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Ergonomics For Dental Hygienists


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Ergonomic health implications as it relates to dental health professionals. This presentation reviews common causes of ergonomic injuries including carpal tunnel syndrome and tendinitis, ways to manage these conditions, and how to prevent them.

Ergonomics For Dental Hygienists

  1. 1. Ergonomics: Health Implications for Dental Hygienists
  2. 2. Overview: Ergonomics and Health Implications for Dental Hygienists <ul><li>Increase awareness </li></ul><ul><li>Decrease work-related pain and injuries </li></ul><ul><li>Heighten productivity </li></ul><ul><li>Improve musculoskeletal health </li></ul><ul><li>Increase comfort </li></ul><ul><li>Improve quality of life </li></ul><ul><li>Extend careers </li></ul>
  3. 3. What is Ergonomics? <ul><li>Ergonomics is the study of workers and their relationship with their occupational environment </li></ul><ul><li>How you position yourself, your patient, how equipment is utilized, how the workplace is designed and how it impacts your health </li></ul><ul><li>ERGONOMICS is a way to work smarter, more efficiently with less effort and discomfort to the human body </li></ul>
  4. 4. Ergonomics in the Dental Health Field <ul><li>Studies show work-related pain in the dental field is not decreasing </li></ul><ul><li>Over half of all dental professionals continue to experience work-related pain </li></ul><ul><li>Why?  The physically challenging nature of the work with numerous risk factors   </li></ul><ul><li>Risk Factors </li></ul><ul><li>Prolonged Static Postures </li></ul><ul><li>Repetitive Movements </li></ul><ul><li>Working in a confined space </li></ul><ul><li>Challenges with positioning yourself or the patient </li></ul><ul><li>Limitations with the tools and equipment used </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  5. 5. Reasons for Early Retirement Among Dental Health Professionals <ul><li>Musculoskeletal Disorders (29.5 %) </li></ul><ul><li>Cardiovascular Disease (21.2%) </li></ul><ul><li>Neurotic Symptoms (16.5%) </li></ul><ul><li>Tumors (7.6%) </li></ul><ul><li>Diseases of the Nervous System (6.1%) </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  6. 6. Ergonomics: The Human Factor <ul><li>People Are Different </li></ul><ul><li>We come in different shapes and sizes yet the workplace is often set up for “ one size fits all ” </li></ul><ul><li>People Have Limitations </li></ul><ul><li>We have physical and mental limits for working </li></ul><ul><li>- The wrist cannot tolerate excessive extension </li></ul><ul><li>- The back cannot tolerate excessive bending or twisting </li></ul><ul><li>- The neck was not meant to be in constant flexion </li></ul><ul><li>- Muscles will fatigue if under constant tension </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  7. 7. Consequences of Poor Ergonomics <ul><li>Fatigue </li></ul><ul><li>Pain/Discomfort </li></ul><ul><li>Illness/Injury </li></ul><ul><li>Missed days at work </li></ul><ul><li>Errors </li></ul><ul><li>Lower productivity </li></ul><ul><li>Patient dissatisfaction </li></ul>
  8. 8. Poor Ergonomics: Signs and Symptoms <ul><li>Physical Signs </li></ul><ul><li>Decreased range of motion </li></ul><ul><li>Deformity </li></ul><ul><li>Decreased grip strength </li></ul><ul><li>Loss of muscle function </li></ul><ul><li>Symptoms </li></ul><ul><li>Pain </li></ul><ul><li>Numbness </li></ul><ul><li>Tingling </li></ul><ul><li>Burning </li></ul><ul><li>Cramping </li></ul><ul><li>Stiffness </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  9. 9. Poor Ergonomics = Musculoskeletal Disorders <ul><li>The World Health Organization definition: </li></ul><ul><li>Musculoskeletal Disorder is “a disorder of the muscles, tendons, peripheral nerves or vascular system not directly resulting from an acute trauma or instantaneous event” </li></ul><ul><li>Two Most Common Causes for Musculoskeletal </li></ul><ul><li>Disorders in the Dental Health Profession </li></ul><ul><li>Cumulative Traumas </li></ul><ul><li>Prolonged Static Postures </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  10. 10. Cumulative Trauma <ul><li>Repetitive Movements like Scaling and Polishing are Cumulative Traumas </li></ul><ul><li>Vibrations transmitted by dental handpieces or mechanical scalers are Cumulative Traumas </li></ul><ul><li>Cumulative Traumas add up </li></ul><ul><li>These microtraumas cause “ wear and tear ” on the muscles, tendons, and nerve tissue </li></ul>
