Hand pain among dental hygienists: Chiming in on the conversation

How many hours a day should dental hygienists work to preserve hand health? Ann Guignon, RDH, offers this perspective.

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I recently came across the following social media post by a dental hygienist. The conversation piqued my interest, and I believe it will pique your interest too:

Has anyone ever come across any research about hand health working five days a week versus four days a week? I started working five days three months ago, and my hands now hurt so bad all the time. I cannot even open jars anymore.”

Fellow hygienists started commenting immediately:

My hands started hurting when I picked up a fifth day.

When I was working five days a week (44-plus hours a week), I was dead by Friday afternoon—mentally and physically. I’ve heard many seasoned hygienists say you should not work over four if you can help it.

My hand went out when I changed to a 10-hour day, four days a week. I ended up with bad ligaments due to hyperflexion.

Now I Cavitron almost all patients and switched my instrument handles to larger ones. It has made a difference.

I worked five days a week for 14 years and it was way too hard on my hands and back. I only work three days now and I feel so much better.

I see a hand therapist. Game changer.

Try right and left gloves. Made a difference for me.

As this comment thread, scientific research, and our own experiences tell us, hand pain, fatigue, and discomfort can be very complex problems. Every commenter in this thread had valid points—and unfortunate experiences.

How much work is too much?

The number of days per week that hygienists work is important. However, there is no standard definition of a "day." Some clinicians have a workday that is six to eight hours long, while others work 10 to 12-hour days. There are clinicians who work consecutive days, while there are others who break the work week up with a day off in the middle.

After reading a dozen additional posts online, I decided to chime in with a "do you..." dialogue. Here is a sample of the many questions I asked:

How long are your appointment times?

How difficult are your patients?

How many patients do you scale in your workday?

Do you take breaks or have a lunch time?

Do you try to power through the day?

Do you try to stretch during the day?

Are you doing chart notes on a computer?

How good are your instruments?

Are your instruments sharp?

Do you have sharpen-free instruments?

Do you have a power scaler that works?

Do you used a tight grip on the mirror for retraction?

Do you hold the high- or low-speed suction device?

Do your gloves cause hand constriction?

Do you use gloves that create thumb stress?

Do hold on the prophy paste cup in your fingers?

Does your room configuration allow you to keep your wrist in neutral?

Are your polishing handpieces heavy?

Do your polishing handpieces swivel?

Is your power scaler handpiece heavy?

Do your power scaler or handpiece cords cause significant cord torque?

Do you use a cord-supported device or technique?

Do you have a long drive to work?

Do you use a tight grip on the steering wheel?

Do you eat balanced, nutritious meals?

Do you drink enough fluids?

Do you get enough sleep or good quality rest?

Is your wrist bent while you sleep at night?

Do you feel mentally stressed?

Are you predisposed to arthritis?

Are you diabetic or prediabetic?

Are you prone to depression?

Do your outside activities involve your hands and fingers, such as playing the piano, knitting, gardening, or cross stitch?

Do you have a preexisting structural disorder such as scoliosis?

Have you experienced an athletic injury or an accident?

Are you spending lots of time texting or on a device keyboard?

What your body needs

There is substantial research showing the body needs to rest. The body needs sufficient time to repair from repetitive motion and cumulative trauma. Working a schedule such as three consecutive 12-hour shifts simply will not allow the body enough time to repair. Muscle soreness is the first sign that damage is going on. Without rest, it can become permanent.

Every hygienist who is experiencing discomfort is headed down a rocky path. It is wise to be concerned about what your body is telling you. I do not know of any research that specifically ties the number of hours per week to a specific type of physical issue, but there is a significant rise in injuries among dental hygienists.

Most of the time, whatever is going on is not a result of just one action or piece of equipment. There is no one right answer for any situation. Just as caries and periodontal disease are complex situations, so is the development of a cumulative trauma disorder.

The incessant use of digital devices brings a new wrinkle to the conversation. Texting is very damaging to the thumb. Handheld devices are getting bigger and bigger, and creating more stress on users’ hands. Devices are everywhere and people are spending hours online and on their phones every day. These behaviors further exacerbate the stress of clinical practice.

Please take care of your body. Cutting back on your days or other strategies can have a positive impact on your health and your future. Do not let anyone lay a guilt trip on you for wanting to work less or wishing to work differently. We need to advocate for ourselves. We need to be part of the solution, which is the reason each one of you is asking questions. We are not human scaling machines.

Editor's note: Online posts edited for clarity.

Anne Nugent Guignon, MPH, RDH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at anne@anneguignon.com.

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