Dental Hygienist

Due to poor positioning, dental hygienist are at a risk of developing musculoskeletal disorders such as “the tendons, tendons sheaths, muscles, and nerves of hands, wrists, arms, elbows, shoulders, neck and back” (Darby & Walsh page 144). 70% of members of the dental team, including dentists, assistants and hygienists reported of having some sort of back pain due to improper positioning http://www.ada.org/en/publications/ada-news/2013-archive/july/posturing-for-relief). Of those 70%, 79% admitted that their back pain was indeed worsening as they continued to perform the same tasks http://www.ada.org/en/publications/ada-news/2013-archive/july/posturing-for-relief).. This is primarily due to repetitive strain syndrome, which include muscoskeletal

disorders.
Carpel tunnel syndrome is a great example of a wrist injury due to repetitive strain syndrome.

Carpel tunnel is defined as “a pinched nerve in [the] wrist” (http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332). Approximately a third a dental hygienists have reported having carpel tunnel syndrome (Darby Walsh 151). It is the cause of repetitive movements such as continuously flexing the wrist. Room temperature in another important factor to consider as a cause for carpel tunnel and many other musculoskeletal disorders. The muscles in the body tend to relax at warmer clients, therefore if the temperature of the dental office is too low, it will cause the muscles to become stiff which will consequently lead to repetitive strain injuries (Darby&Walsh 144). Some preventive measures include good posture with feet flat on the ground and thighs parallel to the ground and avoid over flexing the hand and wrist in any way (Darby and walsh

144).
Thoracic outlet compression is “compression of nerves and/or blood vessels in the upper chest” (http://www.medicinenet.com/thoracic_outlet_syndrome/article.htm) and it is an example of arm injury caused by repetitive strain syndrome. Slouched shoulders and vast neck movements cause thoracic outlet compression. The syndrome results in pain or numbness to the neck, arm and shoulder (Wilkins 95). One way to prevent this syndrome is to evidently keep proper poster, so the head straight while exerting little force on the shoulders and to make sure the height of the chair accommodates to the clinician’s height (Darby and Walsh 155).
Lateral Epicondylitis is a “degenerative elbow disorder” (Darby and walsh 158). This syndrome is caused by forceful use of the wrist or the arm. Lateral Epicondylitis can cause pain in the elbows due to constant extension. Some preventive measurements include keeping the wrist in a neutral position and avoid frequently extending the wrist and arm (darby and walsh 158).
A final example of repetitive strain syndrome is disk herniation which is “displacement of the nucleus of the disc” (Wilkins 95) which causes pressure on the spinal cord. This is due to forward bending to looking to a client’s mouth throughout the day. Herniated discs are tricky in that they not only cause pain to the lower back but consequently increase leg pain, often times making it unbearable to sit for a long period of time (http://orthoinfo.aaos.org/topic.cfm?topic=a00534).
By viewing all these repetitive disorders, Ergonomics shows us that it is essential for the life of a dental hygienist to maintain proper posture or they could develop any of the repetitive strain syndromes listed above. The postures hygienists are expected to maintain throughout the day can be facilitated by the assistance of ergonomically effective equipment.
Dental equipment play an important role in the hygienist’s daily routine. If a piece of equipment is not accessible or is uncomfortable for the hygienist, it has a direct impact o the hygienist’s health. A great example of accessible and comfortable equipment would be the dental chair. The clinician’s chair must be mobile, and should be able to move around the client’s head in less than 5 strokes. It should require minimum force for the clinician to move around the client and should be of correct height, so that the clinician’s feet are flat on the ground. There are existing chairs that are designed to help keep the position straight to avoid any back or shoulder injuries (Darby Walsh 144).
It is important that for proper treatment and thoroughness, the hygienist take advantage of the use of lighting. Since it is dark in the oral cavity, proper lighting helps to provide the clinician with a clear view of what is occurring withing the client’s mouth (Wilkins 93). The lighting is usually located on the ceiling and points directly into the oral cavity.
Another vital piece of equipment is the magnification.

