Posture, Pain, and Prevention: The Ergonomics Wake-Up Call for Dental Professionals

When we translate that to sitting in a 90 degree angle, a traditional operator chair, it adds 40% more pressure to the spine. And then if we're leaning forward or rounding forward, it adds 90% more pressure to the spine. And then for so many of us, we're not symmetrical when we're working. We might lean to one side and that can cause an imbalance in the body as well. Welcome to the Phil Klein Dental Podcast. On today's episode, we're talking about a topic every dental professional deals with, ergonomics. Our guest, Caitlin Parsons, is a registered dental hygienist who's experienced firsthand the neck, shoulder, and back pain that comes from poor posture in the operatory. Now she helps dental professionals protect their bodies, prevent burnout, and stay strong for the long haul. We cover why ergonomics matters, what sitting all day does to your body, and practical changes you can make right now, from stretches and tools to daily habits that actually work. And yes, we even asked her about that 4 p.m. cup of coffee. Caitlin loves it, but she also shares smarter ways to boost your energy that last way longer. So whether you're a dentist, hygienist, or assistant, This episode is all about staying healthy, focused, and pain -free. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Caitlin, thanks for being on the show. Thank you so much for having me. I'm excited to be here. Yeah, we're very happy to talk to you today because the topic is really super important for everybody, everybody that functions in the dental profession. So tell us why it's so important, even though it seems obvious. Tell us why, in your opinion, you're an expert on this, and tell us some of the common mistakes you see that we're making across the board as clinicians. Ergonomics is so important, and I feel like it became more of a conversation during covid or i don't know when it was but i'm really glad because we know that working in dentistry is not easy it's physically mentally and emotionally draining and on the physical side Musculoskeletal disorders are really, really high in dentistry. There's one report that shows that 97% of dental professionals report experiencing pain in their careers. That is huge, right? And so we really want to think about the way that we are working and how we can optimize the way that we work. So some of the common things that... see or i see in dentistry mistakes that we make are forward head posture or forward head carriage, right? Looking down at our patients and that neck flexion of looking down at our patients, we used to think 20 degrees of looking down was actually where we wanted to be. But we know now that that is putting so much more strain on our neck, our shoulders, our spine in general, and can lead to a whole host of things if we're doing that for our entire careers. We see a lot of, I see a lot of people twist spines either during clinical care usually and this can be I see it a lot with hygienists and assistants working at like a seven o'clock position where we're twisted in one direction for the majority of the day this is also if you have a rear delivery system and you're constantly twisting back that repetitive motion leaning forward and rounding forward to reach our patients and see inside of the mouth. And then one big error that I see is just how we're positioning our patients for the tooth or the area of the mouth that we're working on. Yeah, and tell us about that. Tell us about how we do that. What does the positioning of the patient look like where the operator is at risk of poor ergonomic positioning? Yeah. I see a lot of either the patient too high, and when the patient is too high for the clinician, either our shoulders rise up so our hands can be in the mouth, or most commonly we see the elbows out to the side so we can put our hands in the mouth. Typically, when we're working in the mouth on the maxillary arch, so the top, we want the patient to be fully flat or supine. And then... needed, using either a head pillow or depending on the headrest of our chair, lifting that headrest or lifting the chin upward slightly. And then for the mandibular arch. the patient's going to be semi-supine positioned, so a little bit higher and chin tilted downward. And of course, this is a generalization. Every patient is not going to be able to get back to a fully supine position. We know that and not every patient wants to. So sometimes that can be a challenge, but making sure that for the majority of patients, the majority of the day, that's where we're positioning our patients. And then having our patients, again, using a pillow or just having our patients lift, lower, turn their head side to side so we're not doing the movement on our bodies. Do you see these as widespread issues among dental clinicians where, for the most part, they're not following these recommendations? Yeah, I see, I feel like for hygienists especially, we tend to be we want the patient not the dentists don't want this but um we want our patients to be comfortable no matter where you are in dentistry so we feel bad if we're asking them to move throughout the appointment or we're assuming that they can't go back a certain way And then it's also that we get busy, right? And if it's not ingrained in our memory and it's not a habit, when we're busy, we just put that patient back and we just contort our body to work inside of the mouth. We'll be right back with our guest, but first, I want to tell you about VOCO's newest composite, Grandioso 4U. Top clinicians are calling it the most tooth-like universal composite ever made. Unlike traditional composites that force you to choose between either an anterior aesthetic composite, a stronger layering posterior composite, or a fast but aesthetic compromising bulk fill, Grandioso 4U does it all, simplifying your workflow while delivering superior results in a single material. It cures 