Ergonomics and Work-Related Musculoskeletal Disorders

Ergonomics in Dental Hygiene: A Simple Guide
What This Guide Will Cover

  • This section will teach you about ergonomics and how it applies to dental hygiene.

What You Will Learn

  • Understanding Ergonomics: You will learn what ergonomics means and why its principles are important when you work in a dental office.

  • Why Ergonomics Matters: You will understand how using ergonomics helps you treat patients effectively and keeps dental professionals healthy.

  • Identifying Common Problems: You will be able to recognize musculoskeletal disorders (MSDs) that often affect people who work in dental hygiene.

What is Ergonomics?

  • Ergonomics Explained: Ergonomics is a practical science that focuses on making sure there is a good "fit" between people, their tools (technology), and their work environment.

  • Goal of Ergonomics: Its main goal is to make tasks easier and more comfortable, improving how well you can work.

  • Designing for People: Instead of people having to try and fit into how equipment is designed, the equipment should be made to fit the people using it.

  • Making Work Easier: When equipment fits well, it helps you finish tasks more easily and efficiently.

Problems from Poor Ergonomics

  • When your work setup has poor ergonomics, several negative things can happen:

    • Workers might feel less comfortable.

    • They might not be able to do as much work.

    • The workplace might become less safe.

  • For people like dental hygienists:

    • Their work environment includes things like the setup of the office, the equipment they use, and their instruments.

    • Both dentists and dental hygienists are at risk of ergonomic problems that can cause discomfort, pain, or even a disability.

Understanding Musculoskeletal Disorders (MSDs)

  • MSD Definition: An MSD is a health problem where parts of your musculoskeletal system, such as your muscles, tendons, and nerves, get hurt gradually over time.

What Causes Musculoskeletal Injuries?

  1. Strenuous or Awkward Movements:

    • Cleaning teeth (periodontal instrumentation) often needs forceful actions and requires you to hold your body in awkward positions.

    • Injuries that result from these movements can lead to:

      • Losing strength in your body.

      • Difficulty controlling your movements.

      • Symptoms like tingling, numbness, or pain.

  2. Bad Posture:

    • Staying in a twisted position or having uneven shoulders for a long time increases your risk of getting an MSD.

  3. Repeated Movements:

    • The human body is not really built to do the same task over and over again for long periods.

    • Dental work often involves using your arms and hands repeatedly while keeping them in a fixed position.

Ergonomic Risks for Dental Hygienists

  • Common ergonomic risks that dental hygienists face include:

    • Awkward Postures:

    • A neutral posture is the best and causes the least strain on your joints.

    • When your body is not in a neutral position (for example, if your arms are stretched out), it puts more stress on your joints.

    • Static Postures:

    • This means holding your body in one position for a long time.

    • For instance, gripping instruments tightly during periodontal procedures is an example of a static posture.

    • Force:

    • Force refers to how much effort your muscles exert and the pressure placed on different parts of your body.

    • Certain ways of gripping instruments, such as a pinch grip, should be avoided.

    • Repetitive Movements:

    • Doing the same simple movement for more than 50% of your work time can lead to injuries.

    • It is important to consider how often you repeat a movement, how long you do it for, and how much rest you get in between tasks.

Specific Musculoskeletal Disorders for Dental Professionals

  1. Thoracic Outlet Syndrome:

    • This is a painful condition that affects your fingers, hands, and wrists.

    • It happens because nerves and blood vessels in your shoulder area get squeezed.

    • What causes it:

      • Tilting your head forward.

      • Hunching your shoulders.

      • Reaching overhead too much.

  2. Rotator Cuff Tendinitis:

    • This is when the tendons of the muscles in your shoulder get inflamed.

    • What causes it:

      • Holding your elbow above your waist level.

      • Keeping your upper arm stretched out away from your body.

  3. Pronator Syndrome:

    • This is a problem with the wrist and hand that occurs when the median nerve in your forearm is squeezed by the pronator muscle.

    • What causes it:

      • Positioning your lower arm far away from your body.

  4. Extensor Wad Strain:

    • This causes pain because the extensor muscles in your fingers are injured.

    • What causes it:

      • Constantly extending your fingers independently.