  11. 11. Prolonged Static Postures <ul><li>Human body was designed for movement </li></ul><ul><li>Dental hygiene procedures means practitioners must maintain static postures </li></ul><ul><li>Hygienists hold postures that require more than 50% of the body’s muscles to contract to resist gravity </li></ul><ul><li>Muscle overload leads to decreased blood flow and increased pressure on the muscles and joints </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  12. 12. Flowchart: Static Overload <ul><li>PROLONGED STATIC POSTURES </li></ul><ul><li>Muscle Fatigue and Muscle Imbalance </li></ul><ul><li>Muscle Ischemia, Trigger Points, Muscle Substitution </li></ul><ul><li>PAIN </li></ul><ul><li>Protective Muscle Contraction </li></ul><ul><li>Joint Hypomobility, Nerve Compression, Spinal Degeneration/Herniation </li></ul><ul><li>MUSCULSKELETAL DISORDERS </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  13. 13. Static Postures leads to Muscular Imbalances <ul><li>Muscles responsible for rotating the body to one side become tighter (shorter), while opposing muscles become weaker (longer) </li></ul><ul><li>Right handed hygienists repeatedly assume NECK ROTATION TO LEFT with SIDE-BENDING TO RIGHT to gain better visibility </li></ul><ul><li>Problems with NECK ROTATION TO RIGHT with SIDE-BENDING TO LEFT </li></ul>©2008, Valachi from “Practice Dentistry Pain-Free”
  14. 14. Static Postures = Muscle Ischemia <ul><li>As postures deviate from neutral, muscles contract harder to maintain working postures </li></ul><ul><li>During static muscle contraction, the vascular supply to muscle and surrounding tissues is restricted </li></ul><ul><li>Results in depleted nutrient and oxygen supply ( ischemia ) </li></ul><ul><li>Lactic acid and other metabolites accumulates causing pain and tissue damage </li></ul>
  15. 15. Cumulative Traumas and Prolonged Static Postures Lead to Musculoskeletal Disorders <ul><li>Trigger Points and Myofascial Pain Disorders of Neck </li></ul><ul><li>Degenerative Joint Disease (Arthritis) </li></ul><ul><li>Thoracic Outlet Syndrome </li></ul><ul><li>Tendinitis </li></ul><ul><li>Carpal Tunnel </li></ul><ul><li>Syndrome </li></ul><ul><li>Trigger Finger </li></ul><ul><li>Nerve Entrapment Syndromes </li></ul><ul><li>Lower Back Pain </li></ul><ul><li>Sciatica </li></ul>
  16. 16. Myofascial Pain: Trigger Points <ul><li>Trigger Points : groups of muscle fibers that are in a constant state of contraction inside a tight band of muscle </li></ul><ul><li>Feels like a knot or a small pea in muscles, and when pressed on can refer pain to distant parts of the body </li></ul><ul><li>Ischemic areas are susceptible to the development of trigger points </li></ul>
  17. 17. Myofascial Pain: Trigger Points
  18. 18. Myofascial Pain: Trigger Points
  19. 19. Static Postures: Degenerative Joint Disease <ul><li>Synovial fluid, which lubricates the joints, is produced each time a joint moves </li></ul><ul><li>Lack of movement and contracted muscles from static postures reduces the synovial fluid production, resulting in joint hypomobility </li></ul><ul><li>This loss of mobility leads to degenerative changes and more musculoskeletal disorders </li></ul>
  20. 20. Static Postures: Degenerative Joint Disease <ul><li>Symptoms </li></ul><ul><li>Intermittent/chronic pain and stiffness </li></ul><ul><li>“ Creaking” or “cracking” of joints </li></ul><ul><li>Swelling in the joints </li></ul><ul><li>Loss of motion in the joints </li></ul><ul><li>Increased pain with activity or use </li></ul>
  21. 21. Neck and Shoulder Disorders Thoracic Outlet Syndrome <ul><li>Condition resulting from compression of the nerves, arteries, and veins as they pass through from the neck to the arm (thoracic outlet) </li></ul><ul><li>Possible causes: tight scalenes, cervical rib, tight pectoralis muscle, traumas </li></ul><ul><li>Often misdiagnosed </li></ul>
  22. 22. Neck and Shoulder Disorders Thoracic Outlet Syndrome <ul><li>Symptoms </li></ul><ul><li>Pain in the neck, shoulder, arm or hand </li></ul><ul><li>Numbness and tingling of fingers </li></ul><ul><li>Muscle weakness/fatigue </li></ul><ul><li>Cold sensation in the arm, hand or fingers </li></ul>
