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The hidden pains of dentistry ergonomics: a review

Back Pain 1This summary is based on the article published in the International Journal of Clinical Pediatric Dentistry: Ergonomics in Dentistry (January-April 2014)

Anshul Gupta, Manohar Bhat, Tahir Mohammed, Nikita Bansal, Gaurav Gupta

Context

  • The successful application of ergonomics assures high productivity, avoidance of illnesses and injuries, and increased satisfaction among workers.
  • Unsuccessful application, on the other hand, can lead to work-related musculoskeletal disorders (MSDs).

Purpose of the Article

  • The article sets forth broad important background information on ergonomics so the dental practitioner can have a general awareness of ergonomic risk factors as well as some basis for understanding the ongoing dialogue about ergonomics, its diagnosis, treatment, and regulation.
  • The article also provides alternatives in light of the practitioner’s own circumstances, experiences and goals.

Key Findings

Reasons for Early Retirement among Dentists1

  • Musculoskeletal disorders (MSDs) (29.5%)
  • Cardiovascular disease (21.2%)
  • Neurotic symptoms (16.5%)
  • Tumors (7.6%)
  • Diseases of the nervous system (6.1%)

Types of MSDs

Lower Back Pain (LBP)

Cause is often multifactorial but combined motions of lumbar flexion with rotation increase risk to the lumbar disk.

Exists due to abnormal postures, relative weakness and decreased endurance, and then exacerbated by a ‘specific’ injury.

Upper back Pain

More frequent cause of mid back pain is muscular pain from the postural muscles and scapular muscles. The contributions of abnormal posture, static postures, poor strength and endurance, and overall individual conditioning need to be taken into account.

Hand and Wrist Problems

A predominant cause of repetitive motion hand disorders is constant flexion and extension motions of the wrist and fingers.

Ergo 1 Ergo 2 Ergo 3

Risk factors

Awkward Postures

  • More stress is placed on the spinal disks when lifting, lowering, or handling objects with the back bent or twisted compared with when the back is straight.
  • Manipulative tasks requiring repeated or sustained bending or twisting of the wrists, knees, hips, or shoulders.
  • Activities requiring frequent or prolonged work over shoulder height.

Forceful Exertions

  • Such as tooth extractions: place higher loads on the muscles, tendons, ligaments and joints.
  • Prolonged exposure to these exertions may lead to musculoskeletal problems when there is inadequate time for rest or recovery.

Repetitive Motions

  • Effects of repetitive motions are increased when awkward postures and forceful exertions are involved.

Duration

  • Tasks that require use of the same muscles or motions for long durations increase the likelihood of both localized and general fatigue.

Contact Stresses

  • Repeated or continuous contact with hard or sharp objects may create pressure over one area of the body that can inhibit nerve function and blood flow.

Vibration

  • Exposure to local vibration occurs when a specific part of the body comes in contact with a vibrating object.

Psychosocial Factors

  • These include the psychological demands of doing meticulous surgery with little or no rest or diversion and time pressures.

Interventions

Early Treatment of MSDs

Early symptoms in the wrist and hand respond to conservative medical management that includes rest, icing, nonsteroidal anti-inflammatory drugs and splints.

Posture

  • Always try to maintain an erect posture
  • Use an adjustable chair with lumbar, thoracic and arm support
  • Work close to your body
  • Minimize excessive wrist movements
  • Avoid excessive finger movements
  • Alternate work positions between sitting, standing and side of patient
  • Adjust the height of your chair and the patient’s chair to a comfortable level
  • Consider horizontal patient positioning
  • Check the placement of the adjustable light

Patient Positioning

  • Supine positioning of the patient in the chair is usually the most effective way to help to maintain neutral posture.
  • The chair should be raised so the operator’s thighs can freely turn beneath the patient’s chair.

Hand Instruments

When working edges are sharp, the instrument performs more of the work; when the edges are dulled, additional operator force is required to achieve the same result.

Sharp instruments are important for reducing excessive force during instrumentation.

Delivery Systems

  • The dental equipment and instruments should be centered on the dental assistant.
  • From an ergonomic viewpoint, over-the-head and over-the-patient delivery systems better allow the dental assistant to access the hand-pieces for bur changes or other operations.
  • Light and Magnification
  • The goal of overhead lighting is to produce even, shadow-free, color-corrected illumination that is concentrated on the operating field.

Supervised Exercise

  • Exercise and stretching for the treatment of an MSD should be under the supervision of a physician or physical therapist.
  • Injury could incur or a previous injury might be exacerbated by improperly performed exercises.

Proper Temperatures

  • There are no standards for finger temperatures, but it is recommended that hands and fingers be kept above 25° C or 77° F to avoid detrimental effects on dexterity and grip strength.

Procedures and Administration

  • Alternate easy with difficult cases throughout the day and provide buffer periods that accommodate emergency patients or extra time for difficult procedures or patients.

References

List of references included in the review (PDF)

 

This information was reproduced with permission from the PennWell’s Dental Group.

This information is provided as a clinical support tool and does not warrant continuing education credit.

 

2 comments

  1. Regarding upper back pain, a lot of it is tightness in the Rhomboids, between the shoulder blades. This is brought on by our posture and arm positions. Every 6 weeks, I get a massage to “get out the knots”. NOT a pleasant, fluffy massage (its referred to as a “Sports Massage”), but the next day, there is much less tension and an obvious improvement in range of motion.

    Regarding lower back pain, I had pain issues 15 years ago, and the best thing that has kept this under control, as suggested by my Physiotherapist, is core strengthening abdominal crunches to offset the overuse of the back muscles. One does not need to do many to see the results.

  2. I think an article on the aging dentist and his continued physical demands on a body less able to cope with them as age progresses would be a much more helpful approach. The present article is just another worthless paper written by non-dentists telling dentists how to practice dentistry as it suggests unrealistic methods of how to avoid the very real physicalities of the profession. Studying how proactive physical conditioning can help ward off age-related injuries in the dentist and providing some meaningful strategies to minimize these known susceptabiities to these injuries would be a much more useful article to publish by our governing body.

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