ability to see and differentiate changes in the oral cavity is paramount to successful practice. Identifying contrasts of hard and soft tissues, periodontal charting, and maintaining appropriate adaptation and angulation while instrumenting are critical components of dental hygiene treatment.

Types of Loupes

Loupes are frequently used by oral health professionals to magnify the oral cavity. Magnification levels depend on the line of vision and working distance toward the object.7 Three types of loupes are available: the simple loupe, Galilean loupe, and Keplerian loupe.3 Each type is designed for varying levels of optical enlargement and assists in resolving various visual impairments.

Simple loupes have flat lenses with a more restrictive visual magnification field.8 A study by Wajngarten and Garcia3 found that simple loupes only provided minor improvements in visual acuity.

Dental professionals frequently use the Galilean and Keplerian systems.2-4,8 The main differences between these types exist within the refractive field of view, lens shape, and working distance. Galilean loupes use two lenses, a convex and concave lens, and provide magnification between 2.0x and 3.5x. They are best for general dentistry purposes and for individuals with less severe visual impairments.2,8 Additionally, their lighter weight and smaller size provide more affordable options for clinicians.2 With a more extended, more intense range of magnification power, the Keplerian loupes range from 3.5x to 4.5x for greater visual acuity and increased sensitivity for working distance.2

Depending on the clinician’s vision, clinical operative needs, and preferences, additional features may be added to dental loupe systems. Some features create a steeper inclination angle that helps keep the head and neck in a more neutral, upright working position, leading to a more vertical placement of the upper and lower back.2 Prior to purchasing any dental loupes, clinicians should determine their specific needs.

Impact of Age

Dental professionals must take early precautions to optimize their eye health to prolong career longevity. At around ages 40 to 50, the risk of eye conditions, such as presbyopia (farsightedness), increases.4 Presbyopia causes the inability to focus or see objects up close.5 Data show this condition is on the rise, with approximately one in every eight Americans developing it by age 55.9

Eye function declines with aging, significantly affecting the clinician’s natural visual acuity.10 This deterioration can impact diagnostic skills, hinder the ability to see up close and discriminate between colors and textures, and affect indirect and peripheral vision. Loupes benefit clinicians with age-related presbyopia but not all of the systems are suitable.4

The simple loupe provides minimal improvements in vision performance.2 When considering age as a factor for visual acuity, the Galilean system may provide more benefits for addressing presbyopic changes over the Keplerian system. One study that compared dental professionals older than 40 to those younger than 40 suggested Galilean loupes showed greater adaptability and improvement in performance over the Keplerian loupes due to the complexity of the Keplerian system.11 The greater magnification of the Keplerian loupes decreases the working distance, thus creating a smaller working field; in the presence of vision impairments this hinders the ability to keep the objects in focus.4

Musculoskeletal and Postural Effects

Among dental professionals, the most common occupational hazard is the MSD.12 Clinical practice is challenged by patient positioning, operatory spaces, uncomfortable clinician chairs, and the operator’s unique physical characteristics.

A systematic review revealed the areas experiencing the greatest musculoskeletal problems among dental hygienists were wrists, hands, and fingers, followed by neck and upper back areas.13 Such issues with MSDs leave clinicians searching for prevention solutions. Some recommended methods to maintain proper ergonomics include using loupes, operator and patient positioning continuing education, and specialized operator seating.

In recent years, proper posture to maintain neutral positioning with loupes has been promoted for its ergonomic benefits. Studies on dental professionals’ perceptions of loupes report advantages in comfort in vision (59.25%) and enhancement in work efficiency (53%), with a significant relationship between the use of loupes and decreased pain in the back, neck, shoulders, elbows, and feet.14 More than half of participants from two studies noted perceived improvements in the use of the explorer and when scaling with the use of loupes, although the observations of correct ergonomic posture with the use of loupes were not statistically significant.1, 15

Research indicates that using simple loupes, while providing a comfortable working distance, increases the angulation of the neck away from a neutral working position.3 The Galilean and Keplerian systems provide higher visual acuity while maintaining a comfortable working distance. There were no significant observed differences when looking at these two systems.3

