Contributing authors:
Christina Calleros, MS, RDH
Justine Ponce, MS, RDH
We all know colleagues who have struggled with neck or back pain, or who have had surgery for conditions such as carpal tunnel syndrome. Dental hygienists have been subject to work-related injuries like musculoskeletal disorders (MSDs) since the profession began, and this is due to operator position.
This two-part article will delve into the research on selecting ergonomic tools and equipment. This first article discusses ways to decrease ergonomic risk for MSDs related to back and neck pain, and part two will examine ways to prevent carpel tunnel syndrome.
MSDs defined
MSDs affect the bones, joints, muscles, and connective tissues, resulting in pain and/or loss of function.1 Common MSDs in dental hygiene include carpal tunnel syndrome, chronic neck pain, and lower back pain. These injuries are linked to occupations with repetitive motions, long durations of awkward postures, and stress.2
Dental hygienists encounter all these things daily. A 2022 study revealed that 91% of the dental hygienists surveyed were suffering or had suffered from a work-related MSD.3 Considering the staggering prevalence of MSDs, something must be done to reduce the risk. A stronger focus on ergonomics may be the key to addressing this significant issue.
Back and neck pain are among the top-reported MSDs for dental hygienists.4 A 2019 study examined MSD pain among 87 dental workers in Slovenia and found that the most frequent areas of recurring pain were the neck (60.7%), upper back (52.4%), and lower back (41.7%).4 Excess leaning, twisting, and bending puts the body in unnatural positions, placing more pressure and stress on the back and neck. A neutral posture is ideal for minimizing ergonomic risk and preventing MSDs. There are three key areas where dental hygienists can make ergonomic improvements: chair design, loupes, and operatory layout.
Saddle vs. traditional stool
Dental hygienists sit for prolonged periods of time. Therefore, it’s crucial to ensure their seated position is aligned with ergonomic principles. Based on ergonomic recommendations, radiographic studies, and research from physical therapists, it’s been demonstrated that an ergonomic sitting posture means sitting with a slight anterior tilt of the lower back and pelvis, as well as a slight lower back lordosis.5
The traditional dental stools used in most practices place the dental provider in a 90-degree sitting position, which causes a posterior pelvic tilt that is contrary to the recommended position.5 Saddle stools, on the other hand, have been shown to cause a more anterior tilt than traditional dental stools, placing the body in a more ergonomic posture.5,6
Magnifying loupes
Dental hygiene is a visually demanding profession, so a decrease in visual acuity can be harmful to posture and eye health. When dental hygienists cannot see well, they strain their eyes and/or bring their heads closer to the patient's mouth, resulting in awkward and prolonged body positioning of the head and neck.
Magnifying loupes can promote better working postures and avoid this excess strain. A 2008 study examined the impact of magnifying loupes on ideal posture in dental hygiene students by comparing those who used loupes with those who did not. The results showed that those who wore the loupes had a mean score of 5.69 points away from ideal posture, whereas those who didn’t wear loupes had a mean score of 10.76.7 This study alone provides strong evidence that magnifying loupes help to lower the ergonomic risk for dental hygienists.
There are newer loupes on the market called ergonomic loupes that allow hygienists to look forward through prisms, but see the patient's mouth below, which leads to a decrease in neck flexion. Unfortunately, since these loupes are relatively new to the market, no long-term studies have been conducted on the ergonomic risks and prevalence of MSDs associated with their use. For short-term studies, a 2023 study demonstrated that these loupes reduced head inclination and neck muscle activity, thereby decreasing the overall ergonomic risk.8
Operatory layout
Operatory layout is a significant factor in ergonomic risk for MSDs. It’s ideal to arrange the operatory in a way that allows the provider to maintain a neutral posture as much as possible. A neutral posture means avoiding excess twisting, leaning, and bending.9 Placing frequently used instruments in accessible locations in sequential order, typically within 18-20 inches of the provider to avoid overreaching, can help keep the provider in a neutral posture.
Another way to create a more ergonomic operatory is to invest in patient chairs or delivery systems that allow the instrument tray and suction to be moved where the provider is based on the clock position they are in. This allows for less leaning, bending, and twisting when switching instruments during the patient appointment.10
Based on the research provided, saddle stools, magnifying loupes, and movable delivery systems could all decrease dental hygienists’ ergonomic risks in the operatory. It’s important that all dental hygienists explore the impact that equipment or operatory design can have on their work environment before they purchase to ensure they choose the best ergonomic option. What might work for one may not work for all. Every dental hygienist should be aware of and prioritize ergonomics in the dental operatory to help ensure a long and successful career.
Sarah completed this article as a partial fulfillment for the Master of Science in Dental Hygiene from the University of New Mexico, Division of Dental Hygiene. Christina Calleros, MS, RDH, and Justine Ponce, MS, RDH, are faculty members with the University of New Mexico, Division of Dental Hygiene.
References
- Selected health conditions and likelihood of improvement with treatment. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK559512/
- Ng A, Hayes MJ, Polster A. Musculoskeletal disorders and working posture among dental and oral health students. Healthcare (Basel). 2016;4(1):13. doi:10.3390/healthcare4010013
- Saccucci M, Zumbo G, Mercuri P, Pranno N, Sotero S, Zara F, Vozza I. Musculoskeletal disorders related to dental hygienist profession. Int J Dent Hyg. 2022;20(3),571-579. doi:10.1111/idh.12596
- Šćepanović D, Klavs T, Verdenik I, Oblak Č. The prevalence of musculoskeletal pain of dental workers employed in Slovenia. Workplace Health Safety. 2019;67(9):461-469. doi:10.1177/2165079919848137
- 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(12):17. doi:10.1371/journal.pone.0208900
- Annetts S, Coales P, Colville R, Mistry D, Moles K, Thomas B, van Deursen R. A pilot investigation into the effects of different office chairs on spinal angles. Euro Spine J. 2021;21(2),65-70. doi:10.1007/s00586-012-2189-z
- Maillet P, Millar M, Burke J, Maillet M, Maillet W, Neis,N. Effect of magnification loupes on dental hygiene student posture. J Dent Educ. 2008;72(1):33-44.
- Fan X, Yang L, Young N, Kaner I, Kjellman M, Forsman M. Ergonomics and performance of using prismatic loupes in simulated surgical tasks among surgeons - a randomized controlled, cross-over trial. Front Publ Health. 2024;11. doi:10.3389/fpubh.2023.1257365
- Botts S. Establishing the ideal posture for your practice: let’s put it in neutral. RDH. February 15, 2022. https://www.rdhmag.com/ergonomics/article/14223184/establishing-the-ideal-posture-to-reduce-the-risk-of-injury-lets-put-it-in-neutral
- Ahearn DJ, Sanders MJ, Turcotte C. Ergonomic design for dental offices. Work. 2010;35(4):495-503. doi:10.3233/WOR-2010-0986
