Digging past positioning: Hydration, sleep, and sharp instruments influence ergonomic health too

By Nicole Giesey, RDH, MSPTE

Good ergonomics has been a hot topic for all of us since the day we started dental hygiene school. Practicing good ergonomics daily will not only create a safe environment for you to work but will also keep you healthy in your everyday life. Excellent ergonomics is about more than positioning. It is a science that includes not only the hygienist but also the physical things that surround him or her. There are so many factors that contribute to excellent ergonomics. We will discuss three contributing factors that may not be considered in the typical daily practice of ergonomics.

First, let’s define exactly what the term means. Webster defines ergonomics as an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.¹ Besides positioning and posture, how can we reassess the fundamentals to ensure our bodies and our most valued instruments are ready for the tasks at hand? Here are a few important but undervalued things that might slip under the radar:

• Proper hydration
• Healthy sleep
• Instrument sharpness

Yes, the scope of these three fundamentals is broad, but they can be easily and quickly manipulated to boost your ergonomics.

Ergonomics can be broken into two parts. The two main ingredients are the person and the things he or she uses. Now that it is broken into two, let’s relate the science of ergonomics to our practice of dental hygiene. Dental hygienists are so unique. We are the most amazing multitaskers: we make schedules, please people, scale, polish, practice infection control, take medical histories, assess patients, produce - it is no wonder while wearing all of these hats we forget about the most important person in the equation: ourselves. One easy task we can start is to be sure we stay properly hydrated. How does this relate to ergonomics? Dehydration, which is so easy to achieve throughout our busy days, hugely affects ergonomics.

Chronic dehydration

Dehydration can lead to bad moods, low energy, bad breath, headaches, dry skin, dark urine, sugar cravings, and muscle cramping, according to the Mayo Clinic.² In order to stay hydrated, the Mayo Clinic recommends nine cups of fluid a day for women and 13 cups of fluid a day for men.²

So, how does this play a role in ergonomics? Proper hydration will ensure you are energized, alert, and not distracted by headaches and muscle aches. Our job is so physical. Having muscle aches while maintaining proper posture makes it all the more difficult. Not being able to focus properly can put you and your patient at risk during scaling and medical history review. Low energy can lead to slumped positioning, which in turn will contribute to muscle aches and back aches. If this is a chronic habit, it may cut your practicing days down over time. Some problems, like this one, can be easily fixed.

Of course this is not the case for everything, but if you are chronically dehydrated, imagine how your life can change simply by drinking more.

How often are we so in the groove of our daily schedule that after three or four patients we have not gone to the bathroom or even taken a second to drink a cup or two of water? This is where we must make the effort and put ourselves first. A somewhat alarming result of dehydration is an increased risk of developing kidney stones due to decreased urination.³ Not only will dehydration limit your mood and alertness, but it might also put you at risk for other health concerns that could knock you out of the office for days, like a kidney stone.

Healthy sleep habits

Proper sleep schedules and getting enough sleep will directly affect your ergonomics. We all love our hobbies that keep us up at night, but you cannot let them disrupt your sleep. Or maybe you tended to a sick child all night and now have to soldier on through an entire day. The lack of sleep can directly affect you and your ergonomic efforts. We are only human. Even though our minds want to do more, our bodies rely on these important sleep hours to recharge.

Studies from Harvard University have found that short-term lack of sleep can affect judgment, mood, memory, and retention of information. It was also found that it can reduce production and cause accidents in the workplace.⁴

The age-old remedy of warm milk or a cup of hot tea might do the trick, but if you are not sleeping, your body and mind may need to wind down before you try to sleep. Try not to stimulate your mind with electronics such as TV, smartphones, or other devices. Yoga and meditation practice will help improve sleeping patterns.⁵

Yoga is for all ages and levels of ability. The breathing techniques in yoga are so relaxing that the typical triggers of stress that keep you up at night are softened after yoga. This is why yoga needs to be part of a continual routine. Not only will yoga help with improving sleep, but it will also help with posture, muscle tone, and mood elevation. These key points are vital in achieving proper ergonomics.

