A sustainable plan for your body: Ergonomic decisions can determine the length of dental career

The ergonomic decisions you make can determine the length of your career

By Anne Nugent Guignon, RDH, MPH, CSP

Creating a healthy, stable career is on the minds of many. Just like any job, there are inherent physical risks to dental hygiene practice. Years ago, little attention was given to our long-term health and the physical impact of clinical practice on our bodies. Today, our ongoing aches and pains are regular topics among dental hygienists all over the world. Numerous studies indicate that dental health-care workers develop workplace-related musculoskeletal disorders (MSDs) at rates much higher than the general population.

Most hygienists love working with patients, but dental hygiene practice is full of activities that create physical and mental stressors that affect us long after our clinical day ends. Clinicians with aching necks, sore hands, or stiff shoulders can't deliver quality health-care services.

New graduates, prompted by getting off the ground financially, can be sidelined by a workplace-related MSD or an injury just as easily as a seasoned veteran, who is trying to prepare for retirement.

What we're up against

Many factors play into improving career longevity. Hygienists who work hour after hour, day after day, on very tight schedules without any breaks, in high-stress practices are going to wear out quickly. Clinicians who take time to stretch, eat regular meals, stay hydrated, get sufficient rest, exercise regularly, and who aren't burdened with tremendous debt are typically happier with their professional choices. While the lure of financial gain may be great, the human body is not built to work like a nonstop machine. Losing time from work or even having to end your clinical career will quickly eat through the most robust savings account.

Speaking of savings, there are many ways that dental hygienists can make smart financial decisions. It is physically and mentally fatiguing to live paycheck-to-paycheck. Regardless of where you are in your career, it is never too late to create a realistic budget that includes regular contributions to a savings plan. Have a retirement strategy that includes more than funding an annual IRA plan or social security. Credit cards are easy to use, but interest fees are dangerous. Figure out a way to pay the balance in full every month. While it may seem old-fashioned, put potential purchases to the "can I live without it?" test. This strategy slows down impulse buying, puts you in control of your money, and will lessen the temptation to work too many hours to pay off debt.

Today, many hygienists work at a very fast pace with schedules that often extend way past an eight-hour day. Some work more than four days a week. From a physical standpoint, dental hygiene is a very demanding job. As muscle fatigue sets in, the body starts breaking down on a cellular level. And at some point, there will not be any treatment or surgery that can fix the injuries. More hygienists than ever now use yoga, Pilates, meditation, therapeutic massage, acupuncture, and chiropractic treatment with great success. These strategies are not miracle fixes and should be employed on a regular basis to offset musculoskeletal stresses.

Investing in your future

Another way to have a longer and healthier career is to invest in your own equipment. This kind of thinking is very foreign to those who entered dental hygiene more than 15 to 20 years ago. We began our careers thinking that we would show up at work and the dentist would supply everything. Just like employees at any other business, we expected a safe working environment. Several decades ago, dentistry's business model started changing with an increased emphasis on raising production and reducing costs. Regardless of the physical impact, spending money to create a safe dental hygiene workspace is often still not a top priority for a number of employers.

A growing number of hygienists are no longer content to work with equipment that creates physical strain. Rather than play victim, they are taking control of their futures and purchasing their own equipment. This trend is bound to become even more mainstream as more hygienists qualify to deliver care outside of a traditional dental office. A well-thought-out equipment purchase is often tax-deductible. Owning your own equipment can simplify the adjustment phase if one relocates to another practice.

Hygienists who graduated decades ago may find it hard to justify purchasing their own equipment, but once they experience working more comfortably, it becomes less difficult to consider making a purchase. Newer graduates often have an easier time accepting equipment ownership. Well over 50% of today's graduates purchase magnification loupes and headlights while in school and a growing number of schools now require students to purchase their own gloves, masks, and gowns; some even purchase their own ultrasonic dental scalers.

The role of ergonomics

When ergonomists study workplaces, they look for ways to reduce or eliminate awkward positioning, static postures, force, repetition, and vibration. Those who study workplace safety agree dental hygiene practice presents some of the greatest ergonomic challenges in the modern day workforce. There are many ways we can reduce, or even in some cases eliminate, these risk factors.

Sorting through the options to create a safer work environment can feel overwhelming. But it is simply a matter of finding and employing strategies and equipment that support neutral, healthy body postures while keeping our bodies actively moving.