  5. Carpal Tunnel Syndrome:

    • This is pain in the wrist and hand that comes from the median nerve being squeezed inside the wrist.

    • Main causes:

      • Moving your wrist too much (up, down, or side-to-side).

      • Not giving your muscles enough rest while gripping instruments.

  6. Ulnar Nerve Entrapment:

    • This is a painful condition that affects the lower arm and wrist, caused by the ulnar nerve getting squeezed.

    • It is often linked to:

      • Excessive wrist movement.

      • Holding your little finger separate from your hand for long periods.

Things That Increase Your Risk for MSDs

  • You are at a higher risk for injuries if you do the following:

    • Repeat the same movements frequently and with a lot of force.

    • Hold your body in awkward positions.

    • Do not get enough rest between tasks.

Basic Skills for Cleaning Teeth

  • To properly clean teeth, you need to master several skills, which are learned one after another:

    • Correct body positioning.

    • How to hold your instruments.

    • Using the dental mirror effectively.

    • Knowing where to place your finger rests.

    • How to perform instrument strokes.

What to Do and What Not to Do for Ergonomics

  • Do:

    • Keep your body in a neutral, balanced position.

    • Adjust the patient's chair and your equipment so you can use proper techniques.

  • Don't:

    • Change your good posture just to finish a task.

What is Neutral Positioning?

  • Neutral positioning means holding your body in a balanced way that minimizes the chance of getting a musculoskeletal injury.

Important Points for Neutral Positioning

  1. Neck Position:

    • Your head should be tilted forward only about 00 to 1515 degrees.

  2. Back Position:

    • Your back should have a slight forward lean that comes from your hips; avoid curving your back.

  3. Torso Position:

    • Your upper body should be straight; avoid twisting it.

  4. Shoulder Position:

    • Keep your shoulders even and relaxed; do not hunch them up.

  5. Upper Arm Position:

    • Your elbows should be at waist level and slightly away from your body; do not raise your elbows above your waist.

  6. Forearm Position:

    • Your forearms should be parallel to the floor; aim for an angle of more than 6060 degrees between your forearm and upper arm.

  7. Hand Position:

    • The palm side of your hand near your little finger should be lower than your thumb side; avoid holding your palm parallel to the floor.

Steps for a Neutral Clinician Posture

  1. Sit with your buttocks pressed against the back of the chair.

  2. Adjust the seat height so your feet are flat on the floor.

  3. Make sure your weight is evenly distributed; the back of your seat should be a little higher than the front, and your hips should be higher than your knees.

Choosing Your Clinician Stool

  • Each clinician should adjust the height and backrest of their stool to fit their own body comfortably.

    • The stool should provide ideal support for your lower back and promote the natural curves of your spine when you are sitting.

Setting Up the Patient's Neutral Position

  • Key Features:

    • The patient's feet should be at the same level as, or slightly higher than, their nose.

    • The top of their head should be aligned with the top edge of the headrest.

    • The back of the chair should be almost parallel to the floor.

    • You will need to raise the chair slightly when working on areas of the lower jaw (mandibular arch).

Adjusting the Patient's Head for Better Viewing

  • After you adjust the chair, patients should move their head to give you better visibility during treatment:

    • For the Upper Jaw (Maxillary Arch): Have the patient tilt their chin up.

    • For the Lower Jaw (Mandibular Arch): Have the patient tilt their chin down.

Setting Up Equipment in a Neutral Position

  • Light Position for the Lower Jaw (Mandibular Arch):

    • The light should be placed directly above the patient's mouth, at arm's length.

  • Light Position for the Upper Jaw (Maxillary Arch):

    • The light should be positioned over the patient's neck or mouth, also at arm's length.

Right and Wrong Clinician Positioning

  • Correct Positioning:

    • Your upper arms should be parallel to your body, and your shoulders should be relaxed.

  • Incorrect Positioning:

    • Raising your elbows, often because your chair is too high or the patient is not positioned correctly, leads to stress and strain.

How Loupes and Coaxial Illumination Help

  • Magnification Loupes:

    • These glasses make the treatment area bigger and clearer, which helps reduce strain on your eyes.

  • Coaxial Illumination:

    • These are lights mounted on your head that shine where you are looking.

Important Takeaway

  • Always focusing on keeping your body in a neutral position