Get Ahead of the Misery: Injury Prevention Strategies from a Dental Hygienist Body-Builder

You're listening to the Phil Klein Dental Podcast So many of us work long, hard days, and eventually it takes a toll on our body. Initially, we'll experience symptoms of fatigue and loss of vigor. This is particularly evident when we are about to see that 4 p.m. patient where we need to prepare that posterior crown and a patient that barely opens their mouth. The worst scenario would be to develop an injury where it becomes painful and could actually shorten our career. As dentists, we know the significance of prevention, and this absolutely applies to maintaining a fit and pain-free body. So the idea is to get ahead of it before we actually experience the misery. So how do we do that? To answer this question, we're happy to have on our show Katrina Klein. Katrina is a registered dental hygienist for 16 years, national speaker, author, competitive bodybuilder, and certified personal trainer. She's the founder of ErgoFit Life. where ergonomics and fitness are a lifestyle to prevent, reduce, or eliminate pain. Katrina, it's a pleasure to have you on the show. Well, thanks for having me. I'm so glad to be here. Yeah, and your work is very impressive. I mean, not only are you a competitive bodybuilder and you understand strengthening and the whole body through and through, you're a dental hygienist and you understand dentistry and you are a consultant for dental offices that are trying to... out their offices or set up operatories that are ergonomic. Tell us a little bit about your consulting work with dental professionals before we get into the crux of this podcast. Great. So what I do is I will go out and work with dentists, a hygienist assistant, even front office staff, one-on-one with their ergonomics. And I will work with them with the way that they're treating their patients, move the patient here, put your hand there, things like that. But what I also do is a lot of the times practice owners are looking for ways to either make their practice more ergonomic with the equipment that they have or they're rebuilding or they're buying a new practice and they want to make sure that their equipment is good. And so they'll call me first, hopefully, and say, hey, Katrina, what can I do to set this operatory up right? Because a lot of dentists have had dental pain or body pain from practicing dentistry. So they want to prevent that when they're doing these new buildouts. help them with consulting them on equipment needs or how to set up the operatory, dental chairs, delivery systems, things like that. Do you think, generally speaking, dentists are unaware of the dangers that lie ahead when they practice dentistry over many years regarding the ergonomics of their practice? I mean, consider that free operatory stool that they get. Sometimes you buy a dental chair, or often you do, and the dental company that sells you the chair says, hey, if you buy this patient chair and this setup, will give you a free operator stool. Tell us about that. That is incredibly correct. Yes. You know, in dental school, they're taught to a craft. They're taught a craft. They're taught to carve a tooth, pull a tooth, fill a tooth. They're not given education on business or on really ergonomics. It's essentially sit up straight and do it and get it done quickly and keep your patient coming back. At best. So, no, they don't really understand the difference in much of the equipment apart from cost. And because that's not what they're getting their degree in. And so there you talk about that free chair. You know, a lot of the times we we see where you do get a free free operator school with this, you know, twenty thousand dollar chair or whatever. And that chair, it actually ends up costing the dentist money because of. the effects that it has on the body you know we think about the procedures that we do and we often think about how the roi is connected to a procedure code and every one of those procedure codes that are billed are connected to that operator or clinician's ability to maintain good quality of care their advocacy for the patient you know that four o'clock patient that we almost resent for coming in because we're so tired And you get that free operator chair, and it doesn't cost you money in the long run because you just can't get enough done. It's kind of one of those things where if you would have just got the chair that keeps you energized throughout the day or doesn't hurt your body, you could do all those things and feel good about it, and you'd have that good energy that the patient will pick up on and will much more likely accept the treatment recommendations ahead of you. So let me ask you this. When a dentist is looking to purchase a dental chair system, And the sales rep is, or whoever they are, they're at the show or wherever they are, they're seeing this. You know, the person that's trying to sell them the stool, for instance, is going to say, this is an ergonomic chair. This is amazing. This will preserve your back for 10 extra years into your career. So it's hard to quantify the benefit of the chair or compare it to another chair that's out there that's similar in price. How would you advise a dentist to make sure that they're purchasing something that's really helpful to them ergonomically? Oh, I love this. First of all, everyone's going to tell you that their product is ergonomic if there's even a single feature about it. So what I would say for a dentist is the first thing you want to do is make sure that the chair will elevate to a place where they can stand. Even if they don't practice standing dentistry now, it's coming. When dentists start doing it, they feel better. They do it more. And unfortunately, a lot of the chairs don't elevate to a height. that is adequate for a dentist to stand doing treatment. I know that Demelise has a chair that's just recently coming out, the 6400. That one does it. I don't know that there's another one that goes up 35 inches like theirs does, but that's a great feature. Another thing that I recommend to every single dentist when purchasing a patient chair is to look at the chair back width. So many of these chairs are like lazy boys. They've got the massagers built in. The back is super thick. You can't get your legs under them even when you are sitting. These are things that make ergonomics bad for the operator. So a thin back, narrow, so that you can marry your hip to the side of that chair and actually get to the midline of that chair. So that is the key things that I look for. before anything else is make sure you can stand and make sure you can get into the mouth without leaning over. Yeah. So