This course was published in April 2019 and expires April 30, 2022. The author has no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.
After reading this course, the participant should be able to:
- Identify the prevalence of musculoskeletal disorders (MSDs) in dental hygienists.
- Discuss the etiology of work-related injuries among oral health professionals.
- List the ergonomic interventions that can help oral health professionals protect themselves from MSDs.
Musculoskeletal injuries are an occupational hazard in the dental hygiene profession. The prevalence of work-related injuries is exceedingly high, with approximately 96% of dental hygienists reporting pain caused by clinical work behaviors.1 Musculoskeletal injuries are often caused by poor posture, repetitive movement, and the static positions required during the provision of dental hygiene care. Static awkward posture, particularly those with isometric contractions of the trapezius, has been identified as a risk factor particular to these occupations.2 Ergonomic interventions, however, may help reduce the risk of musculoskeletal injuries. Today, there are myriad products designed to improve the ergonomics of dental hygiene practice.2
The use of magnification has great potential to increase the quality of dental hygiene clinical care and to support the musculoskeletal health of dental hygienists.3 Evidence shows that the use of loupes while treating patients improves clinician posture.3,4 Loupes also support dental hygienists’ preferred angle of vision, while maintaining optimal operating posture.3 Branson et al4 found that the use of loupes positively impacted the neck and low back posture of a dental hygienist in a case study. Maillet et al5 demonstrated that dental hygiene students who became comfortable using loupes early in their education experienced significant postural benefits. Before purchasing loupes, dental hygienists need to research this modality, as using improperly selected or adjusted loupes can negatively impact musculoskeletal health and contribute to eye strain.6
Operator chair features and proper seating position are crucial to proper ergonomics. Circulation in the legs, thighs, and feet is maintained by adjusting the operator chair to a proper height. Minimizing stress on the spine by moving the back of the chair closer to or farther away from the seat so that the upper arms and torso are aligned with the long axis of the body is important to maintaining ergonomic health.7 When choosing an operator seat, the following design characteristics are important to consider to support musculoskeletal health:8
Legs. The operator chair should include five legs with casters for stability and easy movement around the operatory.8
Height. The chair height should permit the operator to sit with the thighs parallel or slightly elevated with the knees slightly lower than the hips. It should be easy to adjust the chair from a seated position.8
Backrest. The backrest should be adjustable and positioned between 85° and 100° to touch the lumbar region of the back when comfortably seated.8
Seat. The front edge of the seat should have a rounded edge to prevent any pressure that may impinge nerve pathways and result in the legs “falling asleep.”8
Saddle Seat. A saddle style stool encourages a neutral pelvic position, which supports the spine and healthy posture in terms of ergonomics. Gouvêa et al9 assessed whether the saddle seat provides lower ergonomic risk than conventional seats in dentistry. Their findings provide moderate evidence that saddle seats delivered lower ergonomic risk than conventional seats in the examined population of dental students.9
The crosshatching or multidirectional strokes used during hand instrumentation are achieved by correct adaptation and lateral pressure of the instrument blade along the surface of the tooth. The successful treatment of the periodontally involved patient is dependent on the efficient use of multidirectional strokes, which often causes hand fatigue. Instrumentation affects a large portion of the modifiable musculoskeletal work-related injury risk factors. Problems associated with instrumentation include: forceful exertions, repetition, small diameter instrument handles, flexion and extension of wrists, pinch forces static loading of the fingers and hands, awkward hand postures, and other prehensile motions.10
Ergonomic adjustments have been made to dental hygiene instruments to reduce these issues, including increasing the handle diameter, reducing the weight and improving the balance of instruments, adding padding, adapting the shape and texture of the handle, and varying the handle diameters of the instruments used during dental hygiene procedures.9 Lightweight handles, larger diameter handles, and padding for instruments and mirrors help decrease muscle activity and the applied forces typically required in dental hygiene care.11 Gripping pads are an excellent option for modifying existing instruments. They enable dental hygienists to use a lighter grasp, which results in diminished hand fatigue. These gripping pads enlarge the handle diameter and decrease pressure on the muscles of the hand and thumb, resulting in greater tactile sensitivity and effortless rotation of the instrument.12
The use of intraoral cameras help to increase operator visibility, improving clinician ergonomics during patient education. Intraoral cameras are relatively easy to use and enable immediate viewing of images, while also providing additional light and magnification.13 The added magnification helps clinicians visualize pathology, open margins, fractures, and caries, while maintaining an ergonomically correct posture.13
As hand health is critical to career longevity, ensuring that gloves fit properly is of paramount importance. Properly fitted gloves may help reduce fatigue in the hands and wrists. Too-large gloves leave excess material at the fingertips, which may increase the risk of strain, while too-small gloves interfere with blood flow. The addition of textured fingertips may help improve grasp. Proper ergonomics is key to preventing musculoskeletal injuries, and the adoption of gloves designed specifically for the right and left hands may prevent hand fatigue and reduce the pain and impeded blood flow associated with donning ill-fitting gloves.14,15
Yoga is a method of physical exercises and therapy that originated in ancient India. It encompasses the physical, mental, and spiritual practices for benefit of body, mind, and spirit.16 Research has proven that dental professionals experience work-related musculoskeletal pain.16 Stretching throughout the workday and consistent practice of yoga may not only help to decrease stress and anxiety, but also improve the cognition and immunity of the body.
