One of the most important components of being a great clinician is You. After 30yrs of working as a dental hygienist, I have seen and felt the effects this career can have on the body. There is plenty of literature out there that will confirm the high stats for musculoskeletal disorders, repetitive stress injuries, pain and discomfort within the dental profession.
As a health and safety advisor it is my job now to help eliminate or minimize, as far as is practicably possible, workplace risks of injury or illness. I thought it was a good opportunity to look at some of the common mistakes that can increase fatigue, cause lost productivity with pain or injury, and in the worst-case effect the longevity of your career.
There is a high incidence of hand and wrist complaints, especially with dental hygienists. They tend to be chronic long-term issues that start with a little niggle we just put up with, until the damage can’t be ignored anymore. When we put excessive demands on any part of the body and don’t let it rest, heal and recuperate adequately, the damage continues accumulating until that part becomes disabled. Let me be clear here, the damage that can be caused, is not confined to the arm and hand area. This is simply, one of the most common areas of injury, for dental Hygienists so is a good place to start. The effects on the lower arm and hands of dental Hygienists is a major problem, the Dental Research Journal (Jan-Mar 2012) points to the incidence of carpal tunnel syndrome in dentists not being very high, about 5%, compare that to the 56% of dental hygienists who complain of some symptoms.
What causes these injuries is the cumulative trauma of the tendons, as they slide backwards and forwards through their sheaths, they create friction. If you have enough friction it can create wear and tear, as my Phsysiotherapist explained it’s like a frayed rope, causing inflammation and pain.
Due to the swelling of the tendons or sheaths, you begin to notice some pain and tenderness, these are your warning signs that something isn’t working as well as it should be. It’s the indicator that you need to take a look at what area is affected and how you can manage the risk better? Can the cause be eliminated, if that isn’t possible how can you minimise the damage?
Improved technique – avoid aggressive or continues grip/pinch, palm-down position during grip, awkward finger rest position.
Better designed or more ergonomic tools or equipment – watch out for vibration, non-neutral tool size, or
Improving the structure of your workload
Improving the layout of your work area
“What you do makes a difference, and you have to decide what kind of difference you want to make.” – Jane Goodall
One of the worst choices you can make, is giving all the power to your employer when it comes to what you use in the provision of the treatment. As clinicians, most of us are employed by someone else, this leaves us at the mercy of the employer, or does it? Under HSWA (Health and Safety at Work Act 2015) workplace legislation make’s it everyone’s responsibility to manage risks and improve the health and safety of everyone in the workplace. What does this mean to you? It means you need to have discussions with your employer when things are starting to affect your health. This can be part of forward planning when replacing equipment, better designed hand instruments or making sure the appointment book is structured better.
However, it isn’t all in the employer’s hands and you have to take responsibility for your own health and wellbeing too. This can mean purchasing some of your own equipment, one example would be loops which help with posture and eye strain. Making investments like this can pay off in your long-term career. I often hear how expensive it is and why should I have too buy it? Good question, because this is your career, you may change employers or work in two or three other practices, so it makes sense to have your own personal equipment. If it does require a big investment consider the long-term gains between that and a pair of expensive shoes, hand bag or overseas trip. The question here is which one funds which?
Some of the most common problems we are prone to, with lower arm and hands are:
Carpal Tunnel Syndrome – ‘Pins-n-Needles’ in the hands and fingers, pain in the thumb, index and middle finger, limited range of motion at the wrist, pain radiating up the arm, decreased grip and can be worse at night. Tennis elbow – wrist flexors and extenders causing pain on the lateral side of the elbow. Cubital tunnel syndrome – prolonged use of the elbow while flexed. Trauma from over use can compress the Ulnar Nerve causing pain, numbness, tingling and impaired sensation in the little fingers, side and back of hand. Loss of control and reduced grip strength. Guyon’s Syndrome – repetitive wrist flexing or pressure at the palm/base of hand causing pain, weakness, numbness, tingling, burning in the little finger & part of the ring finger. Wrist Tendinitis – tenderness, joint stiffness or swelling deQuervains tendinitis - causes pain, swelling and inflammation on the thumb side of the wrist which can be made worse with grasping and twisting activities (scaling and polishing)
Prevention is everything! Though reducing the risks can be more complex then I can cover in this article, here are some quick fire bullet points for you to consider and adjust if necessary ..
Glove size - wear gloves that fit the size of your palm, NOT the length of your fingers. Wearing gloves that are too small put a constant pull on that lower thumb joint (CMC/basal/saddle) increasing your risk of arthritis. Latex gloves also have a memory, so they want to return to there original shape at manufacture, so also put stress on the hand. Right size allows the thumb to sit in a natural position, not too tight across the palm or the wrist.
Micro stretches – Only 8-20 seconds long, help counter the prolonged grip and posture problems that clinicians often have. We all know how we should work but I for one will put my hand up and say the individual patient requirements meant I wasn’t always able too. Micro stretching will help reduce stress, injury and pain from headaches, tension and tightness, boost your productivity and make you feel better.
Sharp Instruments!! – keep instruments sharp and replace them as required. This helps reduce the forced grip, reduces instrumentation to remove calculus. Remember a little and often can save you and your patient from time, effort and pain.
Hand Instruments – light weight, well balanced in the hand to reduce the tendency to deviate the wrist, rounded handle with textured grip, large enough to reduce the need for a tight pinch grip, reducing the muscle load.
Insurance – Don’t under estimate the importance of your hands. If you lost a finger, had a chronic injury that prevented you from working, how would this effect your career? For those of you with student debit, add earnings loss over several years, it doesn’t take long to see how much you could lose? This was pointed out to me not so long ago, it was too late for me, I was already managing the long-term effects of hygiene, but I urge the younger professionals among us to consider this.
This is a great profession and the need for oral health care providers, in an ever-changing environment is desperately needed. Looking after yourself so you can look after others is the key to a long, satisfying and productive career, I wish you all great health and safety.