The average dentist will spend up to 60,000 hours during their career working in tense and distorted positions, according to a 2014 International Journal of Clinical Pediatric Dentistry article. Prolonged work in less-than-ideal positions can cause chronic injuries. Given the physical nature of dentistry, proper ergonomics are necessary to help prevent injuries that could throw a wrench into a thriving practice.
With the right ergonomics in place, dentists can help reduce the likelihood for common musculoskeletal disorders (MSDs), enabling them to better protect their bodies and enjoy their profession for as long as they like.
Prevalence of MSDs
The potential that improper positioning can have on a dentist’s physical well-being is quite high. An astounding 61% of dentists experience pain associated with MSDs, according to a 2014 Annals of Medicine and Health Science Research article. These can have a debilitating impact on dental practices. In fact, a 2007 Occupational Safety and Health Administration report found that up to one-third of dentists are forced into early retirement due to these painful conditions.
The pain points of poor ergonomics
It’s extremely common for dentists to face MSDs in the upper back where the trapezius muscles are, or in the head and neck, due to the need to bend their head or neck often to clearly view the oral cavity. In addition, if the spine is not in alignment, this results in flattened or exaggerated curves in the back. This can cause increased dependence on muscles, ligaments and soft tissue in ways that they’re not intended. These areas get stretched, often leading to painful inflammation. Ergonomic posture is important for preventing these disorders.
There are two types of posture: static posture (when your muscles are working to hold your body in a particular position, like sitting in the dental chair or holding a handpiece) and dynamic posture (when you’re moving). When you’re in a static position, roughly 50% of your muscles are contracted to hold your body in one spot. That’s why holding one position for prolonged periods of time isn’t a good idea. Muscles begin to stretch and contract and become fatigued. This causes an imbalance in the strength of one muscle group over another.
Constant positioning of these muscles can lead to decreased blood flow in that area, resulting in ischemia or necrosis. When this happens, the protective muscles try to compensate, often leading to joint hypomobility, which results in nerve compression, spinal disc degeneration and herniation.
The high cost of pain
The costs of MSDs can add up. It’s not just the price of medications or other interventions to treat the pain, but challenges with performing optimally when in pain. For example, many dentists with back pain report having to stop more often, which increases a patient’s chair time. It has also been reported that prolonged pain has caused some dentists trouble achieving the right angulation during a procedure. Over time, this eats into profitability and quality of life.
“When you’re not in alignment physically, it can stop you in your tracks,” said Dr. Stacey Gividen, practicing dentist and lecturer at the University of Montana. “If you’re not in the chair, production is being lost, money is being lost, patients aren’t being seen and the work stacks up. Overhead is still ticking away. It’s easy for all these things to start piling up. What you do in the dental practice when you're sitting and working on patients, and how your ergonomic principles are applied, patient to patient, will decide in some way, shape or form how your practice will perform.”
Evaluating your ergonomics
Ergonomics addresses issues such as how to support correct posture, alleviate the repetitiveness of tasks, optimize equipment positioning and more. There are a number of areas to consider when evaluating ergonomics, including:
Positioning. Dentists and hygienists often have hand and wrist issues if they’re holding one position for long periods of time, causing muscle fatigue. “If you’re unable to move out of a particular position, try moving your feet and shifting your back muscles to help disrupt the static positioning,” said Dr. Gividen. “When you disrupt these static positions, the blood flow returns to the muscles, and you have an increase in the production of the synovial fluid that prevents hypomobility.”
Instrumentation. The heavier the instruments, the more muscle tension will need to be applied to hold them. Smaller instruments are harder to hold onto because they have to be pinched harder to grasp them. Larger, hollow instruments offer higher dexterity capacity.
Force exertions. If you’re extracting a tooth, consider how much force you’re applying. If it’s too much, this can impact your muscles.
Vibrations. If instrumentation has a lot of vibration capacity, you’re likely to grab it harder, leading to more muscle exertion and fatigue.
Loop angulation. “Consider evaluating the angulation of your loop,” said Dr. Gividen. “Oftentimes I see providers have loops but they still have their patients up really high. When your patient is too high, you have to bring your shoulders and your arms up, and this can result in muscle fatigue as well as eye fatigue.”
Patient positioning. It’s very common to place patients high so they can be closer to you. The key is to sit in your chair and then adjust the position of the patient accordingly.
Operatory/Treatment room setup. Consider ways to enhance the design of your room, so you don’t have to rotate around in an uncomfortable position each time you reach into a storage area or need to access equipment.
Dental stool. The key to good posture is to maintain a low back curve. The ideal position is to have your back pushed up against the back of the seat to get the support of the lower lumbar spine. Then tilt forward. Your feet should be flat on the floor, with your hips higher than your knees, and your abdominal muscles contracting a little to stabilize your lower back.
There’s no one-size-fits-all when it comes to procedures and postures, because every person’s size and shape is different. Additionally, the type of dental practice can have an impact on the treatment room and equipment setup needed.
When it comes to practicing ergonomically, having a posture assessment with a physical therapist is a good place to start. It is also important to discuss with your equipment specialist what your room setup should be, along with the right ergonomic equipment for your practice.
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