Another important factor is that yoga not only strengthens the musculoskeletal system but also decreases stress by releasing endorphins and other hormones, which is another contributing factor for perception of musculoskeletal discomfort. Physical exercise is an effective preventive intervention for back, neck, and shoulder pain. Exercise is especially beneficial for dental professionals in that it prevents and treats musculoskeletal disorders and stress, and decreases the existing musculoskeletal pain.17 Yoga is versatile, enjoyable, highly beneficial, and a great way for oral health professionals and their patients to battle stress and anxiety and to decrease work-related musculoskeletal pain.16
The prevention and management of musculoskeletal injuries among dental professionals is a considerable professional concern. Magnification, operator seating, ergonomic instruments, intraoral cameras, gloves, and yoga are just a few approaches that may help prevent musculoskeletal injuries. The current developments in creating ergonomically correct working environments for dental professionals are an encouraging step toward improving operator comfort while reducing musculoskeletal work-related injury.
- Hayes M, Smith D, Cockrell D. An international review of musculoskeletal disorders in the dental hygiene profession. Int Dent J. 2010;60:334–352.
- Morse T, Bruneau H, Dussetschleger J. Musculoskeletal disorders of the neck and shoulder in the dental professions. Work. 2009;35:319–429.
- Sunell S, Rucker L. Surgical magnification in dental hygiene practice. Int J Dent Hyg. 2004;2;26–35.
- Branson B, Black M, Simmer-Beck M. Changes in posture: a case study of a dental hygienist’s use of magnification loupes. Work. 2010;35:467–476.
- Maillet JP, Millar AM, Burke JM, Maillet MA, Maillet WA, Neish NR. Effect of magnification loupes on dental hygiene student posture.J Dent Educ.2008;72:33–44.
- Chang BJ. Ergonomic benefits of surgical telescope systems: selection guidelines. J Calif Dent Assoc. 2002;30:161–169.
- Jacobsen N, Hensten-Pettersen A. Occupational health problems among dental hygienists. Community Dent Oral Epidemiol.1995;23:177–181.
- Occhipinti E, Colombini D. Molteni G, Greico A. Criteria for the ergonomic evaluation of work chairs. Med Lav. 1993;84:274–285.
- Gouvêa GR, Vieira WA, Paranhos LR, Bernardino ÍM, Bulgareli JV, Pereira AC. Assessment of the ergonomic risk from saddle and conventional seats in dentistry: A systematic review and meta-analysis. PLoS One. 2018;13:e0208900.
- Simmer-Beck M, Bray K, Branson B, Glaros A, Weeks J. Comparison of muscle activity associated with structural differences in dental hygiene mirrors. J Dent Hyg. 2006;80:1–17.
- Simmer-Beck M, Branson BG. An evidence-based review of ergonomic features of dental hygiene instruments. Work. 2010;35:477–485.
- Marsh L. Practicing ergonomically correct dental hygiene. Dimensions of Dental Hygiene. 2009;7(1):22–23.
- Marsh L. Picture perfect: How intraoral cameras can improve your practice and case acceptance. Dimensions of Dental Hygiene. 2011;9(6):62–64.
- Kreismann J. The struggle for musculoskeletal health. Dimensions of Dental Hygiene. 2007;5(9):24–25.
- Stone R. The winning hand. Mentor. 2012;3(9):28–31.
- Khokhar Vijender K, Saurabh B, Sharma Raju S. Yoga in dental practice; a new perspective. International Journal of Current Advanced Research. 2016;5(4):734–735.
- Koneru S, Tanikonda R. Role of yoga and physical activity in work-related musculoskeletal disorders among dentists. J Int Soc Prev Community Dent. 2015;5:199–204.