by Juli Kagan, RDH, M.Ed.
Dear RDH eVillage:
I am looking for information on degenerative disc disease and how it relates to hygienists, as well as more about chairs, loupes, catalogs, and occupational therapies.
Thank you!
What is degenerative disc disease?
When the intervertebral discs degenerate, the condition is called degenerative disc disease. Actually, it is a condition, not a disease, which can be painful. Fortunately, it is uncommon, especially among dental professionals. Our problems seem to be more on the lines with musculoskeletal disorders like such as chronic low back pain, tension neck syndrome, trapezius myalgia and rotator cuff impingement (see article by Bethany and Keith Valachi: JADA, Vol 134, No 10, 1344-1350).
Degenerative disc disease is a term that is used to describe the normal age-related changes that can occur in the spine, and can include loss of fluid in the discs and tiny tears or cracks on the outer layer of the disc. Interestingly, two people can have minor degenerative disc disease and one can be asymptomatic while the other person can feel debilitated. More often than not, the condition is brought about by changes in the discs and not from the mechanisms of musculoskeletal disorders, so often found in dentistry.
For more information, here are some references:
- http://www.webmd/cp,/bak-pain/tc/degenerative-disc-disease-topic-overview?
- http://en.wikipedia.org/wiki/Degenerative_disc_disease.com
Chairs, loupes, and other helpful information
There is as much information on this topic as there are styles and types of shoes (gosh, help us!). Below is a bit of information to help you make more informed choices.
Chairs
There are numerous differences in chairs and they are all dependent on you. Are you smaller, larger or just average in size? How about your height? Short, tall, or average? Consider a chair that is just for you. Like the three little bears.
- Do you sit in the center of the chair, or are you often perched? Sit in the center. No negotiating here.
- Consider shifting your vertical position from 90 degrees to slightly pitched forward, as if you are ready to play a sport. There is actually a seated position called the runner's stance where one leg is forward of the other and you are slightly sideways of the patient.
- Clinical dental hygiene is an athletic event. If you don't think so, don't strengthen any muscles and see how you feel after working only a couple hours, let alone an entire day. Contraction allows for action.
- Move your patient. Don't contort yourself!
- Sit on a chair that is about 25% larger than your bottom!
- Get a "wedge" if necessary to sit with your hips slighter higher than your knees (and to help you pitch forward).
- Consider toggling between standing and sitting. I often suggest for longer appointments, such as SRP, to sit for the maxillary and stand for the mandible.
- Consider ergonomic chairs; they may be a bit more expensive, but you'll save your finances and body on the back end (pun intended!).
- Be sure your lumbar region is supported. Get a pad or cushion to help if needed. The chair should have it built in on higher end models.
- Consider a chair with arms, especially if you have neck issues. Learn how to use the chair.
- Consider fabric, which has texture versus slippery leather, which can make you work harder at balancing than necessary.
- Be ready to buy your own chair. It's your body in the end. You are worth the investment.
- Test-drive the chair just as you would a car. And price point matters. More expensive may not always be better.
Resources:
- orascoptic.com
- rgpdental.com
- * From March 10, 2006, RDH eVillage
Loupes
Basically there are two types of loupes: through the lens (TTL) and flip-up. The difference between the two is night and day. Personally, I believe, if you can, splurge on the TTLs and consider them a gift to yourself. Your eyes, mind, and body will thank you.
Like a pair of socks or nylons you wear with your shoes, there are differences, both personal and functional.
Some notes of interest:
- Loupes can be expensive, but they are worth it!
- There is a learning curve which can be challenging at first. Stay with them!
- Your clinical dental hygiene will be higher quality. You will see why literally!
- You will be more efficient with your care and services.
- Your posture will improve, as long as your focal length and declination angles are correct.
- Your shoulder, neck and back muscles will seriously thank you!
- 2.0 to 2.5 magnification is often a good option for dental hygiene care.
- With increased magnification, your field size and brightness decrease.
Resources
- designsforvision.com
- orascoptic.com
- sheervision.com
- surgitel.com
- zeiss.com
Catalogs/Accessories:
- The Blue Boa suction device
- Instruments: different Handles, Sharpness, Double sided mirrors
- Ultrasonics: USI-top of the line, Slim-line inserts.
- Light, automatic handpieces
More ergonomic resources
- http://www.ada.org/prof/prac/wellness/ergonomics.asp
- http://www.rdhmag.com/articles/article_display.html?id=256863
- http://www.dentistrytoday.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=23CC77C3BD074F359214FD4F50FE605B
Occupational therapies
The primary occupational risk factors for MSDs discussed in the literature include: (1,2,3,4,5)
- repetition
- force
- mechanical stresses
- posture
- vibration
- cold temperature
- extrinsic stress
- precise nature of dentistry
- work schedule
- coping with patient anxieties
References
- Herring SA, Weinstein SM. Assessment and Non-surgical Management of Athletic
- Low Back Injury. In JA Nicholas, EB Hershman (eds), The Lower Extremity and
- Spine in Sports Medicine. St. Louis: Mosby, 1995: 1171-1197.
- Frymoyer JW. Back pain and sciatica. N Engl J Med 1988;318:291-300.
- Cypress BK, Characteristics of physician visits for back symptoms: a national
- perspective. Am J Public Health 1983;73:389-395.
- Berquist-Ullman M, LarssonU. Acute low back pain in industry. A controlled
- prospective study with special reference to therapy and confounding factors. Acta
- Orthop Scand 1977;170:1-117.
- Von Korff M, Deyo RA, Cherkin D, et al. Back pain in primary care. Outcomes at
- 1 year. Spine 1993;18: 855-862.
Important considerations
- Operator positioning for wrist, neck and back positions
- Patient positioning
- Patient chair
- Lighting
- Work environment
- How tall are you? This is one of the major contributing factors for MSD's in dentistry.
This list can go on and on (as a matter of fact it does, every month in RDH magazine by Anne Guignon in the Comfort Zone Column).
Finally...
Clinical dental hygiene is an athletic event! Train your body as if you had an endurance competition. You do! Everyday with all your patients!
Take time for yourself. Make an appointment in your calendar to care for you! Your patients will reap the benefits and more importantly, you will feel healthy, vibrant and strong! What more could you ask for?
When you’ve got your health you've got everything!
MIND YOUR BODY: Listen to what it is telling you and…
KEEP MOVING! Both throughout your day and in the gym, outdoors, on an elliptical machine, wherever!
Juli Kagan, RDH, M.Ed., is a certified Pilates instructor, and author, speaker, educator. Review her book, Mind Your Body at MindYourBodyBook.com. You can contact Juli at: [email protected].
