What’s happening to your hands?

by Anne Nugent Guignon, RDH, MPH
[email protected]

Has it ever occurred to you that your procedural gloves may be creating unnecessary hand fatigue? Many people don’t give much thought to gloves and just wear whatever the office provides. Other clinicians keep ordering the same type over and over without considering there may be a brand, fabric, or style that provides more comfort or improved tactile sensitivity.

Mounting concerns about latex1 have fueled research into alternative glove fabrics, resulting in gloves made from synthetic materials such as nitrile,2 neoprene, or vinyl. Early synthetic alternatives were often plagued by problems that included poor fit, stiffness, lack of stretch, tearing, and infection control failures related to microscopic pinholes. In addition to high failure rates caused by cracks and pinholes,3 vinyl gloves fit poorly, making them a bad choice for health-care workers. As of 2010, industry experts report that latex still accounts for 65% of all gloves sold in dentistry, but nitrile sales continue to gain and currently hold 35% of the market share.

Natural rubber latex adapts well to the hand. Its elasticity, similar to a rubber band, allows a glove to stretch as it is taken on and off; however, latex gloves have a higher compressive force than a properly fitted glove made with today’s softer, more elastic nitrile formulas.4 Compression may seem unimportant, but over prolonged periods it can result in hand fatigue. Compressive forces affect tiny blood vessels and nerves and restrict subtle finger and hand movements. Most nitrile gloves create less compression, are more puncture resistant, are powder-free, and provide better protection from dental office chemicals than other glove materials. Transitioning from latex to nitrile takes about a week due to the difference in feel and fit.

Gloves come in a wide variety of sizes, from extra small to extra large. As with other products in dentistry, there is no standardization for glove sizes. One company’s petite glove could have the same physical dimensions as another company’s small glove. Gloves should fit like a comfortable second skin across the palm and through the length of the fingertips.4,5

A good fit in the fingertip area is critical to tactile sensitivity.4 Wearing gloves causes a decrease in dexterity as compared to performing a task without gloves.6 If the glove is too short to fit the fingers or too tight across the palm, flexibility and freedom of movement are compromised. Conversely, a glove that is too big in any of these dimensions feels clumsy and uncomfortable and can reduce clinical efficiency and effectiveness.4,5,7,8 A recent study of surgeons demonstrated that double-gloving does not reduce manual dexterity or tactile sensitivity.9

Ambidextrous gloves, originally designed for limited examinations or short procedures, are sometimes used during lengthy dental appointments. Ambidextrous gloves can be worn on either hand and are fashioned using forms with the entire hand in a flat plane, which creates an unnatural position for the thumb. Hand pain, at the base of the thumb on the palm side of the hand, can be the result of wearing ambidextrous gloves, which force the thumb into a non-neutral position.

Constriction of the soft tissue in the palm or the wrist can lead to pain in the thumb or carpal tunnel area. A properly fitted glove should fit loosely around the wrist and be easy to take on and off.4,5 Repeated compression or forcing joints into unnatural positions over and over elevate the risk for developing a cumulative trauma disorder.4,8

Right and left fitted gloves, designed with the thumb in a natural, neutral position, reduces unnecessary strain on the thumb. Hand-specific gloves, also known as right and left gloves, come in numbered sizes. Right and left gloves cost a bit more but can increase clinician comfort and decrease the chance of developing a repetitive strain injury.4 Some clinicians choose to wear ambidextrous gloves for short tasks and hand-specific gloves for longer, more intricate procedures.

Research shows that thin gloves improve tactile sensitivity.10 Thick gloves increase hand fatigue and reduce gripping power.11 Gloves are available with texture on the entire gripping surface or simply limited to the fingertips. Texture helps reduce grasping forces, especially in a wet working environment, by increasing friction, which improves a clinician’s fine motor control on the instrument shaft.4 Nitrile gloves provide more friction than latex when grasping a dental tool with a textured surface in a wet environment.12 It is easy to achieve a feather-light grasp using textured gloves, a factor critically important when using ultrasonic scalers, feeling for subgingival deposits, analyzing complex root morphology, or evaluating the integrity of a crown margin. The amount and type of texture can vary dramatically from one manufacturer to another.

Ergonomists know that multiple micro-traumas play a critical role in the development of workplace-related cumulative trauma disorders. Gloves are not a one-size-fits-all product. The health of your hands can depend on the gloves you wear. This is part of your personal comfort zone. Do your hands and your career a favor and find gloves that provide comfort and a good fit.

Glove trends in clinical practice

The seven question, Web-based convenience poll generated responses from 242 clinicians. Responses gathered over a 14 day period indicate:

• 48.3% use non-latex gloves exclusively in their primary clinical practice
• 85.9% use ambidextrous gloves
• 8.3% use hand-specific fitted gloves
• 54.1% are free to work with the glove of their choice
• 9.5% are expected to use what is provided, regardless of size or personal preference
• 51.5% reported hand fatigue from wearing improperly fitted gloves

When asked what actions they would take if faced with using poorly fitted gloves, the majority would employ multiple strategies ranging from getting samples, to discussing the situation with office colleagues, to requesting a different brand. One quarter indicated they would purchase their own gloves, while 5% would continue to wear the brand supplied by the office. Less than one third would look for solutions in a journal article, on a manufacturer’s Web site, or seek advice from an ergonomics expert. However, 45% would ask colleagues for a recommendation. Click on the survey research tab at anneguignon.com for additional information.

Anne Nugent Guignon, RDH, MPH, 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.

References

1. Smith AM, Amin HS, et al. Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex. Clin Exp Allergy. 2007 Sep;37(9):1349-1356.
2. Sawyer J, Bennett A. Comparing the level of dexterity offered by latex and nitrile SafeSkin gloves. Ann Occup Hyg. 2006 Apr;50(3):289-96.
3. Rego A, Roley L. In-use barrier integrity of gloves: latex and nitrile superior to vinyl. Am J Infect Control. 1999 Oct;27(5):405-410.
4. Kessler K, Zedilis M. Ergonomics and hand protection FAQs. http://www.reliableplant.com/Read/7377/ergonomics-hand-protection. Accessed June 10, 2010.
5. Murphy D.
6. Berger MA, Krul AJ, Daanen HA. Task specificity of finger dexterity tests. Appl Ergon. 2009 Jan;40(1):145-147.
7. Zatsiorsky VM, Latash ML. Prehension synergies. Exerc Sport Sci Rev. 2004 Apr;32(2):75-80.
8. Drabek T, Boucek CD, Buffington CW. Wearing the wrong size latex surgical gloves impairs manual dexterity. J Occup Environ Hyg. 2010 Mar;7(3):152-155.
9. Fry DE, Harris WE, et al. Influence of double-gloving on manual dexterity and tactile sensation of surgeons. J Am Coll Surg. 2010 Mar;210(3):325-330.
10. Kopka A, Crawford JM, Broome IJ. Anesthetists should wear gloves--touch sensitivity is improved with a new type of thin glove. Acta Anaesthesiol Scand. 2005 Apr;49(4):459-462.
11. Chang CH, Shih YC. The effects of glove thickness and work load on female hand performance and fatigue during an infrequent high-intensity gripping task. Appl Ergon. 2007 May;38(3):317-324.
12. Laroche C, Barr A, Dong H, Rempel D. Effect of dental tool surface texture and material on static friction with a wet gloved fingertip. J Biomech. 2007;40(3):697-701.