that's interesting because in the 1950s and 1960s, many dentists performed dentistry standing up. And then it was unheard of to sit down and do dentistry. I remember in my grandmother's house in the Bronx, New York, on the second floor, there was a dentist. I was like five years old. And I went up there once when I was visiting my grandmother and this. I remember this doctor's office. It was, you know, right out of a museum, what would look like a museum today. And he was standing up. There was no seating for the operator. So you're saying that there are dental chairs, like the chair you mentioned that dentally sells, that rises up where the patient is high enough where the operator can actually stand. Is that what you're mentioning? Yes. Yes. And what's interesting, I love that you talk about that old standing dental chair that we had that was originally a barbershop chair. When we made the decision to go from standing dentistry to sitting dentistry, the issue was our back pain. It was really never the patient. And so what we did is we put the patient into supine, where they're lying flat, and then we made the operator sit down. The problem wasn't the... operator's positioning. The problem was that the field of view was looking forward rather than looking up. The same way a surgeon would never do a surgery with the patient sitting up, we needed that patient aligned back. So we made two different changes rather than just the one that was the most important. And so when we find that dentists go back to standing dentistry, but the patient is now in a supine position with their mouth facing up, it solves so much of the problem. Not all of it, but a lot of it. So you mentioned that 4 p.m. patient when the doctor is quite tired and they're like, oh, my God, I have another patient today and I'm exhausted. How does fatigue affect patient care? So, you know, imagine you're a dentist and you've been hunched over all day. Your muscles have been chronically tightened. You've got knots in your back. You're exhausted. Your hip is screaming at you. Maybe your neck is screaming at you. What kind of quality of work are you going to be able to really truly perform? Are you going to advocate for that patient the way that you would have at 8 a.m. when you were fresh? The chances are you're not. And when I talk at dental conferences or dental meetings or study clubs, I kind of make a joke. And we all know it. We all know that if that 4 o'clock patient comes in, we're just like, okay, we give ourselves a little pep talk and we get through the day. The reality is that's not the kind of clinician that we set out to be. And it's not what our patients deserve. So, you know, the real truth of it is it does, every bit of our practice is affected by fatigue. If we're tired, we're not going to go that extra mile. And our patients do it. They're tired too at four o'clock. Yeah. And what very likely might happen is that the dentist is going to rush because they want to get it done. And that's rushing when you have these. Very important, sophisticated techniques like just putting in a zirconia crown requires a lot of attention to all the steps. Yeah. And if you cut corners, it comes back to haunt you. And for sure, dentistry is not the profession to cut corners. So when it comes to sit-down dentistry, what other costs are involved that are kind of imposed on the clinician? So, you know, you talk about going the cost to the practice, right? You know, the procedure codes and how it hurts our bottom line. There's also a cost to the clinician. And that is, and we know it because we all feel it and we talk about it, but it's our pain. And that pain eventually ends up in a massage chair where we're paying for routine monthly massages. We're seeing a chiropractor, you know, every week. We're going to physical therapy, eventually surgery, a disability claim. All of these things are a cost to the clinician that don't end up on the practices, bottom line, except that those clinicians, while they're in the pain that they're going through, we're going back to that quality, they're not able to perform at their top level. So, you know, in dentistry today, we really can't afford to not be at our top level because our consumers, our clients, our patients are educated now. They know so much more than they ever did. And they pick up on our energy. They know when we're not able to produce good quality care with energy and with vigor and with passion. And they feel it. So it affects both the practice, bottom line. It affects the clinician and their body pain, ending a career. I can't tell you how many times someone will tell me, yeah, I can't practice anymore. I've got to go do real estate or I'm going to get into crypto or whatever. And it's a shame because they love their craft. They don't want to stop doing it, but they have to. They're going to get into crypto because that's really funny. It's sad, but it's really funny. And I can hear dentists saying that. You're a competitive bodybuilder. So you're in the gym a lot and you certainly know about exercising. So in addition to the importance of really sound ergonomic equipment in our practice, when it comes to working out, what muscles are most important for us to focus on in order to benefit us that go hand in hand with the ergonomics? So when it comes to the gym, and thank you, I really appreciate that you understand that this is really truly a piece of the ergonomic pie per se. Strengthening our body is really, if you think about it, we're kind of like dental athletes. We go in and we are working physically all day long. It might be in inches and millimeters. um you know flexion all day long but it still affects us and so if we can strengthen our body so that it can do the job we're asking it to do we have a much much better chance of succeeding and being able to have the endurance to get through the end of the day specifically we want to strengthen our backs you know i'm always encouraging dentists and hygienists and anybody who's working in an awkward posture Strengthen your back, deadlifts, you know, rows. Get a row machine. You can set up the resistance so that it's more of a workout rather than cardio, but it's also great cardio for us. You know, doing things like body squats, dynamic movements where the body has to incorporate both core and the back at the same time because we really need a strong core to support our spine. Yoga. It's another really great thing. It's not necessarily going to do a lot of strengthening, but we need to release those chronically tight muscles that we've been using all day long. So is the neck and the shoulders the prime spot where the dentist will first begin to see pain because of a weak