A Multifactorial Approach to Staying Healthy as a Dental Hygienist - Part I

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. We hear a lot about ways to stay healthy in our society, eat well, exercise, try to minimize stress, and it goes on and on. But are there specific concerns for dental hygienists? Today, we'll be highlighting musculoskeletal disorder, the importance of proper ergonomics in our workplace, and things that we could do in the operatory to maintain health. for long-term career satisfaction. Our guest is Schelli Stedke, who has worked in many areas of dentistry, including clinical care. She has a master's degree in dental hygiene education, and we should also note she recently gained her certification as a registered yoga teacher. She has a passion for helping her fellow dental professionals stay healthy and well for the duration of their career. Shelly, it's really a pleasure to have you on the show. It's a pleasure to be here, Dr. Phil. This is a topic that really interests me because we hear a lot about things happening to dentists in the practice that could preclude their career from reaching its full duration. I'm an example of that. I'm a retired endodontist, and I actually had to get out fairly early because I just played hooky during a lot of those four -handed dentistry classes in dental school, and my ergonomics was really pretty bad, actually. I was very much into direct vision to see where that root canal... orifice was. Even though I looked through a mirror, I still tried to get some direct vision. And over the period of years, it kind of ruined my back. But let's begin with a simple question. Why is proper ergonomic proficiency so important in dentistry and dental hygiene? And why should a dental clinician review it regularly? Dr. Phil, I'm glad you asked that question. And I love that you brought up the example of yourself because in some of the research that I've done, I found that endodontists are very, even higher. risk for musculoskeletal disorders than the general dental population. So even within our profession, there are groups that are more at risk than other groups. And something that I'd love to see more done in the way of research, you know. differentiating between these groups, because what we see is a lot of research that's done on general dentists or general or dental hygienists, more so the general dental population. And it's not segregated into the group so that we can really focus on improving one groups. you know, proficiency or their comfort level while they work. But it's really important because, as you know, being an endodontist, we have a physically demanding job, whether you're a hygienist, an endodontist, an oral surgeon, a general dentist, even dental assistants. really a demanding job and even when we have the best ergonomics and as you say you like direct vision i think we all do in in some capacity and if there's someone not looking over our shoulder helping us to remember that that ergonomic position may be not the best and that we might need to adjust that we start to develop bad habits and when you're developing bad habits in a situation where you're asked to work In a limited field of vision, you're asked to sit in a static position for a long period of time that's not natural for your body. You begin to compensate using muscle groups, overusing some muscle groups, underutilizing others. And this can lead to prolonged pain in our profession. And it's not ideal. And as you said, you ended up leaving the profession early. I actually don't work clinically anymore either and have been through years of... physical therapy, chiropractic. I do a lot of yoga now as a registered yoga teacher, and that helps my comfort level. But I think it would be really hard to go back to practice. And there are about 29% from the research that I've done of dental practitioners that end up leaving the profession early due to physical pain. So this really is a problem in our profession. Yeah. And that's very well said. The scary thing to me is that the whole process is so gradual. You're not practicing optimal ergonomics as you go through the day because your mind is on getting the patient taken care of and you have things to do and you're running around and then you have something to check and you're going from point A to B and you're trying to get there quickly and you don't notice anything happening to yourself because it's so gradual. And then all of a sudden there's some warning signs, right? I mean, you're the expert, I'm not, but that's what happened to me. And then all of a sudden it got very bad pretty quickly. So I assume that that's what you're experiencing when you talk to these dental professionals and try to get them on the right path to good ergonomics. What are some of the common musculoskeletal disorders among dental professionals? And as I mentioned, what are the warning signs that they should be looking for? Yeah. Back to what you mentioned earlier and that you say, you know, you go through your day and you kind of aren't paying attention necessarily to everything that you're doing. And I think that's one of the things that I know as when I was an instructor. We focus on ergonomics. Many, many schools have ergonomic training as you're in school. But the problem is that you do go through your day and you... have anyone looking over your shoulder after you graduate from school. So these bad habits creep in very slowly. As you mentioned, you may have a slight indication of pain. You might have a little tingling, some numbness, but you know, you just kind of write it off. It's not a big deal. And you keep doing what you're doing until suddenly you can't practice anymore because the pain becomes more severe. And the thing is the pain does. leave when you leave the operatory. It might be caused in the operatory, but it really affects all of your life. So some of the signs that professionals out there should be looking for would be maybe some aching in a joint, some numbness, particularly fingertips, tingling or a burning sensation, stiffness in the neck, feeling