We're all different

The first, and most important, concept to keep in mind is the fact that we are all different. A product that works well for your best friend may be a disastrous choice for you, or it could be the other way around-the perfect solution to your particular situation. It is unrealistic for you, or your employer, to assume that there is one universal set of dental hygiene tools. It's all about Goldilocks, finding the most perfect solution for your body.

Many offices expect every clinician to use the same exact equipment, regardless of our size or shape. And on top of that, we are the queens and kings of leftovers. Too many either hate confrontation or are scared to bring up a much-needed conversation, but in the end our bodies take a beating if we continue to use equipment or work in a space that creates undue physical stress.

Asking questions in the right places

Before settling on the next shiny object to buy, start asking questions. Study ads, read magazine articles, and scour the internet. Find a CE course or webinar that has information about the product or technology. See if there is any research to support a manufacturer's claims. Testimonials can soothe prespending jitters, but are they really credible? It's not a bad idea to ask other hygienists about strategies or products. But without firsthand experience, sprinkle the advice with a big grain of salt. It is human nature to think that what works well for one will be the perfect solution for everyone.

Asking a representative from a large dental supply company to drop off a product may seem like an easy solution to your ergonomic woes. Keep in mind their main job is to provide information about products to the primary purchaser, the dentist. Typically, companies that focus on dental hygiene products or who sell directly to dental hygienists are willing and interested in educating us on the ergonomic benefits of their products. If you want a representative's support, set aside the time during your day to chat with them about new products or to receive training on how to use a device.

Since there are so many choices, why not consider attending a large dental or dental hygiene meeting? Carve out some serious time to meet with exhibitors. Learn what companies have to offer and how their products can help you achieve health. Spending time finding the perfect saddle stool that eliminates shoulder and back pain, or a glove that does not torque your thumb into a painful position, may save your career and improve the quality of life outside of the office. In the end, we all need to be well-educated consumers.

Considering Ergonomic Products

Here are some tips for selecting the right products for clinical use. The questions vary for every product category or piece of equipment. What is important to know about a pair of loupes is entirely different than what should be considered when selecting hand instruments or a polishing handpiece.

Magnification loupes should be custom fitted to the user's facial geometry. There are three different styles of loupes: through the lens (TTL), front lens mounted flip up (FU), and through the flip (TTF). Look for a lightweight frame with adjustable nose pads and temple arms. Selecting a frame with a large carrier lens makes it easier to achieve an appropriate declination angle for loupes mounted directly into the lens. Oculars should be lightweight and have a high-resolution image that is clear and crisp from edge to edge.

Many clinicians choose to get measurements taken in their treatment room, but it is also possible to be properly fitted in an exhibit hall. Strive to use a neutral body posture that accurately reflects your working situation. Regardless of the setting, remember to sit up straight, with your head erect, shoulders relaxed, arms to your side, forearms parallel to the floor, and the patient's mouth positioned at waist level.

Auxiliary headlights improve visual acuity and reduce eyestrain. Headlights also eliminate the need to constantly readjust the overhead light, reducing stress on the shoulders, neck, and forearm. Auxiliary lights can attach to the front of a loupes frame or other protective eyewear.

Look for headlights that have an even beam of light across the spot, a realistic battery runtime, and use a safe white-light range. Overall weight is important. Cordless headlights have built-in battery sources, while other models have a small cord that runs to an external battery pack that typically clips onto the waistband or is stored in a pocket.

Saddle stools allow clinicians to sit up higher and closer to the patient using sit/stand positioning. This keeps the pelvis in a neutral position and allows the spine to support and maintain healthy core musculature. Properly fitted, a saddle stool keeps the shoulders neutral and allows the arms to remain close to the side. This posture also reduces or eliminates dangerous reaches.

Seat pan designs vary in both size and shape. It is important to select a design that fits your pelvic width, provides adequate support to the buttocks and thighs, and does not impinge on the tailbone. The modified English saddle is the most popular design and fits many body types well. Western saddles work for those with a narrow pelvis or tight hip flexor muscles. Some clinicians prefer unique hybrid saddle designs.