4mm in just 10 seconds, looks stunning with 5 cluster shades covering all 16 Vita shades, and handles like a dream with 50% less resin. It's a 91% filled nano hybrid, giving you tooth-like strength, ultra-low shrinkage, exceptional wear resistance, and an amalgam-like high radio opacity. So as they say, seeing is believing. So grab your free sample of Grandioso for you today at voco.dental. More and more I'm hearing about standing up while treating patients, or at least doing a combination, a hybrid approach. Can you explain the science behind sitting? Like what actually happens? to the body during long procedures or extended chair time? What's happening to our body during that sitting period? Yeah, sitting is one of the biggest issues for us in dentistry. I actually studied this quite a bit. I wrote a thesis paper on sitting and the adverse effects of sitting. So it's something that I'm passionate about. It's been described in studies as the new smoking because of its physical effects on the body. We know musculoskeletal wise, but also systemically when we're sitting. especially a 90 degree traditional operator chair for long periods of time, that puts a lot more pressure on our spine and the discs between our spine. So there's one image that I love showing in my classes that if we're standing just in a neutral posture position, there's 100% even pressure on the discs of our spine. When we translate that to sitting in a 90 degree angle, a traditional operator chair, it adds 40%. pressure to the spine. And then if we're leaning forward or rounding forward, it adds 90% more pressure to the spine. And then for so many of us, we're not symmetrical when we're working, we might lean to one side. And that can cause an imbalance in the body as well. Most of us, Caitlin, are in the sitting position while we're delivering clinical care. So I assume it'd be good to get up. stand up straight, stretch that back out and try to decompress because apparently we're getting a lot of disc compression from extended periods of sitting. Yeah, there's less pressure on our spine when we're standing, but one of the things with sitting is it can tighten the hip flexor muscles, weakens our glutes, our core is typically not activated, where when we're standing, we can... activate that a bit more and we don't have that shortening of our hip flexors and our hip flexors are attached by tissue to our low back so if our hip flexors from sitting are really really tight that can actually pull on the vertebrae or the muscles of the low back and cause or worsen pain so blood flow circulation we're not getting that normal blood flow that we would have so I highly recommend standing or alternating standing and sitting, making sure that especially if, because there's certain procedures, most of us probably feel more comfortable sitting during, but making sure that you're getting up, you're taking breaks, you're walking around, you're doing stretches to reverse the effects from sitting. So that would help if the clinician could do some treatments in the operatory where they're standing. But that would require a chair to be raised up pretty high. Some of the chairs can do that, but not all of them. And of course, it also depends on how tall the clinician is. I'm 5'8", and I've never had that issue. But I'm sure for tall dentists or hygienists, that's one problem. I think they should all go up high enough that we can stand. that's why i mean saddle stools are a great option for dental professionals because it's really a sit stand orientation so our hips are more in a neutral position if if the saddle stool fits us properly um and we have less constriction of our hip flexors. So we don't have that issue. And we can get a lot closer to our patient so we're not leaning forward or rounding forward to see inside of the mouth. I always found it interesting about saddle stools. You hear from dentists who love them, hygienists the same, but then there are some clinicians that just can't. get comfortable on those stools. And after a while ago, this just ain't for me. I can't spend my day in this thing. Why is it work for some people so well and others? It's just not the right fit. I have a few thoughts. One, we want to find and use saddle stools that support our individual body. So getting a saddle stool just from Amazon or online without trying it out, it might work for some of us, but if it's not designed to support us and our body, it's really the positioning of our sit bones that we want to, that's how we figure out what saddle stool works for us. So for some people, a saddle stool might just never feel good. So of course, during the day and at the end of the day, it does not feel good to be on it long if it's not meant for you. But more than that, or outside of that, if we're going from a traditional seated 90 degree angle chair to a saddle stool, Just like going to the gym and working those muscles, we are working new muscles. Our body is not used to being in that position. So it takes time to build that muscle memory, to build that strength to sit up properly. So if you have a chair that fits and supports you, it generally feels good. You're not getting pain or pinching or numbness anywhere. And it's positioned properly for you as well. It can take... mean, I got used to mine really quickly, not to say I wasn't a little bit sore at the end of my day because my muscles weren't used to it. But we should be used to it in a few weeks time. But there should never be sharp acute pain. And how do you get the right saddle stool for yourself when you're ordering it? You can't like have the company send you a couple of samples, right? I mean, these are chairs. How do you do that? Yeah, I really recommend getting one that's made for dental. So that's the first thing. If you can go to a dental convention in your area that has saddle stools that you can literally try them all out. That is, I think, the best way. You can, there are a lot of companies. I know like crown seating is, I use crown seating. I love their saddle stools. They have multiple different versions for different sizes and shapes, which I think is important. You get those through a distributor. So Henry Schein, Patterson, all of that. And usually you can get a couple of different saddle stools sent to you through your distributor to try. So in addition to the saddle stool recommendation, what are some practical changes or adjustments dental teams can make immediately, right after listening to this podcast, to improve ergonomics in their operatories? We'll be right back to our guest in a second. 