They found that 99% of licensed hygienists reported having experienced pain or discomfort while treating patients! The hygienists reported pain in the neck and shoulder region, hands, fingers, and lower back. Nelson & Jevack (2001) concluded, "Due to the number of students and licensed dental hygienists who experience pain...proper ergonomics should be enforced in dental hygiene education for future physical wellness and career longevity among dental hygienists" (p. 119).
The researchers (Nelson & Jevack, 2001) suggest -- as others have -- that instruments be redesigned, but also, the working environment needs to be improved for "better adjustments on patient chairs such as adequate height and tilt adjustments, operator stools with support for arms, adequate work breaks, proper lighting angles, space for legs under the patient chair, early medical intervention for symptoms, and angled instruments to reduce wrist flexion" (p. 119). Michalak-Turcotte (2000) recommends that an ergonomic plan be developed for each practitioner. She states, "The objective of an ergonomic program is to fit the job to the worker, rather than the worker to the work" (p. 41). Therefore, each hygienist needs a plan that is specifically suited to him/her and which includes attention to temperature, lighting, nose, equipment design, and workstation design. Due to the repetitive nature of their work, they are at a higher risk for lower back, neck, shoulder, hand, and wrist pain than other health care occupations. This makes it imperative that ergonomic plans be developed and implemented.
Michalak-Turcotte (2000) points out the practice of dental hygiene varies from person to person. Each will have different equipment and instruments requiring different maintenance, different policies about scheduling patients, varying length of appointments, etc. In other words, every practitioner has a different stress level. They suggest alternating patients so that heavy calculus patients don't come in consecutively and planning ways to reduce stress. They point out that dental hygienists usually work sitting down while the patient is usually in a supine position. The hygienist has to use wrist flexion and extended shoulder abduction.
Working in a fixed position can lead to "static loading" on the neck and shoulders.
Some parts of the mouth are not easy to see and require the hygienist to bend and twist at the waist and torque the neck if he or she wants to get a good view. Using a mouth mirror properly can eliminate much of this awkward positioning. Magnification can also enhance the hygienist's visualization. Instruments should be light-weight with hollow handles that are large in diameter and balanced. The hygienist should stretch his or her hand prior to getting a different instrument. Dull instruments require more force, so keep them sharpened (Michalak-Turcotte, 2000). Ill-fitting or poorly designed gloves are suspect as a potential contributor to disorders because more pressure in the fingers may be required; thus, good-fitting, well-designed gloves are essential (Liskiewicz & Kerschbaum, 1997). Because proper posture is the most effective strategy for maintenance of musculoskeletal health, the operator chair should be carefully chosen for appropriate, ergonomically correct posture. It is arguably the most important piece of equipment in the dental office if it prevents fatigue and work-related injuries. The seat should tilt for a comfortable pelvic angle, the seat's depth should accommodate leg length, and the chair should have an adjustable armrest to stabilize the operator's arm. It should have specially designed elbow and wrist supports. The patient chair should have operator arm supports that attach to the backrest. In addition, stretching exercises are helpful as well as practicing relaxation techniques. When dental hygienists are fully aware of work related injuries common in the dental office, they will be more likely to choose to practice ergonomic techniques that promote musculoskeletal health.
Liskiewicz, T. And Kerschbaum, W.E. (1997). Cumulative trauma disorders: An ergonomic approach for prevention. Journal of Dental Hygiene, 71 (4), 162-168.
Michalak-Turcotte, C. (2000). Controlling dental hygiene work-related musculoskeletal disorders: The ergonomic process. Journal of Dental Hygiene, 74 (1), 41-58.
Nelson, J.O. And Jevack, J.E. (2001). Experiencing pain due to incorrect body positioning. Journal of Dental Hygiene, 75 (1), 90-129. Retrieved 15 February 2007 from Expanded Academic ASAP database.
Syme, S.E., Fried, J.L. And Strassier, H.E. (1997). Enhanced visualization using magnification systems. Journal of Dental Hygiene, 71 (5), 202-207.