ADHA Access July 2012 : Page 17
can throw the hygienist into the ‘vicious pain cycle’. A sample video of specific exercises for the dental hygienist can be viewed at www. posturedontics.com/video_highlights_smart_moves.php. This article touches the ‘tip of the iceberg’ regarding how dental hygienists can create a healthier work environment in multiple opera -tory settings and prevent work-related pain. The problem is multifactorial and requires addressing multiple risk factors—some that are beyond the scope of this article. First, dental hygienists must understand the etiologies of the problem of work-related pain in order to select effective interventions. They can then make wise choices regarding selection and adjustment of ergonomic equipment, patient and operator positioning, and exercise routines. It is important that dental hygienists attain this education in hy-giene school, before structural damage has occurred. This will then allow them to incorporate these strategies into practice to facilitate balanced musculoskeletal health that will enable longer, healthier careers; increase productivity; enable safer workplaces; and prevent musculoskeletal disorders. Figure 7. The overhead light should parallel the hygienist’s line of sight as closely as possible to eliminate shadowing. A head-mounted light will parallel the line of sight most closely. (Photo ©2010 from “Positioning for Success” DVD) References 1. Morse T, Bruneau H, Dussetschleger J. Musculoskeletal disorders of the neck and shoulder in the dental professions. Work. 2010;35(4):419-29. 2. Sanders JM, Turcotte CM. Occupational stress in dental hygienists. Work. 2010;35(4):455-65. 3. Hayes M, Taylor J, Smith D. Predictors of work-related musculoskeletal disorders among dental hygienists. Int J Dent Hyg. 2011;Nov 14 DOI: 10.1111/j.1601-5037.2011.00536.x 4. Akesson I, Johnsson B, Rylander L, et al. Musculoskeletal disorders among female dental personnel—clinical examination and a 5-year follow-up study of symptoms. Int Arch Occup Environ Health. 1999;72(6):395-403. 5. Akesson I, Schutz A, Horstmann V, et al. Musculoskeletal symptoms among dental personnel—lack of association with mercury and selenium status, overweight and smoking. Swed Dent J. 2000;24(1-2):23-28. 6. Oberg T, Oberg U. Musculoskeletal complaints in dental hygiene: a survey study from a Swedish county. J Dent Hyg. 1993;67(3):257-261. 7. Lalumandier JA, McPhee SD, Parrott CB, et al. Musculoskeletal pain: preva -lence, prevention, and differences among dental office personnel. Gen Dent. 2001;49(2):160-166. 8. Valachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J AmDent Assoc. 2003;134(10):1344-1350. 9. Valachi B. 3-Month Follow-up Study on In-Office Dental Ergonomic Consulta -tions. 2009. Available at http://www.posturedontics.com/meeting-planners. php. ‘Bethany’s Speaker Kit’, Page 6. 10. Cailliet R. Neck and Arm Pain. 3rd ed.Philadelphia, Pa: FA Davis Company; 1991:49. 11. Karwowski W, Marras WS (eds). The Occupational Ergonomics Handbook. Boca Raton, Fla: CRC Press LLC; 1998:170,182-184,835,914,1765-66. 12. Oberg T, Karsznia A, Sandsjo L, et al. Workload, fatigue, and pause patterns in clinical dental hygiene. J Dent Hyg. 1995;69(5):223-229. 13. Milerad E, Ericson MO, Nisell R, et al. An electromyographic study of dental work. Ergonomics. 1991;34(7):953-962. 14. Johnson EG, Godges JJ, Lohman EB, et al. Disability self-assessment and upper quarter muscle balance between female dental hygienists and non-dental hygienists. J Dent Hyg. 2003; 77(4):217-223. 15. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1: The Upper Half of Body. 2nd ed. Baltimore, Md: Lippincott, Williams, and Wilkins; 1998:4,12,19,35. 16. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65(4):653-660. 17. Hanten WP, Olson SL, Butts NL, et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000;80(10):997-1003. 18. McGill SM, Hughson RL, Parks K. Lumbar erector spinae oxygenation dur -ing prolonged contractions: implications for prolonged work. Ergonomics. 2000;43(4):486-493. 19. Callaghan JP, McGill SM. Low back joint loading and kinematics during stand -ing and unsupported sitting. Ergonomics. 2001;44(3): 20. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work-2: neck and shoulder kinematics. Man Ther 2005;10(4):281. mounted lighting nearly eliminates shadowing, since the light parallels the hygienist’s line of sight. These attach either to your loupe frame or separately to a head strap. Many of the newer, portable models are very lightweight. 8) Gloves—It’s a Fit. Ambidextrous gloves may cause carpal tun-nel syndrome-type pain, especially at the base of the thumb. Molded in a flat hand position, these gloves were originally designed for short medical exams. 34 During treatment, ambidextrous gloves exert one-third more force than fitted gloves as you pull them into a working position, which can cause muscular strain at the base of the thumb. Fitted gloves are molded in a more dynamic working hand position and reduce strain while operating. 9) Cord Management. Consider replacing heavy handpiece cords with newer, lighter-weight, more flexible cords available through most dental supply companies. Heavy cords can be better managed by hold-ing the cord between the fourth and fifth fingers, draping the cord over the arm, or even positioning the cord over the overhead light handle. 10) Exercise to Strengthen. Even with the aforementioned in-terventions, both traveling and non-traveling hygienists will inevitably encounter difficult patients and need to compromise their postures. This is why strengthening exercises to increase the endurance of the postural stabilizing muscles is especially important for dental profes-sionals. This is most critical for women in dentistry since they tend to have less muscle mass than men. 35 When female dental hygienists leave a neutral, balanced working posture, there is less strength avail -able to stabilize their bodies. Hence, the delivery of dental hygiene requires excellent muscular endurance of specific trunk and shoulder girdle stabilizing muscles, especially the middle and lower trapezius muscles. When weak, these muscles tend to fatigue quickly with the forward head, rounded up -per back and elevated arm postures commonly seen among dental hygienists. As this occurs, postural stabilizing muscles become weaker as the compensating muscles (upper trapezius, levator scapula and upper rhomboids) become shorter, tighter and more ischemic, creat-ing a painful imbalance. 36 An effective routine to balance the musculoskeletal health of dental hygienists will target the stabilizing muscles and stretch the compen-sating muscles. This is an imbalance that is unique to dentistry, which is why so many generic exercise routines—Pilates, circuit training, use of personal trainers, etc.—that may benefit the general population lead story continued on page 18 access JUL 2012 17
Publication List
Using a screen reader? Click Here