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I'm a left-handed practitioner, so almost every room I go into, I have to twist or pivot the patient chair so that I can get to the areas of the chair that I work in. But making sure that everything that you're using during the patient appointment, your handpieces, your suction, your instruments, are within arm's reach. So you're not bending, rounding, reaching. That's number one. As we talked about before, our patient positioning and our positioning is really important. Using indirect vision, and I highly recommend, I'm a big ergonomic loop girl, highly recommend them. Are these the loops where you look straight ahead and there's a mirror in there that reflects down? The audience can't see, but you're nodding your head. What are we, some choices? Do you have any recommendations? Yeah, so ergonomic loops allow us to be in alignment. So our head. we're not doing that neck flexion I talked about before and looking down. It's actually a little bit of a trip when you first use them, but you are looking. forward, but seeing down inside of the patient's mouth. This also can be a learning curve, especially if you've been in dentistry for a bit. Our first instinct is just to look down. So I do recommend if you get them to try them on at home to, I mean, men aren't going to be painting their nails, but do moving rice with chopsticks, like getting used to that movement and that orientation. uh a few there's a lot of companies that make them just like with saddle stools i recommend trying them out understanding their warranties, understanding their customer service, because many clinicians, if you've had to exchange your loops or something goes on with them, you want support that is going to be there and make that transaction easy. I use Andow Medical. I love them. They're the lightest weight loops on the market. They have a wide field of view. So I have 5.0s as a hygienist in magnification, but I can see almost the entire mouth while I'm working on a patient. But every company is going to be different a little bit in their magnification, in their depth of field, field of view. But Andow Medical, Lumadent makes great ones. I know Oriscoptic has them, Qoptics. but again trying them on seeing how it feels asking about you know their warranty what happens if something comes up and i need a replacement or these don't fit making sure that some you know you're supported after the purchase Yeah, and technical support and just regular support where you can actually call somebody is something that has to be considered because get it on Amazon, then you really don't have assurances that there's going to be someone there to help you in case you need to get some technical support. So let me ask you this, Caitlin. We're talking about ergonomics and mistakes that we've talked about in this episode that clinicians routinely make in their daily practice of dentistry. If I'm a team member in a bigger office and there's a bunch of people... working in their respective operatories, and I see something that's egregiously wrong or incorrect with their posture, the way they're moving in their operatory, reaching for things, bending, rounding, as you mentioned, these kinds of things. What's the best way to communicate these mistakes to my colleagues? Should I take photos of them while they're doing it and then say, hey, take a look at this and pursue the conversation that way? What are some of the ways we can help our colleagues get out of these bad habits once we identify them? Yeah, I think that's a great question. And one just really simple thing is opening up the lines of communication. Hey, I noticed that you've been talking about having pain or I noticed that you keep reaching or twisting during this one thing or I'm, you know, just having communication, taking photos and videos either of yourself while you're. Doing patient care or having someone else on the team is a great way to see what you're actually doing versus what we think we might be doing and to make changes. Supporting each other, just having that environment, that culture of wellness that we can have that. dialogue with each other. Starting the day, if you have team meetings, doing a quick breathing exercise or doing a stretch routine, it could take literally 30 seconds to do it together. And that starts the day on a very different note. Having continuing education courses around ergonomics and working together on it. Having team meetings around this kind of stuff. Having a chart in your office in the break room with different stretches. bringing in someone to teach yoga. Like there are so many things that we could do that don't cost money, like you said, to support each other. But communication is one of the biggest things. And just whether you're the dentist and the practice owner or someone on the team talking about an employee, just being compassionate and caring about them is, I think, one of the most important things. Yeah, now you talk a lot about stretching. Is that something that you recommend the team members do? throughout the day? And what kind of stretches? I mean, is that really significant? That makes a big difference, doesn't it? I think it does for multiple reasons. So especially if we're sitting, but even if we're talking about standing, when we are looking down at our patients or