back? Typically, it's going to be the neck and then the low back. First is usually the neck and then the low back. And the neck has to do with the loops that we wear. Until recently, the last few years, prismatic loops were not. were not really being utilized. And so our heads were put in a forward head flexion position of 20 to 30 degrees, which is equivalent of having 20 to 30 pounds of weight on our cervical spine, which is our neck. And so in dentistry, we know that we can move teeth through bones, right? So we know that bones are not cement. If we put the pressure of 20 to 30 pounds on our neck for eight hours a day times four days a week times 50 weeks a year, of course our necks are going to go into a kyphotic state so that they're forward and then we have pain we have pinched nerves bulging discs all the things and so putting our heads upward is is huge and and that's usually the first place we feel it is in our neck and then secondly is our back because we're leaning forward as a result of trying to compensate for our head position yeah it's one thing leads to another and it's yeah and what you're saying makes so much sense i mean i I'm six foot five. I practiced endodontics for 14 years in Philadelphia and ended up with severe herniated disc problems. Yeah. And I got to the point where just walking was excruciating. We didn't have a endodontic microscope in our office. So because it was before then, that's how old I am. And, you know, I was leaning over the patient and viewing everything with direct vision. sitting yeah so I did just about everything wrong I did it for 14 years but it got to the point where it was destructive to my lifestyle and I'm a tennis player so when I started to see that I couldn't play tennis anymore I knew I had to make a change so I started this company Viva Learning which is now 25 years 24 years old so I'm still here doing this and feeling a lot better that I'm not practicing in the mouth but of course I miss miss that but this is great too But what you're saying, I am an example of a total ergonomic failure, which shortened my career. Luckily, I was able to go into something else. But tell us about the ergonomic strategies that can be used to help dentists prolong their career where they're working in a very comfortable way. So the first thing I would say... is incorporate, you know, standing, you know, start with hygiene checks. Just do all the hygiene checks standing. That variation in posture will give you hope. It will certainly allow you to have some variation in posture. Relieve the back, relieve the hips, relieve the shoulders a little bit. It makes the hygiene checks much shorter, so you're a little less resentful about having to get away from that crown prep to come do a five-minute hygiene check. Next, I would say actually consider getting ergonomic training. That is something that I do. And I say that, but even if it's not me, I would say get someone to come out that actually specializes in dental ergonomics that has worked in the mouth, understands what it feels like to battle the lip, the tongue, the cheek, all the things, and help you with your positioning because we don't know what we don't know. And if you have someone watching you and working one-on-one with you in the operatory, don't do the virtual stuff. It's, you know, I tried it during COVID. It'll suffice. But you really want to get that one-on-one time with the ergonomic specialist. Move your arm down. Put the patient chair here. All these different things. And that is hugely impactful. You know, they say that the studies show that the number one impactful ergonomic tool is loose. the number two and only by two percent is ergonomic training so what was the number one tool loops loops magnification yeah so and it had been um it had been ergonomic training for decades it just recently changed but i believe that that has to do with the prismatic loops because they're so they're just a game changer and so you know if you if you take the equipment part out of it the ergonomic training is the is now the number two, but still quite impactful thing that a dentist or hygienist or assistant can do to improve their injury prevention strategies. So what percentage of the working day of a dentist do you propose them to be standing up? You know, that really depends on the doctor. Now, I recommend 50% of the time. So with hygienists, I say every other patient. With doctors, it's a little more complicated because not everything is. is set on the hour. So I say start with the hygiene checks, do short appointments, anterior restorations, you know, occlusal checks, all those kinds of things that take you a little bit of time. Do those standing for longer procedures, you know, incorporate, you know, you sit, but then incorporate a moment in there where you can take a breath, take a nice deep breath, fill your lungs, get the shoulders back, reset the body, and then go back in. And it's amazing what just a full breath of air can do not just for your body but for your brain very interesting i mean there's been a huge movement towards standing up at the computer with these keyboard stands that have risers on it and they go all the way up i guess and the monitor too the whole thing is like on some sort of hydraulic lift you've seen those i'm sure oh yes i recommend them a lot for front office staff yeah yeah very very interesting Talking to our audience now, if you want to get more information from Katrina, I guess the best place to go would be ergofitlife.com. Yeah, yeah. And you can email me, ergofitlife at gmail. My information's out there. I'm all over social media on Instagram and on Facebook. I actually have a private group on Facebook. And I do talk about, you know, dental ergonomics. I also talk a lot about strengthening exercises, stretches. um nutrition and fun inspirational things too i try to keep it a little bit light you know but um i you know i kind of try to it's about a lifestyle you know if you think about it ergonomics and fitness they're truly a lifestyle for keeping ourselves healthy and happy and loving what we do and being able to serve the population at large. And that's what I'm here to do. Yeah. And we really appreciate everything you've done. Thank you very much to Dental Ease for helping us get you to be on this podcast. Dental Ease is a great company. And as you mentioned, they have equipment that if you're looking to build out your operatory, definitely check out Dental Ease. It's dental easy. And you can look that up online. Thank you very much, Katrina. We look forward to having you on future podcasts. Thank you. I really appreciate it. It was fun. 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