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Dentistry has always been a taxing profession both on the mind and the body. And dentists and hygienists who scale by hand instead of using ultrasonics may be noticing a few more physical aches and pains, especially if hand scaling.
That pain is also not just in the hands, wrists, and arms; hand scaling can also take a toll on the back, neck, shoulders, and legs. Dentists and hygienists are at risk for conditions such as carpal tunnel syndrome, repetitive motion injuries, and even chronic headaches. This pain can strike at any point during a hygienist's career: Between 64% and 93% of dental professionals experience general musculoskeletal pain. In fact, musculoskeletal disorders are the leading reason for early retirement among dental professionals.
Musculoskeletal Pain: Cause
Average everyday hand scaling leads to repetitive motions, often in awkward positions, a recipe for pain and physical disorders that can derail a career.
Musculoskeletal Pain: Prevention
During hand scaling, you can avoid pain and repetitive stress injuries with the following tips:
Better Positioning (for doctors and patients)
The less bending, hunching, twisting, craning, leaning, or reaching you do, the less tension you'll put on their muscles, joints, and bones.
The proper position for working with a patient is seated, with the spine in a neutral position and shoulders relaxed. Working as close to the patient as possible avoids overextending the arms or back and always facing the patient.
You should also keep their feet flat on the floor and adjust the stool's height so the thighs slope slightly downward. Weight should be evenly distributed between each foot and your buttocks, similar to a tripod.
If the procedure calls for a better view of the patient's oral cavity, you can ask the patient to turn their head and use HD mirrors to improve visibility. Keeping instruments at roughly arm's height and within a 21-inch radius is ideal.
The patient's body position also has a tremendous impact on ergonomics. According to RDH Magazine, the patient should ideally be positioned supine for treating the upper arch and semi-supine for the lower arch, but this practice is often impractical due to time constraints.
Instead, they recommend positioning the back of the patient's chair at a 10- to 15-degree angle from the floor. Then, use a contoured dental neck cushion to achieve the proper orientation of the occlusal plane.
You should be sure to ask your patients to position their heads at the end of the headrest to eliminate the need to reach over the empty space on the headrest.
Ergonomic Instruments and Equipment
Ergonomics should be a key consideration when choosing dental instruments and equipment.
The Operator Stool
From an ergonomic perspective, the operator stool is the most important chair in the treatment room. Proper positioning begins by adjusting the stool first and the patient second.
A stool should be adjustable, with adequate lumbar, thoracic, and arm support. It should allow for a space of three finger-widths behind the knee. If the stool has a tilting feature, tilt the seat forward between 5 and 15 degrees. (If not, use an ergonomic wedge cushion.)
Saddle-seat stools may be the ideal option for dental hygienists – especially shorter people. This type of stool maintains the pelvis in a neutral position and allows the optimal curve of the spine.
Another helpful piece of ergonomic equipment is a loupe with a built-in headlight. Loupes provide magnification, so you don't have to bend to see the patient's oral cavity better. Headlights move with the head, eliminating the need (and annoyance) to continually readjust the overhead light.
Instruments can also make a significant difference. You should look for an instrument with an ideal weight and large diameter that provides a textured grip surface. These instruments will be easier to maneuver and cause less hand fatigue while probing, scaling, and root planing.
The science behind ergonomic design matters too. The new Harmony Ergonomic Scalers and Curettes are a good example.
The result of a cutting-edge iterative research and development process that analyzed over 2.8 million data points, the Harmony Scalers and Curettes reduce pinch force up to 65% and pressure on the tooth by 37%. The handle features a recessed double-helix texture for optimal tactile sensitivity with less tactile fatigue. The silicone grips are extended by 30% to provide a secure and nimble grasp.
Another essential factor in instrument ergonomics is the sharpness of the blade. Sharp scalers require less force to do the same amount of work, which can help both clinician and patient be more comfortable.
Harmony Scalers and Curettes feature EverEdge 2.0 Technology with working ends that are 72% sharper out-of-the-box than the next leading competitor and remain 50% sharper after 500 strokes.
Simple Wellness Exercises
Before undertaking any physical activity—from a morning run to a day of treating patients—it's always a good idea to warm up the joints and muscles. Daily stretches and regular yoga practice can help maintain fitness for work without attending in-person classes to reap the benefits. Countless high-quality yoga videos are available for free online.
Musculoskeletal pain is not rare nor even uncommon. There's no shame in feeling pain as a dental professional, as it is fairly common to experience this. The good news is that a few changes to your working routine, posture, instruments, or fitness regimen can do wonders for the body and can potentially extend your careers by years of injury-free practice.