Ergonomic Principles for Dental Hygienists

Speaker: Karen W. Clark, OTR/L, CEAS II

Ergo Rx, PLLC

Outline

I. Introduction to ERGONOMICS and General Anatomy

II. Risk Factors III. Body MechanicsIV. Exercises for Life and WorkV. Recommended Equipment/Compensatory

TechniquesVI. Questions and Answers

What is Ergonomics?Wikipedia states:

• Human factors and ergonomics (HF&E), aka comfort design, functional design, and user-friendly systems,[1] is a multidisciplinary field incorporating contributions from psychology, engineering, biomechanics, mechanobiology, industrial design, physiology and anthropometry. In essence it is the study of designing equipment and devices that fit the human body and its cognitive abilities. The two terms "human factors" and "ergonomics" are essentially synonymous.

Merriam-Webster Dictionary

• 1• : an applied science concerned with designing and

arranging things people use so that the people and things interact most efficiently and safely —called also biotechnology, human engineering, human factors

• 2• : the design characteristics of an object resulting

especially from the application of the science of ergonomics

“Fitting the Job to the Worker”

Basic ERGONOMIC principles:1. Reduce Musculoskeletal Disorders2. Reduce wasteful motions3. Decrease fatigue4. Increase productivity5. Increase time efficiency6. Decrease rate of errors in job

Bones

Spinal column-33 total vertebrae Skeletal system- 206 bones

Muscles

• There are 639 (640) muscles in the human body

• There are three types of muscles: visceral (smooth), cardiac, and skeletal.

• Skeletal -voluntary moving muscles.

Lymphatic System

• There are between 400 and 700 lymph nodes and vessels in the body.

• They are the body’s “trash collectors” .

• The lymphatic vessels move one way- from distal to heart.

Q: How does this all go together?????Q: Why does it matter????

• Nutrient Pathway Disorders occur due to static and or awkward postures, force, repetition, vibration and contact stress.

• The above systems are blocked, inhibited or stressed to the point of skin break down, muscle atrophy, paralysis and/or neurological deficits.

• Other involved system- Cardiopulmonary

Genetic or Congenital Risk vs. Other Health Issues

• Age• History of Heart Disease• History of Diabetes• Gender• Compliance of worker• Skeletal disorders

(scoliosis)

CANNOT CHANGE

• Overweight• Lack of sleep/rest (6 hrs

or less of sleep per CDC)• Poor diet• Poor habits (i.e.

smoking)• Poor endurance,

flexibility strength

CAN CHANGE!!!

#1 Risk factor

• Force of grip or pinch during cleanings

• Examples: holding scaling tools, polishing, flossing

Force Risk Factor

#2 Risk factor

• Prolonged vibration of tools

• Examples: hand piece• Study from Journal of

Professional Excellence Dimensions of Dental Hygiene.

#3 Risk factor

• Awkward Postures• Examples: General

cleaning and especially cleaning the upper teeth.

• Reference page: Study completed by Marquette University- Feb. 2005 Journal of California Dental Association.

More Awkward Postures

#4 Risk Factor

• Repetition of tasks• Examples: (2 hours or

more of the same motion without break), patient who has not had prior dental care and has excessive build up.

• Study in Journal of Occupational and Environmental Medicine June 2005. Vol. 47 Issue 6

#5 Risk Factor

• Contact Stress• Examples: the pressure

against the palm applied by tools or the pressure applied to the posterior aspect of the leg or knee (popliteal) while seated

Contact StressOperatory Chair hydrolics had failed- had to sit like this for 35 mins!!!!

Warning Signs of MSD’s

• Decreased strength with gripping instruments• Decreased Range of Motion (ROM) in the

turning of head to side or reaching arms over head, behind back or back of head.

• Numbness or tingling in fingers, elbow or neck.

• Over sensitivity on the posterior surface of the forearm and boney aspects of elbow.

Top MSD’s For Dental Professionals

• Carpal Tunnel- numbness, pain in hand/wrist, and forearm. Wake up with stiff hands

• Chronic Low Back Pain- tight feeling, burning, and aching of lower back muscles.

• Trapezius Myalgia- pain, tenderness and trigger points on upper traps.

• Rotator Cuff Impingment- pain in shoulder when reaching overhead.

• Lateral Epicondylitis (tennis elbow)- pain at elbow, especially when gripping and lifting combined.

• Tension neck syndrome- pain in shoulders and neck due to stress and constant elevation of shoulders.

Other Contributing Risk Factors

• Stressful working environment- Type A personality- perfectionist- less tolerable to change- hurried- impatient- competitive

• Poor lighting• Lack of space• Older equipment• Broken equipment

What to do now???

