After finishing your final dental procedure of the day, you pause to let the pain in your back subside before walking out. Your neck hurts, your shoulders sag, and you realize it’s only Tuesday. It’s time to consider improving your posture in the dental clinic.
Some dental professionals may believe that pain and exhaustion at the end of the day are unavoidable aspects of the job, but they are not. What are some pain-reduction strategies you can use?
How is this possible, given decades of technological and clinical advancements? Unfortunately, an ergonomic contradiction in dental treatment delivery will exist until equipment configurations, optical systems, seating options, or delivery unit configurations are drastically altered to allow operators to gain access to the oral cavity while maintaining a neutral or balanced posture. In the last 30 years, it has been the only significant ergonomic supporting device to impact dentistry. With less emphasis in dental schools on four-handed dentistry techniques and ergonomics, neck and back pain issues for all practitioners are common.
To achieve a direct line of sight into the oral cavity, operators must lean or tilt forward. Even when using a mouth mirror and loupes, this is a requirement even though both implements can reduce the degree of forwarding lean or rock, which is beneficial for torque reduction.
In treatment delivery, two significant forward lean or tilt types occur frequently. The first type is commonly referred to as head declination, with the fulcrum point located in the cervical region of the neck (below).
The rotational force torque is measured in foot pounds (or newton meters for scientific purists). 6.56 foot-pounds of torque must be resisted for every second your bowling ball head is positioned in a 45-degree forward lean or tilt originating from the cervical area of your neck to keep your face from collapsing into your chest. So what? Consider this analogy: maintaining a 45-degree forward tilt for 10 minutes requires the muscular effort equivalent to curling a 20-pound dumbbell 92 times!
Torque caused by forward head tilt is primarily resisted by the erector spinae, which originates on the sacrum and inserts into the occipital notch on the back of your skull.
The second type of operator, forward lean or tilt, produces an even more dramatic comparison. It is common to see operators leaning forward from the pelvis by up to 30 degrees to gain a better vision into the oral cavity. In this position, the torque formula distance component is significantly increased (below), and the lumbar region erector spinae must resist 18.62 foot-pounds of torque.
Maintaining a total upper body lean or tilt of 30 degrees from the pelvis for 10 minutes requires the same muscular effort as curling a 20-pound dumbbell 266 times or curling a 100-pound barbell 53 times!
Weightlifting and resistance training can be excellent forms of exercise with numerous physiological benefits. This is not the case with the prolonged static contractions required to keep common operator positions. In fact, due to compression and a lack of dynamic movement, prolonged static contractions of muscle groups such as the erector spinae in the lumbar and cervical areas can result in decreased blood flow into and out of a room. Reduced blood flow and prolonged compression periods frequently result in muscle, skeletal, and nerve tissue degeneration.
Is it possible to practice dentistry in a neutral or balanced operator position while avoiding the adverse health effects of torque resistance? No, unless you can deliver treatment using a surgical microscope that allows you to sit in a neutral balanced position due to an optically repositioned vision line to the oral cavity. Younger endodontists are skilled at using the microscope and will significantly benefit from the healthy positioning ergonomics associated with microscope use. Routine use of a microscope during treatment delivery does not appear to be prevalent among the rest of the profession.
According to the International Ergonomics Association, ergonomics is the scientific discipline that studies how workers and other aspects of a system interact and how that system can be best designed for well-being and outcomes. It includes tasks, tools, environments, and human mental and physical abilities. In the dental office, ergonomic considerations range from posture and lighting to how you reach for your instruments.
We frequently find ourselves in dentistry performing repetitive motions, possibly in a cramped or twisted posture, such as leaning over a patient. According to the Journal of Physical Therapy Science, bad posture combined with repetitive motions can cause pain, fatigue, and musculoskeletal problems.
The International Journal of Occupational Safety and Ergonomics (JOSE) describes how our bodies respond to pain by contracting protective muscles, resulting in stiff joints and herniated or degenerated spinal discs. What’s the good news? Recognizing bad posture and correcting it may help you avoid injuries.
According to a study published by the British Dental Journal Team, musculoskeletal disorders are the leading cause of illness-related early retirement for dental professionals. The lower back, shoulders, and hands are common trouble spots.
A dental practitioner may miss the early stages of musculoskeletal disorders. It’s critical to be mindful of your working habits and posture and any risk factors for these disorders. Risk factors identified by the Pakistan Journal of Medical Sciences include:
- A penchant for prolonged sitting and standing
- A habitual hunched or stooped posture
- Working without a helper
- Taking no breaks
- Failure to employ preventive measures such as relaxation and stretching exercises
Whether you are just starting or are well into your career, you must develop good habits. Here are a few simple steps you can take daily to help prevent and reduce injuries.
- Choose a lumbar support stool that allows you to sit with your feet flat on the floor and your thighs slanted downward. Suppose you are unsure which chairs would provide adequate lumbar support. In that case, a dental convention may be an excellent place to begin by examining various options, and your dental supplier may be able to assist you in determining which stool to select.
- Position the patient so you can maintain the ideal ergonomic form and avoid straining your neck and back.
- Use appropriate lighting to reduce eye strain and prevent your neck from craning forward.
- Create an operating space where you can easily reach and grip your instruments.
Taking brief stretches throughout the day, such as those described by the American Dental Association, can also help your muscles (and mind) relax. Stretching exercises can also help to alleviate pain and discomfort. See your doctor if stretching does not relieve your pain or discomfort or if you are experiencing ongoing or severe pain. You can also be referred to a physical therapist or specialist who can advise on improving your condition.
Taking steps to avoid musculoskeletal problems can help you stay active and cheerful despite the physical hazards of our profession. If you prioritize ergonomics, you may be rewarded with a long and healthy career.