When evaluating trunk flexion, both the Galilean and Keplerian systems showed significant improvement in operator positioning compared to no magnification devices.2 Using loupes in combination with saddle seats may improve the operator’s posture by supporting the natural lumbar curve of the spine.16 However, limited statistical evidence links their overall effectiveness in reducing MSDs.16

Limitations and Future Considerations

Even though the use of loupes assists with improved ergonomics, posture, and visual acuity, they are still not widely used. Clinicians learn about loupes from continuing education, peers, hands-on demonstrations, and within their academic settings.14 These sources may present differing information on loupes’ advantages and disadvantages, contributing to differing levels of acceptance. Research shows that some clinicians avoid using loupes because they do not want to rely on them.14 In addition, cost is cited as a primary barrier to the adoption of loupes, especially during the early years of training.2,14

Conclusion

Muscle pain and fatigue remain a common complaint among dental professionals. Thus, methods to alleviate the physical strain on the body are necessary to prevent MSDs. Incorporating loupes into the clinician’s daily practice can improve ergonomics and visual acuity, significantly reducing the possibility of developing MSDs. Magnification devices, such as loupes, are a great aid and should be considered an additional tool in the dental professional’s armamentarium, starting early in dental hygiene education. Moreover, with the various eye conditions related to aging, it is necessary to consider the different types of loupes that will adequately assist with enhancing visual performance and well-being for career longevity. More studies are needed to increase the level of evidence and acceptance of loupes as a necessary tool for the clinician.


References

  1. Ludwig EA, McCombs GB, Tolle SL, Russell DM. The effect of magnification loupes on dental hygienists’ posture while exploring. J Dent Hyg. 2017;91:46-52.
  2. Aldosari MA. Dental magnification loupes: an update of the evidence. J Contemp Dent Pract. 2021;22:310-315.
  3. Wajngarten D, Garcia PPNS. Effect of magnification devices on dental students’ visual acuity. PLoS One. 2019;14:e0212793.
  4. Perrin P, Eichenberger M, Neuhaus KW, Lussi A. Visual acuity and magnification devices in dentistry. Swiss Dent J. 2016;126:222-235.
  5. American Optometric Association. Visual Acuity. Available at: aoa.org/healthy-eyes/vision-and-vision-correction/visual-acuity?sso=y. Accessed February 26, 2024.
  6. Marsden J, Stevens S, Ebri A. How to measure distance visual acuity. Community Eye Health. 2019;32(107):46.
  7. Low JF, Dom TNM, Baharin SA. Magnification in endodontics: a review of its application and acceptance among dental practitioners. Eur J Dent. 2018;12:610-616.
  8. Pazos JM, Regalo SCH, de Vasconcelos P, Campos JADB, Garcia PPNS. Effect of magnification factor by Galilean loupes on working posture of dental students in simulated clinical procedures: associations between direct and observational measurements. PeerJ. 2022;10:e13021.
  9. Zebardast N, Friedman DS, Vitale S. The prevalence and demographic associations of presenting near-vision impairment among adults living in the United States. Am J Ophthalmol. 2017;174:134-144.
  10. Lintag-Nguyen K, Dahm TS. Ensure career longevity with eye health. Dimensions of Dental Hygiene. 2021;19(10):14–18.
  11. Eichenberger M, Perrin P, Neuhaus KW, Bringolf U, Lussi A. Influence of loupes and age on the near visual acuity of practicing dentists [published correction appears in J Biomed Opt. 2011 Jun;16(6):069802]. J Biomed Opt. 2011;16:035003.
  12. 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.
  13. Jacquier-Bret J, Gorce P. Prevalence of body area work-related musculoskeletal disorders among healthcare professionals: a systematic review. Int J Environ Res Public Health. 2023;20:841.
  14. Aboalshamat K, Daoud O, Mahmoud LA, et al. Practices and attitudes of dental loupes and their relationship to musculoskeletal disorders among dental practitioners. Int J Dent. 2020;2020:8828709.
  15. Ludwig EA, Tolle SL, Jenkins E, Russell D. Magnification loupes influence on neck and trunk flexion of dental hygienists while scaling-a pilot study. Int J Dent Hyg. 2021;19:106-113.
  16. 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.

From Dimensions of Dental Hygiene. March 2024; 22(2):24-26

Leave A Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More

Privacy & Cookies Policy