in one position for a long period of time, we want... to get the blood flowing and especially if we're sitting and we know the adverse effects from sitting right tightness in the chest the hips weakness in all these areas or if we're sitting or standing and leaning to one side which i see you're tilting our head and we have that imbalance we can use a yoga practice or different stretches between patients to rebalance our body to get the circulation moving to reduce of course air of aches or pain or tightness in the body. But then it also for us as clinicians in a practice that is go, go, go all the time, that is also our opportunity to like pause, even if it's for 10 seconds, for 30 seconds to just pause, to be in our bodies, to listen to what's going on and to sort of regroup and rebalance our nervous system. And that is, I think something so important that then we can show up for the next patient and we're. lot more present we're feeling a lot better we're not carrying the physical or mental stress from the patient before yeah yeah no that's good um do you have a website where you can download some stretching uh yeah what is that My website is the aligned hygienist.com. I have a ton of free resources either on my website. I share on Instagram, also the aligned hygienist. I have a chair side guide that is different stretches. And then I have this wellness guide with chair side stretches and ergonomic checklist. So if you're looking to adjust your ergonomics, not sure where to start, that's a great tool. And it also has different breathing exercises, really simple things that. we can implement chair side. And you also go to dental offices as a consultant I know and you do a full ergonomic assessment of the practice. Yeah, I mean, I work with individual clinicians and I'll go in and do an ergonomic assessment when they're with patients. But I do love going in and supporting the entire team. So usually my kind of base package is going in for a day, starting when they start before patient care, ideally in a team meeting if they have one. And I'm there throughout the day. I go to every clinician. I go to the assistants, even the front office and do a full ergonomic assessment. everyone on the team it's not required but recommended to fill out a form before so i know a little bit of what's going on are there areas of pain what are you struggling with um so we can fine tune and address those things but then we do a ce at lunchtime or sometimes offices will opt to do a yoga class or a yoga class at the end of the day um but typically there for an entire day, depending on how big the team is. And everyone after that gets a full ergonomic and wellness assessment from me. They also get a few other things, continuing education. But doing it together, like we talked about before, that creates a culture of wellness that then it's not just on the leader. Everyone else can, hey, I remember. She said that you had to, you know, stop doing X, Y, and Z and hold each other accountable through those changes. I think that it's very important for employee retention to focus on this kind of thing. Again, as I mentioned earlier in the program, or maybe it was another podcast we did together, can't keep track of these anymore. There's a shortage of dental hygienists, there's a shortage of assistance. And when you have someone really good, and I'm talking for a dental practice owner, you want to hold on to them. I mean, you want to hold on to them because, you know, they could go to another practice. And if there's another practice that has a culture where they emphasize and prioritize ergonomics and clinician wellness, you're going to lose some really good people to that other office. So having someone come in like yourself, Caitlin, says something about the practice besides all the benefit. that it provides in and of itself. It says something about the culture and the practice, which I think dentists have to keep an eye on. So we talked about things we could do, Caitlin, in this episode about preventing some of the ramifications of poor ergonomic posture and layout in the dental practice. But when a clinician is in the throes of the condition, they're actually experiencing pain and discomfort in their back, in their shoulders, in their wrist throughout the day. What steps... can they take to start reversing the damage before it gets out of hand? Trying to get to the root cause of what's going on and nip that in the bud. And then I'm big on finding balance in the body. So if we have neck pain and a big part of it is because we're looking down at our patients all day, we really want to find a balance of... stretching the tight overused muscles and strengthening the weak underused muscles to bring our body back into balance. What about a physical therapist for those that don't feel they have the knowledge to actually do this on their own? I mean, they can watch a YouTube video and their friends could show them how to do certain things. But when it comes to their career and it's jeopardizing the way they practice, when is it time? to say i need to look into a physical therapist to get me better yeah that's a good question everyone's going to be different on that but if you're trying different youtube videos or you're going to these classes and nothing is changing or it's not going away i highly recommend seeing a doctor if you need to getting an x-ray um i I saw a physical therapist for my neck at one point. I am personally trained as a yoga therapist. I describe it as physical therapy meets yoga. So this is a lot of the work I do, but getting one-on -one support from someone, A, who knows the body and is a specialist, of course, but who understands the work we do in dentistry so they can help you to keep improving. But if things aren't going away and if not, it's getting worse and you have not had it checked out, you don't know. what's going on, that is definitely going to be the first step. So you're a yoga