Maximize Your Visual Acuity

Increased magnification—from loupes to dental microscopes–can boost treatment outcomes, improve diagnostic ability, and mitigate musculoskeletal health risks.

By Jean C. Wu, DDS and Arvie Malik, RDH, BS On Jul 16, 2004 0

Figure 1. Example of an optimal balanced position using the dental microscope, with ideal back and arm support provided by an ergonomic chair.

Dental technology is progressing at a rapid rate. With the availability of magnification through spectacle mounted telescopes/loupes, the clinical microscope, and the endoscope, dental hygienists are better able to visualize the treatment area. Such improved visual acuity can provide clinicians with increased treatment options to enhance periodontal therapies.

These exciting developments can initially be challenging to incorporate into clinical practice due to the necessary learning curve. Once these initial obstacles are overcome, increased magnification can assist diagnostic capabilities and may improve treatment outcomes.

Magnification not only assists with greater visibility, but also—when properly implemented—can facilitate idealized postural positioning for musculoskeletal health (Figure 1).

Figure 2. Example of optimal working posture using spectacle mounted telescope/loupes.

WHY MAGNIFY?

Eyesight usually diminishes between the ages of 30 and 50.¹ With reduced visual acuity, enhancing or magnifying the treatment site as well as increased illumination can greatly enhance visualization of the working field. Improved visibility allows the hygienist to better asses problems and remove deposits, thus improving the efficacy of the treatment.²

Currently, there are three magnifying systems available: spectacle mounted telescopes/loupes, the dental microscope, and the dental endoscope. Studies have demonstrated the physical health benefits of magnification.^3,4 When properly fitted and used, reduced incidences of neck, back, and shoulder problems, decreased eye fatigue, and enhanced vision have been reported (Figure 2).^3,4

SPECTACLE MOUNTED TELESCOPES/LOUPES

The use of spectacle mounted telescopes/loupes during patient care can magnify the clinical site 2 to 6 times. Improved visibility through magnification allows an idealized working distance and proper head and neck posture. The focal length of the loupes should be tailored to the operator’s preferred working distance. The specific declination angle should be adjusted to maintain a comfortable tilt of the head. Correct adjustment of the interpupillary distance is critical to obtain binocular optics and avoid eyestrain.

Figure 3. Example of compromised musculoskeletal positioning using a spectacle mounted telescope/loupes.

Eye fatigue may still occur with prolonged use because of converging vision. When properly fitted and used, reduced incidences of neck, back, and shoulder problems, decreased eye fatigue, and enhanced vision have been reported.^3,4 Visualization of the operating field can be assisted with supplemental illumination but this can increase the weight and can affect the comfort of the system.

The advantages of spectacle mounted telescopes/loupes are the relatively short learning curve, portability, and moderate cost. However, dental hygienists must remain vigilant about maintaining good posture while wearing loupes because when visibility is challenged, the tendency is to resort to compromised musculoskeletal positioning (Figure 3).

Figure 4. Premolar magnified approximately 2.5x through the dental microscope. The image is similar to that seen through spectacle mounted telescope/loupes.

Figure 5. Premolar magnified approximately 6x through the dental microscope.

DENTAL MICROSCOPES

The dental microscope not only provides the clinician more profound magnification but also illuminates the treatment area to allow viewing of fine details.⁵ The dental microscope can enhance the treatment site from approximately 2.5 to 21 times magnification (Figures 4-6). The ergonomic advantage of microscopes is that they allow the clinician to maintain a neutral seated position during treatment. The clinician’s head is kept straight and the eyes look directly ahead through the microscope to visualize the treatment site. The microscope lens is placed directly over the treatment site and the patient is adjusted to focus the site.

The microscope is best used with ergonomic dental chairs, which are readily available and assist the clinician in maintaining a comfortable, balanced, and supported seated position. This way, the dental hygienist can sit with the thighs parallel to the floor and the back and forearms supported by the chair while viewing the working field through the microscope (Figure 1).

Figure 6. Premolar magnified approximately 14x through the dental microscope.

DENTAL ENDOSCOPE

Another option for magnification is the dental endoscope (Figure 7). Magnification with spectacle mounted telescopes/loupes or the microscope predominately allow supragingival visualization. The dental endoscope facilitates subgingival visual examination without relying on tactile sense and without surgical flap access. The clinician views a video monitor that displays the magnified image (24x to 48x) transmitted by a 0.99 mm fiber optic bundle attached to a subgingival probe. The fiber optic bundle transmits light and video images as well as subgingival irrigation. Various hand instruments are available for use with the endoscope that adapt to different locations in the mouth. There are modified curets and ultrasonic tips to facilitate subgingival treatment. A sterile disposable sheath protects the endoscope against contamination and also allows irrigation of the viewing field.

With the endoscope, the clinician has the option to perform single-handed endoscopy treatment where the clinical area is first examined and then the problem site is reaccessed for treatment. Treatment can also be provided with a two-handed technique, where a subgingival probe with an attached fiber optic bundle is held with the nondominant hand and periodontal instrumentation is done with the dominant hand. A neutral body position can be maintained while viewing the magnified treatment site on the video monitor throughout treatment.

CONCLUSION

With the new magnification technologies available, the dental hygienist is empowered with technology to improve vision during patient care. The traditional approach to patient therapy with limited vision and compromised musculoskeletal positioning can result in work-related injuries. Magnification can greatly enhance visibility, which can assist in accurate analysis and treatment while maintaining an ergonomically healthy working environment.

REFERENCES

Gordon S. The Aging Eye: A HarvardMedicalSchoolBook. 1st ed. New York: Fireside/Simon and Schuster; 2001:17-129.
Osuna T. Magnification use in dental hygiene. Access. 2003;17(suppl):1-8.
Sunell S, Rucker LM. Ergonomic risk factors associated with clinical dental hygiene practice. Probe. 2003;37(4):159-166.
Sunell S, Maschak L. Positioning for clinical dental hygiene care: preventing back, neck and shoulder pain. Probe. 1996;30(6):216-219.
Sheets CG, Paquette JM, Hatate K. The clinical microscope in an aesthetic restorative practice. J Esthet Restor Dent. 2001;13:187-200.

From Dimensions of Dental Hygiene. July 2004;2(7):30, 32-35.