As Hygienist you teach your patients daily prevention is the key to good

dental health.

Proper Body MechanicsGeneral Rules

1. Push, Don’t Pull.2. Lift With Your Legs.3. 90, 90, 90. (More Like 100,100,100.)4. Keep Spine Aligned.5. Limit Twisting or Bending at Waist.6. Change Positions Often!!!!7. Keep Neutral Hand/Shoulder positions.

Specific Positioning for Hygienist by Patricia Nunn RDH, MS from Dimensions March 2004

Aligning the Spine

90, 90, 90Pay attention to slumping postures, in sitting or standing 100, 100, 100 for hygienist

Pictures and descriptions by Patricia Nunn RDH, MS in March 2004 Dimensions “Preventive Positioning”

Push, Don’t Pull

Limit Bending and Twisting at Waist

Keep Changing Positions

• Sit to stand often• Stand while charting if you have been sitting

for a long time.• Go for a walk during lunch even if it is for 10

minutes. Walk the stairs 5 times.• Complete “Ergo Break” stretches or “Chairside

Stretches”. (see last pages for graphics)

Lift With Your Legs

WHAT DO YOU SEE???

Cleaning room and tools Check out angle of neck & knees

ANYTHING WRONG HERE???

Charting and X-ray stationThis hygienist is working on a child; what are risk factors?

WHAT IS THE “RISK FACTOR”??

• Dentist and assistant

Attention: Anyone with prior history of illness or injury!!!

-As with all exercise programs, if you have any cardiac, respiratory, or orthopedic problems, consult your physician first!!! Do not begin any new exercise without his/her approval. -The following exercises are considered low stress and low impact. However, the holding of positions without proper breathing CAN raise your blood pressure. Again, please consult your doctor first. -Always begin any exercise with 10 minutes or more of slow stretching of all muscle groups.-Always count out loud to assist proper breathing.

A quote from Ben Franklin

“An ounce of prevention is worth a

pound of cure.”

ERGO BREAK

Exercises for Life

CORE EXERCISES1. Paraspinal Squeeze- Stomach in, back and up. While sitting, standing or lying down. Goal: to hold for 30 seconds and be able to talk during the exercise! Repeat 10- 20 times in a day.2. Side lying leg lifts- In side lying on floor, lift both feet off floor as high as you are able (without straining) and hold for 10 seconds. Goal 30 seconds. Repeat 5 times, 3days/wk.

Cont. Core Exercises

3. Large ball exercises- Sit on ball with feet supported on floor or hooked under the bed. Cross arms on chest and lean back until muscles in stomach contract. Hold and deep breathe for 10-30 seconds. Return to neutral, rest if needed and repeat 5-10 times. Do 3 times wkly.

4. Any Yoga class will do. Start with beginners. It is harder than it looks!!!!

5. Plank- Fully extend body on floor, raise to “push up” position and hold for 20-30 seconds. Rest and repeat up to 10 times. 3x’s a wk.

Neck- Stretches

1. No “Turtle Neck” Please- while driving or sitting in a chair. Look straight ahead (no tucking chin) and push head back into head rest. That is what it’s for!! Hold for 5 seconds, repeat up to 20 times. Note: if you do this in the car, only do it during the red lights please!!!!! Set your mirrors while in this position to keep your head in proper position during driving. You wont be able to see out mirrors if you start to slouch.

Neck/Pec Stretches

• Upper trap/levator stretch- While sitting place on hand behind back (over lower back). Next, slowly turn head away from arm that is behind until stretch is felt. For greater stretch, slowly look down. Hold for 10 secs, slowly return to neutral. Repeat up to 5 times. Do each side. Warning: DO NOT COMPLETE THIS STRETCH IF YOU HAVE ANY NECK INJURIES, SPINAL STENOSIS, BULGING/HERNIATED DISC OR CAROTID ARTERY BLOCKAGE.

Legs

1. The “Sonicare” Squat- During the two minutes you brush your teeth you can bend slightly at the knees and hold. Be sure to breath comfortably. Don’t worry about holding it the entire 2 minutes the first go around. Two minutes is your goal. Repeat twice daily (and floss!!!!)

2. Take the stairs or park further from building. Not a problem if you don’t have a BLUE lot parking pass!! Every little bit helps.

3. Piriformis Stretch- Laying or standing. Watch demo.

Legs

3. Lunges- Slow and steady without weights to start. Make sure the knee of the leg stepping forward never goes beyond the foot on the floor. Can add weights (2lb.-5lb.)as you tolerate, 20 reps each side without any soreness next day.