To customize your seating, select a saddle with an adjustable cylinder height and seat pan tilt lever. Padding options vary. Many like the support memory foam provides, but some clinicians prefer a seat pan with less padding. Medical grade vinyl fabrics with subtle, textured surfaces are optimal, providing just enough traction to prevent sliding forward. It is hard to maintain a relaxed posture if the upholstery is too soft or very slick.

Gloves that fit properly reduce hand strain. Since there is no standardization in glove sizing, it is critical to test various brands to find the correct fit. Ambidextrous latex gloves pull the thumb out of a neutral position, creating excessive strain on the joint. There are newer, thinner nitrile gloves that eliminate the need for hand-specific gloves. Select gloves that have adequate finger length, and fit both the size and width of your palm. Textured gloves help reduce pinch/grip and improve tactile sensitivity. There are now chloroprene gloves specifically formulated to improve grasp during long, wet procedures.

Instruments vary dramatically. Consider larger-handled instruments that are balanced, lightweight, and have textured handles. Some handles are specifically designed with fingertip rests that stabilize the grasp without increasing pinch/grip. Sharp instruments require less force. Some companies offer instruments that do not require sharpening, maintaining a sharp edge throughout the life of the instrument.

High-definition mirrors, made from multiple layers of metal oxide, are very bright and reflect light well. The reflected image is more color-true than standard rhodium mirrors. To minimize surface scratches, use special mirror covers or cassettes that have slots for individual instruments.

Computer-controlled anesthesia delivery devices are much kinder to the hand. Standard syringes are significantly heavier than wand-type devices. Syringe-based anesthesia delivery requires forceful thumb pressures and causes the thumb to extend and flex. Small hands are more at risk because the range of motion is even more exaggerated to accommodate the girth of the syringe. Computer-controlled devices utilize a microprocessor to control flow and aspiration. Anesthesia delivery is activated using a footswitch, which eliminates unnecessary stress and repletion to the hand. The wand-type system uses a light pen grasp to guide needle insertion.

Polishing handpieces should be selected on the basis of need. Handpieces powered by compressed air should swivel, fit comfortably in the hand, and be attached to a lightweight hose. There is now a polishing handpiece fashioned with a contra-angled hose-end connection. The angled connection redistributes the overall weight of the hose, allowing a more neutral hand position, just like contra-angled prophy angles.

Cordless polishers also have distinct advantages. Clinicians no longer have to support the weight of an air hose. On-off switches and speed controls are fingertip activated. Some clinicians prefer using a cordless handpiece with a foot-operated rheostat control. Cordless polishers are ideal in alternative settings such as a school or nursing home. Smaller profile, disposable prophy angles improve access to even the tightest areas. Soft, flexible cups work effectively with a light touch.

Power-driven scalers are rapidly becoming a standard of care, allowing more efficient and thorough biofilm disruption. Whether one is using a magnetostrictive or piezo electric unit, power scalers work best when we employ a light grasp. Large, robust tips produce more vibration and can reduce tactile sensitivity as compared to the new ultra-slim designs. Slim inserts should only be used in low settings, making ultrasonic scaling an appropriate instrumentation choice for even simple patients.

Consider the weight of the ultrasonic handpiece and the cord. Lightweight cords reduce torque. The generator in most piezo systems is housed in the handpiece, so magnetostrictive handpieces tend to be slimmer and feel lighter. Cordless foot controls or ones with a "cruise control" reduce foot and ankle stress.

Suction systems and mouth props can alleviate a lot of hand stress, especially if the devices are hands-free. Even a traditional saliva ejector can be configured so it does not slide around the mouth. Special spongy covers that cover the end of a saliva ejector improve stability. There are several combination mouth prop/saliva ejector devices fabricated to make moisture evacuation during power scaling or sealant application a breeze. There is also a patient-controlled suction device that doubles as a jaw support system.

Facemasks and uniforms are now made with breathable fabrics. Facemasks, designed to fit personal facial geometry, provide a better seal and reduce fogging. Uniforms made with temperature-regulating fabrics and stretchy materials that don't restrict movement keep clinicians comfortable.

Hearing protection is a new frontier for most dental professionals. Most have not considered how our ears can sustain permanent, irreversible damage from continuous exposure to loud noise in the dental office. Noise from high-speed and low-speed handpieces, ultrasonic dental scalers, suction systems, compressors, and model trimmers adds up.

