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Got pain? How dental hygienists can relieve occupational pain with multi-modal approach

Dec. 19, 2017
Lisa Wadsworth, RDH, and Tom Viola, a pharmacist, discuss medications often used for treatment of occupational pain.   

By Lisa C. Wadsworth, RDH, BS, with Thomas A. Viola, RPh, CCP

Musculoskeletal pain is real, yet often dental professionals (administrative team included) feel compelled to keep working, suffering in silence all the while trying different modes of self-help, drugs, or anecdotal therapies.

Believe me, I can relate. In my past history, neck, back, and shoulder pain led me to medical appointments, chiropractic care, physical therapy, yoga, weight lifting, acupuncture, rest, and finally surgery. After undergoing the surgeon’s knife for both cervical and lumbar spinal fusions, my world was crumbling.

A full-time career in dental hygiene came to an end, and my spirit was broken. Knowing that there are many clinical providers suffering in silence, the goal of this article is to share a bit of my story while also inviting Tom Viola to provide insight into how some medications may be helpful.

The practice of dental hygiene holds the greatest risk for musculoskeletal disorder (MSD). For some, signs of fatigue, pain, and nerve sensitivity start before we graduate from hygiene school. What’s more, approximately 96% of dental hygienists have experienced work-related pain during their careers.(1)

Caregiving in the dental profession causes the practitioner to hold muscles and the spine in unnatural and static positions for long periods of time. This places our necks, shoulders, spine and hands at tremendous risk for permanent damage.

You can say that our bodies weren’t designed for careers in dental hygiene. Our bodies are meant to be in motion—flexing and stretching in normal forward, or up and down ranges, not suspended unnaturally, like a robotic machine over our patients for eight hours a day. If our bodies came with a warranty, working in hygiene would void it!

The path to diagnosis—let alone wellness—is sometimes subjective, as is the measurement of individual pain thresholds. The feeling of pain is not clinically measurable with an “ouch meter.” Pain thresholds are different for everyone and are often compounded by a physiological and/or psychological component.

For most, the thought of a disability claim and loss of a career as a caregiver are overwhelming and frightening. Despite this fear, we have been programed to keep everything we need within close range so that we do not have to move to reach the next instrument or gauze square, further exacerbating the static position that wreaks havoc on our bodies.

Fortunately, the tide is shifting to wellness and self-care first, yet so many of us are hurting and trying to go it alone. If you have ever sat with colleagues at a dental meeting, just look around you. What do you see? Our colleagues are stiff, slow to get up, limited in the use of their hands, arms and backs, trying desperately to reinvent how they practice or what will come next. We can’t sit still for one more minute, nor should we!

So, what do we do in the meantime? Some turn to prescriptions or over-the-counter aids without much knowledge or medical support. Perhaps when Mick Jagger sang about “Mother’s Little Helper” he was referring to the pills that a provider may use to ease the pain and get him or her through the day.

Enter advice from the expert! Tom Viola, a nationally recognized speaker and pharmacologist, has these words for us all. Read and absorb.

Viola’s Advice

Obviously, what we need is a comprehensive pain management program, which includes physical therapy and avoiding the activities and exertions that caused the injury in the first place and now perpetuate the pain.

In addition, non-prescription analgesics play an important role in the treatment of acute musculoskeletal pain. These include the nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen) as well as the drug acetaminophen (Tylenol). Many patients believe that since these agents are available without a prescription, they are inferior in their ability to relieve pain, when compared to the opioid analgesics (such as hydrocodone and oxycodone).

However, many studies have concluded that the opposite is true. At regular doses, non-opioid analgesics are as effective as opioid analgesics in relieving musculoskeletal pain, without the potential for producing serious adverse reactions (such as respiratory depression) and without the potential for dependence and addiction.

NSAIDs inhibit the production of prostaglandins which produce pain, fever and inflammation. While doses of up to 400mg are effective for treating cases of mild to moderate pain, higher doses provide no further true analgesic effect. Yet, ibuprofen is still effective for treating cases of moderate to severe pain at higher doses, up to 600mg to 800mg. How? At these higher doses, ibuprofen also produces its anti-inflammatory effect, and almost all cases of musculoskeletal pain involve some degree of inflammation.

However, NSAIDs also inhibit the production of prostaglandins which produce numerous beneficial effects, such as the production of the gastrointestinal mucous lining, regulation of normal platelet activity, bronchodilation and maintenance of adequate blood flow to the kidneys. Thus, NSAIDs also produce adverse effects such as gastrointestinal upset and mucosal injury, increased risk of bleeding, difficulty breathing and possible kidney damage, especially with long-term use.

NSAIDs may interact with lithium and with methotrexate, since NSAIDs may increase the blood levels of both drugs and produce serious adverse effects. In addition, NSAIDs should be avoided during pregnancy since they may decrease prostaglandins necessary for maintaining proper fetal circulation during pregnancy and for uterine contraction during delivery.

Although there is yet no non-prescription analgesic product that combines an NSAID with acetaminophen, several studies have demonstrated that such a combination offers superior analgesia and is more effective in the prophylaxis and treatment of acute musculoskeletal pain than either acetaminophen or the NSAID alone. Acetaminophen and NSAIDs have similar but different mechanisms of action and, so, a combination of the two ingredients would offer a synergistic approach to pain relief. Several non-prescription analgesics also contain caffeine. There is considerable evidence that products containing caffeine demonstrate greater analgesic efficacy than products containing the analgesic alone.

Choosing to use non-prescription analgesics is just a piece of the pain management puzzle. Other modalities such as low impact exercise such as yoga, stress reduction techniques, massage therapy, acupuncture, and hydrotherapy methods can contribute to pain relief and physical rehabilitations.

The bottom line is that pain management is a very complex and personal process. There is no silver bullet, or one-size-fits-all solution. Instead, maintaining the right balance of traditional pharmacology and non-drug related therapies is probably the most effective and least addictive route to recovery and/or coping.


So, take Tom’s knowledge to heart, you will be well prepared to seek the advice of your medical provider instead of going it alone. A multidisciplinary treatment plan for healing and comfort may be the best way to gain control of your body and your career.

We leave you with hope for the new year, and ask that you place your health and self-care first.


  1. Hayes MJ, Smith DR, Cockrell D. An international review of musculoskeletal disorders in the dental hygiene profession. Int Dent J. 2010;60:343–352.

Lisa C. Wadsworth, RDH, BS, is the owner of Lisa C. Wadsworth Inc., a consultancy focused on coaching and education for the entire dental team on periodontal protocol, oral systemic-links, implant dentistry, and ergonomics. Lisa is a certified life coach and has successfully coached dental providers who must leave the clinical setting. Lisa began her career as a dental assistant, progressed to a certification in implant surgical assisting, a degree in dental hygiene, a bachelor’s degree in psychology, and certification as a life coach. Lisa is a frequent writer for many national hygiene publications. Contact Lisa at [email protected], visit her website at, or call (215) 262-6168.

Thomas Viola, RPh, CCP, the founder of “Pharmacology Declassified,” is a board-certified pharmacist who also serves the dental profession as a clinical educator, professional speaker and published author. Tom is on the faculty of ten dental professional degree programs and has received several awards for outstanding teacher of the year. Tom has presented hundreds of continuing education courses to dental professionals, nationally and internationally, in the areas of oral pharmacology and local anesthesia and is well-known for his regular contributions to several dental professional journals. Contact Tom at [email protected], visit his website at or call (609) 504-9252.