  23. 23. Cumulative Trauma Injury: Tendinitis <ul><li>When tendons slide back and forth through their sheaths friction is created </li></ul><ul><li>As with any other moving part, enough friction can cause wear and tear along with inflammation </li></ul><ul><li>When tendons or sheaths swell, and there is pain and tenderness </li></ul>
  24. 24. Wrist Tendinitis <ul><li>Pain, swelling and inflammation on the thumb side of the wrist </li></ul><ul><li>Made worse with grasping and twisting activities (polishing and scaling) </li></ul><ul><li>Occasional “catching” or snapping when moving thumb </li></ul>
  25. 25. Shoulder Tendinitis <ul><li>Elevated arm postures cause shoulder impingement </li></ul><ul><li>Leads to tendinitis in the rotator cuff </li></ul><ul><li>Pain is usually felt in the front or the side of the shoulder </li></ul><ul><li>Worse with activity </li></ul>
  26. 26. Carpal Tunnel Syndrome <ul><li>Compression of the Median Nerve as it passes through the Carpal Tunnel </li></ul><ul><li>Caused by pinching and gripping activities with the wrist bent </li></ul><ul><li>Made worse with repetitive flexion and extension activities at the wrists </li></ul>
  27. 27. Carpal Tunnel Syndrome <ul><li>Symptoms </li></ul><ul><li>“ Pins and needles” in the hands and fingers </li></ul><ul><li>Pain in the thumb, index and middle finger </li></ul><ul><li>Limited range of motion at the wrist </li></ul><ul><li>Pain radiating up the arm </li></ul><ul><li>Decreased grip strength </li></ul><ul><li>More pain at night </li></ul>
  28. 28. Trigger Finger (Tenosynovitis) <ul><li>Sustained forceful grips and repetitive motion irritates the tendon and tendon sheath (tenosynovium) </li></ul><ul><li>Nodules form in tendon causing warmth, swelling, tenderness of the tendon </li></ul><ul><li>Pain occurs during movement that place tendons in tension </li></ul><ul><li>Fingers lock in “Trigger Position” </li></ul>
  29. 29. Cubital Tunnel Syndrome <ul><li>Prolonged use of the elbow while flexed or trauma from overuse can compress the Ulnar Nerve </li></ul><ul><li>Pain, numbness, tingling and impaired sensation in the little and ring fingers, side and back of hand </li></ul><ul><li>Loss of fine control </li></ul><ul><li>Reduced grip strength </li></ul>
  30. 30. <ul><li>Compression of ulnar nerve in Guyon’s canal at the base of the palm </li></ul><ul><li>Caused by repetitive wrist flexing or excessive pressure on palm/base of hand </li></ul><ul><li>Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger </li></ul><ul><li>Symptoms may worsen at night or early morning </li></ul>Guyon’s Syndrome
  31. 31. Upper Crossed Syndrome <ul><li>Tight Levator Scapulae Upper Trapezius Scalenes Pectorals </li></ul><ul><li>Weak Middle/Lower Traps Rhomboids Serratus Anterior Deep Neck Flexors </li></ul><ul><li>Elevated shoulders </li></ul><ul><li>Forward head postures </li></ul><ul><li>Jutting shoulder blades </li></ul><ul><li>Neck Pain and Upper Back Pain </li></ul>
  32. 32. Low Back Pain <ul><li>Low Back Pain is the leading cause of occupational disability in the dental healthcare profession </li></ul><ul><li>Studies show that low back pain is clearly related to seated postures and sitting duration </li></ul>
  33. 33. Low Back Pain <ul><li>We often think of a back injury as caused by a single event, like lifting a heavy load </li></ul><ul><li>The lower back is vulnerable to Cumulative Trauma </li></ul><ul><li>More lower back injuries result from the cumulative effects of bending, twisting, or excessive sitting </li></ul><ul><li>Working continuously in a seated position places tremendous static load on the back muscles, discs, and joints </li></ul>
  34. 34. Low Back Pain: The Problem with Sitting <ul><li>With seated postures, pressure in the lumbar disks increases by 50% from standing </li></ul><ul><li>Unsupported sitting causes 2x more axial loading in the spine than standing </li></ul><ul><li>During forward flexion and rotation (a position often assumed by dental hygienists) the pressure increases by 200% </li></ul>
  35. 35. Low Back Pain: Disc Degeneration, Bulge and Herniation <ul><li>Spinal discs provide for flexibility shock absorption </li></ul><ul><li>Discs are composed of tough outer layer (annulus fibrosis) and gel-like center (nucleus pulposis) </li></ul><ul><li>When weight is applied to the disc, the nucleus expands outward and puts pressure on the annulus fibrosis </li></ul>