Shoulder/Arms

1. Corner Push ups- Stand in a corner, place arms on opposite walls at shoulder height and at comfortable distance apart. Slowly bend elbows, while keeping head in neutral until scapula’s touch. Hold for 10 sec, return to start, and repeat x’s 20. 3x’s wkly. (Hold longer for stretch, less reps.

2. Bench press- Lying on floor or firm bed with knees bent comfortably. Grasp rod with both hands (mop or broom) and lift straight up toward ceiling. This should be slow and smooth. Once fully extended hold for count of 10, return to start and repeat x’s 20. 3x’s wkly.

Arms/Shoulders

3. Ball or balloon toss- Can play with the kids for 15 minutes hitting a beach ball or balloon in the air. To make it harder add 1lb. wrist weights. Any task completed with arms above the shoulders is two times as stressful on the heart. Take breaks as needed.

4. Tricep/Sawing logs- Start with 15oz can of food or a bottle of water in one hand. Lean onto table with other hand for support. Move hand with bottle back and forth from floor to ceiling in a “sawing motion”, slowly repeat 20 times. 3x’s wkly.

Aerobic Exercise

• Walking is the best low impact aerobic exercise. You can do it anywhere. Make sure you keep a swift pace (WHERE’S THE FIRE) and swing your arms forward and back. When they come forward you should bend slightly at elbow. This works biceps and triceps.

• Low impact aerobics, Swiss ball, Pilates and low impact circuit training are all good.

AT HOME

• You only work 8-10 hours a day. Pay attention to what you do OFF the clock. House cleaning tasks, cooking, washing dishes and yard work.

• Also, what type of pillow do you have? When was the last time you bought a new one? Is it contoured? What type of sleeper are you- side, stomach, back with arms above?????

• What type of mattress do you have? 1/3 of your life is spent in bed

• Watch time spent on laptops and other devices.

Recommended Equipment

Saddle Stool Loupes

Recommended Equipment

• Blue Boa Suction System• Tools with VERA system• Ultrasonic tools• Other Magnification systems- procedure scope, surgical

operating microscopes, generic magnification lenses• Seat cushions which give a slight forward tilt. For

example: Fit-Sit found online at ergonomic-products.com. You sit ¾ of your day. Swiss ball stools and those with adjustable arm rest and backs are also wonderful. Trade with others at lunch.

Recommended Techniques • Use the 12 o’clock method- over the head.• Use your mirror for upper teeth cleaning.• Change sides or positions often, if possible.• Position the patient to better suit you- get your stool

set for you first, then adjust patient to elbow height.• Take Ergo Breaks after every cleaning. Should only

take 2 minutes tops.• Arrange tools within 16” of center, at the most 24” for

less used tools. Adjust height of tray at elbow height.

Bibliography and Reference Resources

• OSHA.gov - This is the official website for the Occupational Safety and Health Administration. Search Ergonomics and it will bring up a variety of tools to assess you office, work and home. Search Ergonomics for Dental Professionals for a list of potential risks and ADA/OSHA Alliance explaining their joint effort to educate those in the Dental Industry on safe working conditions and technical knowledge in the area of Ergonomics.

• NIOSH.gov – The National Institute of Occupational Safety & Health. • CDC.gov – The Centers for Disease Control and Prevention. Search Ergonomics.

They have over 1300 results. Yet the first one on the list is Musculoskeletal Disorders and Ergonomics Programs and Guidelines. Must be a hot topic!

• Ergonomicsimplified.com – free evaluation tools and equipment. • Ehs.uky.edu – Home page of UK Environmental Health and Safety. Search

Ergonomics.• Backschoolofatlanta.com - variety of classes, books & listings of professional

Ergonomic specialist (just like Mrs. Clark- look for her name )

Continue of Bibliography and Reference Resources

• Karwowski W., Marras W. The Occupational Ergonomics Handbook. Flordia: CRC Press LLC 1999:1765-66

• Murphy, D. (Ed.), 1998, Ergonomics and the Dental Care Worker, Washington, D.C.: American Public Health Association.

• Matiyakon W.,McNitt-Gray J. The Journal of Professional Excellence Dimensions of Dental Hygiene. Preventing Shoulder Injury. January 2007;5(1)16-18.

• Nunn P. The Journal of Professional Excellence Dimensions of Dental Hygiene. Preventive Positioning. March 2004;2(3):12-14,16,18-19.

Continue of Bibiography and Reference Resources

• McKenzie, R. Treat Your Own Neck (Back). 3rd ed. New Zealand: Spinal Publications 1997.

• Murphy, D. Ergonomics and the Dental Care Worker. Washington: American Public Health Assoc. 1998

• Valachi, B. Practice Dentistry Pain Free. Evidence-Based Strategies to Prevent Pain and Extend Your Career. Portland, OR: Posturedontics Press. 2008.