Ergonomic Adjustments Can Foster Improved Hand and Wrist Health

When it comes to practicing dentistry, there’s nothing like a good pair of hands. Unfortunately, the profession can take a toll on hands, wrists, and pretty much everything else, in the form of musculoskeletal disorders (MSDs).

Research shows that oral health care practitioners are at high risk of developing work-related MSDs. In fact, some studies report that more than 95% experience MSD-related pain, in some cases, so severe it interferes with careers. This has been found to be especially true in the case of hand and wrist pain, especially among dental hygienists and endodontists.^1–5

Ergonomic problems are so integral to the practice of dentistry that dental schools are beginning to address it in their curricula. But it’s not rocket science. Vast improvements are found to result from most minor adjustments such as in proper patient and instrument positioning, and taking stretch breaks.⁶

Repetitive motion, and static, awkward postures are thought to be major contributors to ergonomic problems.Hands can be particularly vulnerable when much of the daily workload involves precise use of hand instruments and vibrating handpieces in minute spaces. Two of the most common hand and wrist injuries in the dental profession, carpal tunnel syndrome and tendinitis, can certainly end up taking a bite out of a practice’s bottom line and, worse, end careers.⁵

Ergonomic Measures

But while the practice of dentistry is a virtual minefield of ergonomic health hazards, good ergonomics can give clinicians the best chance at preventing career-ending disasters. For example, neutral wrist positioning and a good, neutral posture can work wonders in avoiding nerve compression. This can be supported through chair positioning and by exerting a firm grasp on the instrument du jour, which has become increasingly easier to do thanks to evolving instrument designs. Many of the hand and rotary instruments of today feature handles that are textured for easy gripping, and are of a larger diameter — at least 10 mm — and lighter weight — 15 g or less.^4,5,7,8

Such design tweaks, along with keeping instruments sharp, have been shown to improve ergonomics by reducing muscle load and pinch-force demand. Use of a variety of well-balanced instruments with padded handles of varying diameters, weights and textures is also said to be beneficial. This prevents clinicians from being stuck in a static position in which one or two muscles are overused.^4,5,7,8

Manufacturers are increasingly offering cordless handpieces, which not only allow portability between operatories, but eliminate the resistance caused by power cords, which may exacerbate MSDs in hands. In addition, they can greatly reduce the time spent polishing, and, by extension, reduce muscle workload.⁵

Among other variables affecting ergonomics for hands and wrists are properly fitting gloves, which should not sag or bind. Adequate lighting and optimal visual acuity are also crucial, as straining to see clearly via a series of body contortions will ultimately affect hands and wrists — and not in a good way.⁵

Among adjuncts that can improve visual acuity is a good isolation system such as Isolite 3. Offering shadowless illumination in addition to a non-curing amber light, Isolite ensures that practitioners won’t need to strain to see into the oral cavity. And with continuous suction and efficient retraction of oral tissues a clear field is assured, while hands get a break from fighting wayward tongues. And with all of its features combined, Isolite is sure to speed up patient chair time, which translates to less clinician strain.

Oral health care is exacting work. But with a little forethought, there are countless ways clinicians can maintain healthy ergonomics and save their wrists and hands to practice another day.

REFERENCES

1. Hayes MJ, Smith DR, Cockrell D. A systematic review of musculoskeletal disorders among dental professionals. Int J Dent Hyg. 2009;7:159–165.
2. Sartorio F, Vercelli S, Ferriero G, D’Angelo F, Migliario M, Franchignoni M. Work-related musculoskeletal diseases in dental professionals: 1-prevalence and risk factors. G Ital Med Lav Ergon. 2005;27:165–169.
3. Kierklo A, Kobus A, Jaworska M, Botuliński B. Work-related musculoskeletal disorders among dentists — a questionnaire survey. Ann Agric Environ Med. 2011;18:79–84.
4. Estrich CG, Caruso TJ, Gruninger SE, Pleva D. Musculoskeletal complaints among dental practitioners. Available at: https://www.researchgate.net/publication/263898777_0390_Musculoskeletal_Complaints_Among_Dental_Practitioners. Accessed March 20, 2019.
5. Stone R. Sleight of hand. Mentor. 2017;8(12): 34–36,38–39.
6. Brody AV. How Physical Therapists Are Helping Dental Students Break Bad Habits. Available at: http://decisionsindentistry.com/2019/03/how-physical-therapists-are-helping-dental-students-break-bad-habits/. Accessed March 20, 2019.
7. Dong H, Loomer P, Barr A, LaRoche C, Young E, Rempel D. The effect of tool handle shape on hand muscle load and pinch force in at simulated dental scaling task. Appl Ergon.2007;38:525–531.
8. Simmer-Beck M, Branson BG. An evidence-based review of ergonomic features of dental hygiene instruments. Work.2010;35:477–485.