a little tired, more tired than normal in certain areas of the body. Some more serious warning signs might be a decreased range of motion, loss of grip strength. You know, you're suddenly taking a pan out of the oven and you lose grip of it and not realizing that. So the loss of normal sensation and then also loss of coordination. Those can all be. warning signs that you may have the onset of an MSD. And like you say, it kind of gradually, there's a gradual onset, and then typically there's a tipping point. Once you get past that gradual onset, then suddenly it can be pretty progressive and it can get worse quickly. So it's important to address those signs early on. Right. Now, as far as the dental hygienist, which is included in the title of this podcast, what's the specific concerns of a dental hygienist regarding this? So specifically, I would be remiss if I didn't mention carpal tunnel syndrome. That is something that is sort of the classic MSD in dental hygiene. And you can look through many areas of research that refer to this. And there are many, many hygienists that suffer from this. And in your educational training, typically, you know, proper clock positioning is taught as to how to approach the patient. Proper arm positioning is taught, finger, hand positioning. But again, as you begin to work in maybe not an ideal setting, maybe you are restricted in your ability to move around your operatory. Maybe the size is small. You find yourself compensating in ways that you might be bending your wrist in ways that you hadn't done in school. Or you don't have someone correcting you and it's just easier to do it that way. And then suddenly it begins. It begins to hurt a lot. So carpal tunnel is definitely the most reported MSD and then probably hand and wrist pain after that. And that is followed closely by neck and shoulder pain. There is reported pain in the lower back and the hips as well. And I think that's from sitting, possibly leaning more. weight into one hip than the other because we're trying to tip in to get closer to our patient so we can have that direct vision, as you mentioned. So what are some of the factors, and also please include equipment in this, that are within our control? What could we do internally in our own practice to really try to prevent these things from getting out of hand? So I think one of the biggest factors in your control is just... self-awareness, the self-awareness of your positioning, kind of that mental checklist in your mind. And that's a habit that you have to develop because, and I know I'm guilty of this, when I was working in private practice, you know, you go into your operatory, it's set up a certain way. You don't really think about how you could change that to optimally reflect your ergonomic positioning. So I think kind of looking at your operatory, if you've been in a practice for a long period of time with fresh eyes, going in and kind of stepping back from that and thinking through what can I do to make my workflow easier? What kind of equipment can I use that is going to make that workflow? easier that I can reach in a more consistent manner without twisting my torso, without having to reach over something. Actually, the more we move from the torso and twist as we're working, the harder that is on our back and then that reflects into our limbs. So that's not a good situation to be in. You want to look at all the areas surrounding your operatory. Are you able to move all the way around your patient to get to every clock position that you need to get to in order to give proper treatment? The equipment that you use, your large, your small equipment, this could be things like your radiograph machine. You know, is it easily accessible? Are you able to get it on both sides of the patient very easily? Loops have been shown to actually reduce some neck strain if used properly, but they have to be used properly to do that. And then how your gloves fit. If they're too tight, you're going to cause some finger strain on that. Looking at prophy angles. So there are some really great modern pieces of equipment out there. Some of the cordless prophy angles are wonderful. They have less vibration. They're quieter because noise is actually also kind of, I don't know if you'd classify it as a musculoskeletal disorder, but we do need to be aware of our hearing. more modern equipment that doesn't vibrate as much, that's lighter, that's ergonomically designed, we should try to incorporate that into our repertoire of equipment. Feel free to give some examples of hand pieces or equipment or anything that you feel our audience could at least look into. Do you have any favorites or things you can recommend? Yeah, I actually, I'm really fond of the NSKI Profi Mobile. It is a cordless profi angle that is used. It's fairly new on the market within the last few years. And it's very ergonomically designed. The micromachining in it is really good. So it's very quiet. It offers very little vibration. It's quiet, which is good for kids, but also good for your hand. And it's weighted in such a way that it rests in the crook of your thumb in an ideal position so that you have really good access to the patient's mouth without having to overextend the wrist. A typical dental hygienist would have that in their hand. How much of their day? What percentage of the day would that be in their hand? I'm guessing probably about 20% to 25% of their day because typically you're polishing every patient's teeth. And if you're seeing 8 to 10 patients a day, you may be polishing for 5 to 10 minutes of each patient appointment during that appointment. So it's really important that you have good equipment to utilize while you're doing that because as you can see, when you're using it repeatedly over and over again on each patient, you want to have stuff that works well and that is not going to exacerbate any MSDs long term. Yeah, no, that's an excellent point. So as far as hand instrumentation, that motion, amazing to me that you don't develop carpal tunnel syndrome and those kinds of disorders that cause numbness