  36. 36. Low Back Pain Disc Degeneration and Herniation <ul><li>Sitting while flexing forward compresses the discs in the front </li></ul><ul><li>Uneven pressure on the disc leads to disc bulging and herniation </li></ul><ul><li>When the disc bulges or herniates backwards the nerves can become pinched </li></ul>
  37. 37. Low Back Pain: Sciatica <ul><li>Pain from lower back or hip radiating to the buttocks and legs </li></ul><ul><li>Leg weakness, numbness, or tingling </li></ul><ul><li>Commonly caused by prolapsed intervertebral disc pressuring the sciatic nerve </li></ul><ul><li>Worsened with prolonged sitting or excessive bending and lifting </li></ul>
  38. 38. Low Back Pain: A Vicious Cycle <ul><li>People with back problems seem to be faced with this vicious cycle </li></ul><ul><li>There is considerable evidence that bed rest and passive treatments have limited value </li></ul><ul><li>We now know that activity and the right kind of exercise are critical to treating back pain </li></ul>Stop Moving Back Pain Hurts to Move Stiffness Weakness
  39. 39. Lower Crossed Syndrome <ul><li>Tight Hip Flexors Lower Back Muscles </li></ul><ul><li>Weak Abdominal Muscles Gluteus Maximus </li></ul><ul><li>Swayback - excessive curve of the lower back </li></ul><ul><li>Anterior Pelvic Tilt - hips tilted forward </li></ul><ul><li>Lower Back Pain </li></ul>
  40. 40. What is the best position to sit in? Traditional 90 º Sitting Is not It <ul><li>Problems with Traditional 90 ° Sitting </li></ul><ul><li>Looks nice but it’s just not comfortable </li></ul><ul><li>Natural curve of the lower back collapses </li></ul><ul><li>Leads to muscle tension and misaligned vertebrae </li></ul><ul><li>Increases static load on the discs </li></ul><ul><li>Decreases circulation in lower extremities </li></ul>
  41. 41. What is the best position to sit in? Leg Balanced Sitting <ul><li>Allows for forward and upward postures to transfer some of the body’s support to the feet </li></ul><ul><li>Hip angle of 100 ° to 120 ° </li></ul><ul><li>Knee angle of 110° to 135° </li></ul><ul><li>Forward seat tilt of 45° to 55° from horizontal </li></ul><ul><li>Opposing muscle groups are balanced and curve in lower back is maintained </li></ul>
  42. 42. Chair Selection <ul><li>Saddle Seat Design </li></ul><ul><li>True waterfall design is an essential feature </li></ul><ul><li>Hydraulic piston assembly for the widest range of motion </li></ul><ul><li>Seat should be adjustable so hips can be slightly elevated beyond parallel without restricting blood flow to the legs </li></ul>
  43. 43. Ergonomics for Dental Hygienists Workstation Layout <ul><li>Clutter threatens the safety and cleanliness of the dental operatory </li></ul><ul><li>Allows convenient positioning when required </li></ul><ul><li>Provide a clear line of sight to the oral cavity and all required equipment </li></ul>
  44. 44. Ergonomics for Dental Hygienists Workstation Layout <ul><li>Optimize space for work from 7 o’clock to 1 o’clock position for right handed Hygienists (11° to 5° if Left Handed) </li></ul><ul><li>Instruments should be accessible while seated (within 20 inches of the front of body) </li></ul><ul><li>Hoses should be positioned away from the body </li></ul><ul><li>Over-the-Patient or Over-the-Head equipment is most ergonomic </li></ul><ul><li>Use mobile carts for less commonly used equipment </li></ul>
  45. 45. Ergonomics for Dental Hygienists Scheduling <ul><li>Scheduling of procedures should be considered. </li></ul><ul><li>Difficult procedures scheduled back-to-back does not allow your body sufficient relaxation time </li></ul><ul><li>Potential strategies </li></ul><ul><ul><li>Increase treatment time for more difficult patients </li></ul></ul><ul><ul><li>Alternate heavy and light calculus patients within a schedule </li></ul></ul><ul><ul><li>Vary procedures within the same appointment </li></ul></ul><ul><ul><li>Shorten patient’s recall interval </li></ul></ul>
  46. 46. Ergonomics for Dental Hygienists Reduce Physical Effort <ul><li>Avoid bent or unnatural postures </li></ul><ul><li>Minimize sustained effort </li></ul><ul><li>Brief but frequent rest pauses can minimize fatigue and enhance productivity </li></ul><ul><li>Incorporate different activities to shift musculoskeletal demands from one part of the body to another </li></ul>