Instruments

Now that we’ve discussed the importance of keeping the body hydrated and rested, the other half of the science focuses on the things that we use and how we interact with them. So much of what we use in our daily routines can cause improper ergonomics, especially instruments. Having sharp instruments is vital to not only patient care but to your health and ergonomics. Remember that ergonomics is a science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely. “Efficiently” and “safely” are the key words as they relate to instrumentation, and we must have sharp instruments.

The market for instruments is so large right now that the hygienist can cherry-pick what he or she needs and at what price. There are many smaller instrument companies that have the same quality as the big names for a lower price. Trying out instruments before buying is an option for most companies. Also, make sure you find out where they are made. Steel quality can vary widely among manufacturers.

The main barrier to having sharp instruments is working for an employer that does not value sharp instruments and expects you to use the ones they used in dental school with the 1/4th handle. Instruments are an investment in the security of your time and production, and their cost is small when you look at the bigger picture. If you do not use sharp instruments, you will have to perform many more strokes, extend patient chair time, possibly agitate the patient due to longer scaling, indirectly burnish calculus, frustrate yourself, experience hand fatigue, and more. Overall stress on both the patient and hygienist increases.

If you are practicing in a frugal office and the doctor refuses or is hard-pressed to buy you instruments or pay for resharpening, you must emphasize the financial benefits. The famous adage “time is money” applies here. If it is taking twice as long to scale due to dull or broken scalers, the emphasis on production is key.

Sharp instruments not only will cut down hand fatigue and stress to the patient and yourself, but will also cut down chair time. If you save 10 minutes per patient, by the end of the day you could possibly have enough extra time to treat another patient. This agreement to use that time efficiently will have to be that you always have new or resharpened instruments! Evaluation of your instruments must be continual so that you know when they are starting to become dull.

The patient’s point of view is also important here. Remember that word of mouth is so important in marketing. If patients do not feel that you are effectively cleaning their teeth because you keep “digging and digging,” they will talk about that to their friends and family. The patient may not completely know the effect of sharp instruments, but they can feel your frustration and know if you are struggling with scaling.

Of course, this struggle is not indicative of your skill set; rather, it is a byproduct of your environment. No matter what the reason, the patients can sense it. Not having sharp instruments will cause way more harm beyond the scope of ergonomics. It will trickle into the business’s bottom line through patient satisfaction, even possibly harm the patient through the fatigue of longer appointments and burnished calculus from improper and unintentional smoothing of deposits.

The way to achieve and maintain proper ergonomics in relation to the things that surround you is to constantly evaluate and use the best version of your tools. Out of the many things you use that impact your ergonomics, instruments are at the top of the list. Having sharp instruments is critical in achieving proper ergonomics.

When you think of the word “ergonomics” as a hygienist, you often think of how you hold an instrument or your posture. There is a science behind ergonomics and when you really examine its key components, you will see that little things that you can easily fix will provide you with a large reward physically and financially. Without achieving and maintaining proper ergonomics, the two main concerns of the science, our efficiency and safety, are at risk.

Author’s note: This article is dedicated to all of the educators instilling the science of proper ergonomics into hygienists from day one of dental hygiene school. A special thank you goes to Maureen Vendemia for her passion and continual leadership in dental hygiene education. The path to success is paved by those that taught us our first step. RDH

Nicole Giesey, RDH, MSPTE, enjoys researching, writing, and educating on topics related to dental hygiene. She is the dental hygiene product specialist for Maxill. She can be contacted at [email protected].

References

1. Ergonomics. Merriam-Webster website. www.merriam-webster.com/dictionary/ergonomics. Accessed November 25, 2016.
2. Dehydration. Mayo Clinic website. www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/dxc-20261072. Accessed November 25, 2016.
3. What Causes Kidney Stones? Urology Care Foundation website. http://www.urologyhealth.org/urologic-conditions/kidney-stones/causes. Accessed November 29, 2016.
4. Healthy Sleep. Division of Sleep Medicine at Harvard Medical School website. http://healthysleep.med.harvard.edu. Accessed November 27, 2016.
5. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009;15(5):593-600.