and tingling. You know, that's really true because we really are using very fine motor skills repeatedly with forceful pressure over and over. And I think some of it can be genetics. Some of it's just the way we're made. MSDs are reported more in people that don't exercise or maybe are not, you know, in decent physical shape. And you don't have to be in the best physical shape, but just being aware that, you know, you are using your muscles. But I can't explain why it doesn't happen to everyone. But I will say when hygienists are trained in school, and I'm not familiar certainly with every dental hygiene school out there, but I've worked at a few and, you know, attended several others. In doing that, the training that goes into the hand instrumentation is very intense and it's very rigorous. And I believe those habits, for lack of a better word, are kind of beat into your brain that you're going to create a good habit. And so they address that early on in the education system of a dental hygienist. The idea is that you keep the risk neutral while you're scaling. you know, people get back into that habit after they graduate. Keeping the wrist neutral, you mentioned. Yes. Yeah. So when students are taught early on in their educational career, they're taught to keep the wrist in a neutral position and actually have very little finger movement. So the motion is coming from the forearm and it's called a rolling motion. So you're rocking and rolling on the tooth surface or in the gingival sulcus. And that's how they're taught to do that. For the first year, typically you've got a dental hygiene instructor looking over your shoulder, making sure that you're in the right position, making sure that you're utilizing the instruments correctly with the grip and with that rocking and rolling motion. And then as your training continues, then we're looking more at outward positioning. And then ultimately what we're looking at is the... dental hygiene outcome. Was the student or was the practitioner able to treat the patient effectively? And we want to see the results of the scaling and root planning procedure. And somewhere in there, that ergonomic recognition gets lost. In addition, it should also be noted that hand instrumentation, even though it is very, very common in dental hygiene, and it is kind of the backbone of what is taught in dental hygiene, electronic instrumentation is becoming more and more the norm and kind of commonplace. And I should say that with the exception of since COVID has happened because there have been restrictions on electronic instrumentation. But as we begin to utilize those electronic instruments again, NSK does have a wonderful piezo unit, which is a gentle electronic instrumentation that they have two different. One that can be attached directly to the dental unit itself. And it's nice and small. It's very ergonomic. It's micro-machined to be auto-tuned. So therefore, it doesn't have excess chatter. It doesn't propagate damage to the tissue of the patient. And then they also have a tabletop version for those periodontists that like to irrigate or dental hygienists that like to irrigate their patient's sulcus or pocket as they're cleaning. So this is a great alternative to possibly a Cavitron, but it would be the NSK-Piazo scaler. Just to wrap up this podcast, and it's been very good, there's certainly a lot more we can talk about. You know, we really haven't talked about what a dental hygienist should do, or I know it's focused on this podcast on dental hygiene, but any dentist or dental care professional, if they start seeing these things happening and they're trying to correct them, but they're still happening. So what are some of the treatment options? if one is faced with the dilemma of having a work-related musculoskeletal disorder. There's a couple different ways you can go with this, and usually there's some tradition. treatment options, and that would be the typical allopathic medicine or Western medicine. This could include going to see a physical therapist, seeking drug therapy, some steroid injections, splints. Different things like that. Ultrasound is shown to be a pretty effective technique for carpal tunnel. And sometimes it's ultimately surgery. So those are some of the more traditional treatment options. And then there are other people that also seek some complementary alternative medicine. And this is becoming much more common, I believe, in our society and in our culture. It used to be kind of like, oh, you know, what are people out there doing something really strange and weird? And not to say that there's what I do want to stress is there's no one fix, one stop shop where you're going to do something and everything is going to be better. I really feel like it's a multifactorial. factorial approach. So you may have a mix of some traditional options as well as some complementary alternative medical treatments. And this could include chiropractic. It could include massage, some breathing techniques, acupuncture or acupressure. I've even heard of cupping. I think that was big before the last Olympics. There were some athletes that were doing some cupping. meditation, Reiki, yoga, and sometimes some herbal supplements are all different techniques or combinations of techniques that people seek in order to try to help themselves feel better. Yeah, wow. You really do have a great background on this stuff. And that's a great segue to our next podcast. And I'm talking to my audience now. If you're interested, there's a part two to this. And Schelli’s going to be talking about breathing, yoga. even meditation, these kinds of things that could really help people through this. And of course, ultimately, you have to correct the etiology, which is really a problem with the ergonomic situation in the first place. But once you're kind of struck with this kind of disorder, this condition, these types of things really help you get through it. We'll learn more about that on the next podcast. So thank you very much, Schelli. We look forward to having you on the next one. Thank you very much, Dr. Phil.