Smart Choices and Habits for Career-long Health
"In dental school I thought I was invincible. I didn’t realize the magnitude of the problem in our profession."
"I wish I had paid more attention earlier in my career; I never thought it would ever happen to me."
These are the voices of recent dental school graduates who have launched themselves into promising careers, only to be thwarted by a painful musculoskeletal syndrome. The reality is that 2 out of 3 practicing dentists experience occupational pain. This problem usually begins in dental school-by their third year, more than 70 percent of students complain of musculoskeletal pain. This is partly due to contorting around institutional equipment purchased in bulk, generic quantities for financial considerations. While these units may be adequate for the delivery of dental care, many of them have poor ergonomic design. By graduation, students often have acquired postural imbalances and pain syndromes that they believe simply comes with the job and may choose equipment that merely supports a poor posture acquired in dental school.
Good ergonomic practice habits and quality equipment selection are two of the smartest investments new grads can make in their careers. When it comes to equipment, the choices you make can either improve or worsen your musculoskeletal health. Investing in the wrong equipment leaves you with a dilemma—either replace the equipment (an expensive proposition) or you live with it (a painful alternative). Such choices are especially important for new graduates who may be making a large initial investment or for established offices planning renovations.
Top 10 Strategies for Health
Here are my ‘Top Ten” strategies for new dental grads, to ensure a longer, healthier career.
1. Tilt It: Select operator stools with ergonomic tilting seats and backrests. Tilt the seat only 5-10 degrees forward and adjust the height so your hips are higher than your knees. This places your pelvis in a position that naturally balances your spinal curves. If your chair won’t go high enough to achieve this, consider ordering a taller cylinder for your stool.
2. Narrow Backrest: Look for patient chairs with narrow upper backrests to allow close access in the 8-10 o’clock positions. This also will allow closer positioning for your assistant, who will greatly appreciate your chair selection!
A steep declination angle is a key when selecting loupes.
3. Magnification: Invest in good quality ergonomic magnification. Procedure scopes and microscopes enable the best head posture (near 0 degrees), and well-selected telescopes will provide a forward head posture of about 20 degrees. When shopping for magnification, insist on three important ergonomic features: a steep declination angle, proper working distance (measured with forearms about parallel to the floor) and large frames (with scopes mounted low on the frame).
4. Indirect Vision: With tight production schedules, it is easy for new grads to forget positioning options and strive for a direct view of the working surface. Remember, if you cannot gain a direct view without leaving your balanced working posture, use your mirror.
5. Proper Height: The most common positioning problem I observe in dental schools is positioning the patient too high. As a general guideline, try to position the tooth surface at about elbow level or a couple of inches above. Positioning higher than this leads to shoulder elevation and arm abduction (both risk factors for shoulder pain), especially in the 8 to 10 o’clock positions.
Schedule short breaks throughout the day to walk and stretch.
6. Regular Breaks: With school loans looming overhead, it is tempting for new grads to schedule heavily and even push through lunch breaks to improve their productivity. However, prolonged, static postures are one of the biggest culprits when it comes to damaging microtrauma. Be sure to schedule your patients so you have short breaks in-between to walk and stretch. Also, remember to perform chairside stretches regularly during naturally occurring 10-15 second pauses during procedures.
7. Switch Up: Move the muscle workload around to different areas of the body to avoid overworking one group of muscles. Consider placing different operator stools in each operatory: a traditional operator stool, a stool with arms and a saddle-type stool. To maximize this strategy, try standing for exams, geriatric patients, extractions and impression-making. Standing using different muscles than does sitting, and also reduces lumbar disc pressure and muscle strain.
8. Proper Fit: Before buying a new patient chair, make sure it is the right size for your operatory. Measure its length when fully reclined, and compare to the available operatory space. Ensure that you have at least 20 inches of clearance between the end of the headrest and the counter (or delivery system) so you can easily work in the 12 o’clock position. This position enables you to maintain some of the most neutral body postures.
9. Proper Exercise: Many new grads embark upon vigorous exercise routines, only to discover they are targeting muscles that worsen imbalances to which dentists are uniquely predisposed. A painful musculoskeletal dysfunction can result. Make sure you educate yourself on which muscles dentists should target and which exercises can worsen your health.
Choose a delivery system based on your body size and working position.
10. Delivery Systems: Different types of delivery systems are more suitable to different body sizes, dental specialties and operatory layouts. For instance, rear delivery requires an assistant who is well-educated in true four-handed dentistry, or the dentist may be continually twisting to retrieve instruments and handpieces. Side delivery may be better from an ergonomic standpoint, but limits productivity since the assistant cannot perform his or her duties fully. Over-the-patient delivery is great from an ergonomic standpoint if you have a long torso; otherwise the operator is reaching upward, a risk for shoulder injury.
My most important advice to new grads is this: do not wait for the painful episode before investing in quality ergonomically correct equipment and education. Just as dentists recommend oral health care prevention to their patients, so should they heed their own advice when it comes to their own bodies. An ounce of prevention now can be worth a ton of saved time, pain and expense in later years!