  47. 47. Ergonomics for Dental Hygienists Equipment <ul><li>If your air/water syringe has a tightly coiled cord, consider replacing it with a lightweight hose </li></ul><ul><li>Swiveling devices can be placed on a handpiece to reduce torque </li></ul><ul><li>Newer handpieces are much lighter than the older models </li></ul>
  48. 48. Ergonomics for Dental Hygienists Hand Instruments <ul><li>Look for: </li></ul><ul><li>Hollow or resin handles </li></ul><ul><li>Round, textured grooves, and compressible handles </li></ul><ul><li>Carbon-steel construction </li></ul><ul><li>Color-coding may make instrument identification easier </li></ul>
  49. 49. Ergonomics for the Dental Hygienists Magnification Systems <ul><li>Should improve neck postures and Provide clearer vision </li></ul><ul><li>Consider additional lighting </li></ul><ul><li>Weight should also be considered </li></ul>
  50. 50. Ergonomics for Dental Hygienists Gloves <ul><li>Gloves are one of the most overlooked ergonomic items </li></ul><ul><li>Hand-specific gloves allow the thumb to be in a more natural position </li></ul><ul><li>Gloves should not be too tight across the palm or too constricting at the wrist </li></ul><ul><li>The finger length should be adequate to allow for comfortable finger movement </li></ul>
  51. 51. Preventing Ergonomic Injuries <ul><li>Move </li></ul><ul><li>Change Position </li></ul><ul><li>There is no one “correct” posture best for an entire working day </li></ul><ul><li>The Human Body Needs Change and Mobility </li></ul>
  52. 52. Preventing Ergonomic Injuries <ul><li>Taking frequent, shorter breaks is preferable to taking longer, fewer breaks </li></ul><ul><li>Change positions before painful symptoms arise </li></ul><ul><li>Remember to go back to neutral postures </li></ul>
  53. 53. Preventing Ergonomic Injuries Stretching Guidelines <ul><li>Never stretch to the point of pain or discomfort </li></ul><ul><li>Do not bounce or use quick, jerky movements </li></ul><ul><li>Stretch should be performed every half hour </li></ul>
  54. 54. Suboccipital Muscles <ul><li>Deep muscles at the base of the skull responsible for protraction, rotation, and tilting of the head </li></ul><ul><li>Suboccipitals become shortened with forward head postures </li></ul><ul><li>Common cause for headaches </li></ul>
  55. 55. Levator Scapulae <ul><li>Primary function is to elevate the scapula </li></ul><ul><li>Also bends the neck to the side </li></ul><ul><li>Tightens up when carrying a bag with a strap or talking on the phone </li></ul>
  56. 56. Scalenes <ul><li>Functions to stabilize the neck during lateral movements </li></ul><ul><li>Aids in inspiration </li></ul><ul><li>Becomes tight with awkward leaning positions while seated </li></ul>
  57. 57. Trapezius <ul><li>Upper elevates the shoulders </li></ul><ul><li>Middle retracts the shoulder blades </li></ul><ul><li>Lower rotates the shoulder blade downwards </li></ul><ul><li>Becomes tight with elevated arm postures </li></ul>
  58. 58. Pectoralis Minor <ul><li>Functions to draw the shoulder blade forward and downward </li></ul><ul><li>Tight in people with a rounded shoulder posture </li></ul><ul><li>Shortened pec minor is a possible cause for Thoracic Outlet Syndrome </li></ul>
  59. 59. Wrist Flexors/Extensors <ul><li>Prime function is to flex and extend the wrist </li></ul><ul><li>“ Tennis Elbow ” is pain on the lateral side of elbow </li></ul><ul><li>“ Golfer’s Elbow ” is pain on the medial side of the elbow </li></ul>
  60. 60. Hamstrings <ul><li>Main function is to bend the knee </li></ul><ul><li>Secondary role in extending the hip </li></ul><ul><li>Weak low back and glute muscles increases tightness in the hamstrings </li></ul><ul><li>Prolonged seated postures also causes tight hamstrings </li></ul>
  61. 61. Iliopsoas <ul><li>Primary function is to flex the hip (bring thigh up towards the abdomen) </li></ul><ul><li>People with chronic lower back pain often have very tight hip flexors </li></ul><ul><li>Commonly shortened with prolonged seated postures </li></ul>
  62. 62. Piriformis <ul><li>Main function is to externally rotate the hip/thigh </li></ul><ul><li>Shortened in people who sit for long periods of time </li></ul><ul><li>“ Piriformis Syndrome” causes compression of the Sciatica nerve </li></ul>
  63. 63. Questions and Answers