Standard earplugs provide a physical barrier, but interfere with communication with patients. Sophisticated, "smart ear plugs" are now available. The smart ear plugs compress damaging noise at the high-end range without interfering with verbal communication between coworkers or patients.

Documentation does not have to be a time-consuming process. Current voice-activated or foot-operated systems are efficient and provide seamless integration with today's digital documentation software. The learning curves for today's systems are much simpler than earlier models.

Room configuration, portable and mobile equipment allow us to customize our space. Equipment that is frequently used needs to be easy to reach and in a place that minimizes unnecessary reaching, twisting, turning, or bending. Over-the-patient delivery systems are much safer for unassisted clinicians than rear delivery.

Mobile equipment, like a cart on wheels, is easy to reposition within a room. Portable equipment includes systems that are not only mobile, but also allow clinicians to deliver care in any setting and are housed in wheeled, suitcase-like units or as simple backpacks.

We need to earnestly employ multiple, concurrent strategies to obtain and sustain a positive career from an ergonomic standpoint. Obviously, the equipment we use and the layout of our treatment room plays a huge role in our physical well-being. But the office emotional temperament, our personal physical condition, and financial stress levels also impact our overall health index. Healthy careers are a result of the treatment room environment as well as how we live our lives on a day-by-day basis. Creating a long-term, sustainable career is a huge jigsaw puzzle that we put together one piece at a time. RDH

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A peek into Anne’s treatment room

Thirty years ago, the inevitable dental hygiene aches and pains started showing up. My dentist employer at the time was resistant to every plea for help, so I made a bold play. I started buying my own equipment and have never looked back. The decision to take charge of my body and career freed me to get what I wanted, and what worked well in my hands.

Through the years, I’ve used a lot of products. In many cases, I’m now using a third-, fourth-, or fifth-generation version of the original idea. While I’ve not tried every device on the planet, the merits of today’s products are stunning as compared to what was around in the early years. Kudos to the companies who have spent millions of dollars in R&D searching for ways to help us work with less stress!

Marketing people call me an early adopter, and true to form, I fell madly in love with manually tuned magnetostrictive ultrasonics, loupes, and headlights two decades ago. Those initial purchase decisions changed the way I practiced and literally saved my clinical career. The mere thought of not having exactly what I need for every patient drives me nuts, so I have more than one of the “essentials.” While this is my personal story, each of us is on our own journey. This is a list of the products and equipment that allow me to deliver the best care that I can with the least stress to my body:

Magnification and headlights

Orascoptic—EyeZoom loupes and HDL 3.0 loupes
Orascoptic—Spark Cordless and Endeavor 3-way light

Saddle stool

Crown Seating—QAC modified English design

Mirrors

Zirc—HD Crystal Mirror
Nordent—DuraLite handles
MirrorGear—mirror covers

Polishing handpieces/prophy angles

Young Dental—Young Contra Angle corded handpiece
Dental EZE—iStar Mobile cordless handpiece
Young Dental—Vera contra prophy angle

Power-driven instrumentation/inserts

USI—25 MPLC manually tuned magnetostrictive ultrasonic scaler
USI—E and E+ universal and R&L inserts
Hu-Friedy—XT insert
Dentsply—Thinsert, standard and mini Triple Bend

Gloves/masks/uniforms

Microflex UltraForm nitrile gloves
Crosstex—Ultra NoFog Secure Fit facemask
Uniforms—Twice as Nice

Suction systems/mouth props/organization

Blue Boa—Suction extension tubing
Otis Formaject—Pink tipped saliva ejectors
Zirc—Mr. Thirsty, saliva ejector tip sponges, MirrorMagic, EZ Tray shelf

My wish list

If I could give anesthesia in Texas, or provide clinical care in a more independent setting than the state allows, or my clinical days were not winding down, I’d be adding these items in a heartbeat.

Hearing protection

Dental innovations—DI-15 Ear Protection

Documentationdevices/advanced periodontal

Dental Rat—Foot-operated computer mouse device
Florida Probe—Voice Works voice-activated charting system
Danville—PerioScope Dental Endoscope
Hu-Friedy EMS—AirFlow Subgingival Air Polishing device

Anesthesia/portable equipment

Milestone Scientific—The Wand STA All Injection System
DNTLworks—Portable equipment package

ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].