instructor, Caitlin, and obviously, you know, as well as anybody that yoga involves a great deal of stretching and flexibility. You're also very much involved in strengthening, using bands, weights, whatever you do. And that's really important to prevent injuries and stay strong and flexible. And when you do have a problem because of poor ergonomics in the operatory, it helps you get better to some extent if you're under the right regimen. But I think it's important to note that even if you're doing this rigorously, stretching and strengthening, but you're still doing the same bad ergonomic habits in the operatory, you're kind of on a cycle, a hamster's wheel that's never going to really resolve itself. So many things I want to touch on in there. So at the beginning of my hygiene career, when I was in pain, reached burnout, started yoga. aware of my ergonomics or anything about that I just focused on stretching and strengthening my body and my pain reduced drastically so I think there's a huge piece at what we do outside of the op that makes a big difference I also think that if we're doing all of the things like stretching and strengthening and we're not addressing what we're doing every day all day in the op we're missing a huge piece and vice versa Me as a yoga therapist, I actually work more on finding that balance. Like I said, yes, it's stretching, but it's also strengthening practices. I use bands. I have them use their body weight, doing different exercises to, again, build better stability in the body. But not every yoga class and yoga teacher is going to be focused on that. Some of it can be just stretching. And I think if we're just stretching or just strengthening. Depending on our body, we're missing a huge piece. I think I would have done a lot better in my career as an endodontist if there was some program in dental school. Someone hired like you teaching us, even for a short period of time, even if it was a couple of months. I know the dental curriculum is so packed in dental schools. There's no room for any of this stuff. But it makes sense to have this kind of education early on before you actually get out. If all the dental student would remember is how important it is. to maintain good ergonomics and what the ramifications are if you don't, and the importance of wellness, stretching, and strengthening. All this stuff just hammered into our heads at least for a couple of months. I think that would be a huge benefit to the dental student as they embark on this kind of difficult career. So as we wrap up this podcast, Caitlin, I do want to ask you, in your opinion, and your experience with this, how do you think improving ergonomics translate directly into becoming a better, more focused clinician? Yeah, I have a lot of experience in this department. especially personally i think that when first of all when we understand ergonomics and we dial our room setup like we have that all dialed in for the most part and it can take time but when our ergonomics is pretty good not to say it's perfect we're not striving for perfection but we're pretty good we have first of all our body is in a better position for the majority of the day which means when our body is in a better position where our muscles and our body are working more efficiently and more effectively which means that we have less less to recover from at the end of the day or the end of the week when we have good ergonomics and our physical health we're not constantly worried about pain the entire time we have more mental stamina we have more capacity for our patients we have more energy throughout the day and throughout our patient care patient appointments we can be more focused we can be more excited more driven more motivated to take care of our patients. That's very true. I got to ask you this before we wrap it up because I'm a big coffee drinker. I love coffee. Now, you know, when I was practicing at four o'clock and I had another patient, you know, I would start another pot of coffee and rely on that to give me that extra boost to get through that last patient. Do you drink coffee as someone who's like a super expert on all this mind, body, energy stuff? What do you think of coffee? uh coffee drinker to coffee drinker i love my coffee um this is something that i have a not a constant battle with but um I love the taste of it. I love the little ritual of it. I love the energy from it. So if I could and it didn't have any effects on me, I would choose coffee at four o'clock. But I highly recommend finding our own energy in our own body. So whether that's getting up and doing a few stretches, there are so many breathing exercises that are super simple. We can do chair side that take less than a minute that literally energizes our system. increase the sympathetic nervous system, vice versa. There's some that can calm us down, but finding that energy within, whether it's even going on a five minute walk around the office or outside or. We're doing jumping jacks, right? Kind of harboring our own inner energy is going to be so much better for us than the spike of coffee and then the downhill after that. You got a lot of discipline there, Caitlin. Not all the time. Yeah, I know. All the things you talked about sound great, but they don't taste as good as a really good hot cup of coffee with a little half and half in it. But listen. We balance our lives, right? We keep everything in perspective. Great stuff. Thank you so much. And if you want to reach Caitlin as far as getting her free stuff or go further than that and get some consulting, remind us of the website. It's thealignedhygienist.com. You can pretty much find me anywhere, The Aligned Hygienist. Right. And you can Google Caitlin Parsons, P-A-R-S-O-N-S. Caitlin is C-A-I-T-L-I-N, and that's the aligned with E-D after aligned, thealignedhygienist.com. Caitlin, thank you very much for your time. We really appreciate your contributions to Viva Learning, and we'll see you soon. Thank you.