Magnification is used to help the hygienist see properly into the mouth and “is needed to improve visualization” (wilkins 93). The hygienist could choose to have prescripted glasses, flip-up which are fundamentally only used to magnify the oral cavity or loupes which have a light attached to them and usually strapped around the glasses (wilkins 93).
Handpieces are fundamentally made delicate and light for hygienists. They include dental mirrors, which are designed to be used by the nondominant hand in order to decrease and, if needed, increase the exertion of the wrist (Wilkins 151). They are ergonomically designed to fit perfectly in the hygienists hand (WIlikin 93). Ergonomically designed handppieces are “larger diameter handles” (darby walsh 150). This facilitates the grasp of the handle. The reach of the tray, which includes the hand pieces should be at an arms reach, usually right next to the hygienist (Wilkins

94).
Cords need to be managed properly and in an organized fashion in order to be ergonomically successful. A large variety of dental tools, including ultrasonic instruments have cords connected to them. It is vital that the cords are short, so that they not touch the ground, but not too short so that there is no straining on the wrists and arms and are easily sanitized (wilkins 93). The use of ultrasonic or vibrating instruments assists in limiting the motions of the wrist (Darby walsh 151). However, one downside to vibrating tools is that, if the tool is used nonstop for a long period of time then it causes the arm, wrist and hand to become numb (Darby walsh 151). Another type of cord that could possibly be used by hygienists are curly cords. However, curly cords are not ergonomically recommended because they prompt disproportionate bending and pulling. Furthermore, curly cords “provide an ergonomic risk by increasing fatigue level and creating muscle imbalances” (wilkins 94). For this reason, straight cords of an appropriate length are preferred over curly cords.
The instruments viewed give a brief description on how ergonomics play a principal role on the lives of dental hygienists. The appropriate equipment is required in the dental hygiene profession in order to avoid any physical damages to the clinician. However, it is also important to look at how to utilize this equipment to ensure maximum security and to provide an ergonomic safe environment.
It is essentially crucial that the hygienist limits the exertion of force throughout the day and to properly manage their days in terms of time and organization. Darby and Walsh categorize the motions of dental hygienists into five class and they recommend that hygienists essentially only use the first 3 classes while performing their tasts on the client. Class 1 states that the hygienist simple use their fingers. Class 2 emphasized the use of both the fingers and the wrist. Finally class 3 refers to the “movement of fingers, wirst, and arm” (Darby and Walsh 144). It is highly not recommended for the hygienist to exert force on the shoulders or their entire body. 69.5% of dental hygienists claimed that they felt some sort of pain in their wrist (http://www.ohcow.on.ca/uploads/Resource/Workbooks/ERGONOMICS%20AND%20DENTAL%20WORK.pdf). This is quite a high percentage and may have to do with the hygienist’s lack of ergonomics.
Instruments need to be used in a uniform motion. For instance, the fulcrum helps move the hand wrist and elbow uniformly. The fulcrum is added on the instruments to simplify motions and to limit the movement of the wrist. However, if a dental hygienist doesn’t use the fulcrum effectively, then it can cause paint in the wrist.
So far, the physical aspects of ergonomics in the dental profession have been discussed. Proper posture, equipment and the appropriate way to utilize instruments are crucial for the dental hygienist. Though, in order for a hygienist to stay mentally healthy, it is essential that they manage their time and give themselves adequate time in between appointments. The hygienist should make sure to alternate tasks everyday. For instance, the hygienist shouldn’t schedule two heavy appointments together. They should allow for enough time in between clients to simply catch a breath and relax their muscles that work tirelessly all throughout the day.
The work layout must be adequately positioned. For instance, an ergonomically safe zone would be one that is uncluttered and organized with no papers simply lying around. The lights above the client should be easy to reach and the instrument tray, like previously mentioned should not be at the opposite side of the client, but rather in front of the clinician (Wilkins 94).
It is important to always maintain the neutral position, that is with their back straight, legs apart and feet flat on the ground. The shoulders should be relaxed and not stressed and the wrist should always be straight and never bent (Darby walsh 148).