Content Dam Diq Online Articles 2018 04 Kupczyckthum42718

The ergonomics behind uncooperative dental patients: Holding your tongue while holding theirs

April 20, 2021
Kathryn Kupczyk, RSDH, describes how important it is for dental patients to assist with the ergonomics involved with treatment.

Upon graduating dental hygiene school, I was elated to accept a position in a private practice office. The frustrations, stress, and constant planning of appointments in the hygiene clinical setting would be different in the real world. Handling challenging clinical patients in the context of school was something that was just that—in the context of school. Dental patients in the private practice setting would be more accommodating, “regulars” if you will.

However, it was to my dismay that many patients instead feel they can demand and command the hygiene appointment. Instead of the hygienist taking control, the hygienist internalizes stressors such as fear of disappointment, pressure to keep the flow and positivity of the appointment going, and the insurmountable amount of mental and physical load.

Holding their tongues, defy physics in what shape a human spine should be, and get through the appointment.

The patient, in turn, learns that this behavior is accepted, and will more than likely repeat such behavior at their next appointment. Your patience is taken advantage of, and, yet you must continue through seven more appointments that day.

Ergonomics during each dental patient appointment are important; however, it’s usually the first thing to go. There are many reasons for this. Either the patient is refusing to be in the correct positioning for the procedure, or the female hygienist feels uncomfortable to not be at the correct closeness to the patient. To be ergonomically correct, women must work closer to the patient's head than is socially comfortable.1 Social constructs of gender require that women maintain an appropriate distance.

Therefore, women may have to assume more difficult postures than their male counterparts and may also be more prone to musculoskeletal disorders (MSDs).1

You might also be interested in: Stress management techniques can benefit both your career and patients

Impact of poor ergonomics

The successful application of ergonomics assures high productivity, avoidance of illnesses and injuries, and increased satisfaction among workers.2 Of course, adjustments will be needed for patients who for medical reasons cannot lay supine in the dental chair. It is helpful to work with your dental team to foresee these changes and plan ahead in your schedule. More stress is placed on the spinal disks when lifting, lowering, or handling objects with the back bent or twisted compared with when the back is straight.2

Moreover, effects of repetitive motions from performing the same work activities are increased when awkward postures and forceful exertions are involved.2 These effects include several work-related musculoskeletal disorders (WMSDs) including, but not limited to: lower and upper back pain and wrist conditions such as Tendinitis/tenosynovitis, De Quervain's disease, trigger finger, carpal tunnel syndrome, and Guyon's canal syndrome.2

Research has shown that dentists and dental hygienists with work-related MSDs show a significant tendency to be more dissatisfied at work and to be more burdened by anxiety, experiencing poorer psychosomatic health, and feeling less confident.2 Although stretching, correcting posture and ensuring the operatory has the correct feng shui can help, it is a two-way street.

Both you and your able-bodied dental patient need to synergistically adapt to guarantee good working postures, sufficient lighting, and easy access to required instrumentation and materials for different working practices and clinical procedures. Do not be afraid to move and again move a patient in the correct way. Explain to your patient why the positioning they are in is important for the success of the procedure and for you as their dental provider.

Another reason to retire early

Second to WMSDs, cardiovascular disease is the second reason that most dentists retire early from their careers. Although research on this topic has not been done for hygienists, it is worth mentioning that internal stress affects the body negatively from a cardiovascular standpoint. Find a healthy outlet to oust stressors accumulated in the workplace. Brainstorming, implementing, and practicing a comprehensive stress-management program might be a better response than unhealthy ways of expelling work-related stress.

Recently, I have felt this stressor becoming more commonplace as a side effect of social media. Certainly, there has been an epic switch in how people communicate since the advent of social media.

More dental patients now command and demand their dental treatment (or the lack thereof) instead of the dental professional prescribing treatment options. Perhaps there is a perception of hearing the dental treatment I am presenting as if it is “fake news.”

In a way, we are all being trained to be skeptics. As of August 2017, two-thirds of Americans report that they get at least some of their news on social media—with two-in-10 doing so often, according to a new survey from Pew Research Center. For the first time in the Pew Center’s surveys, more than half (55%) of Americans ages 50 or older report getting news on social media sites such as Facebook and YouTube.

Although I may have built a case of comprehensive clinical evidence that would make CSI proud, some patients will deny treatment haphazardly, regardless of the amount of intraoral photos, measurements and tests now displayed on the monitor in front of them, and performed on them minutes before. Coming up with a synergistic way for the entire team to handle these skeptical conversations is helpful and necessary. For health and well-being of the patient is at the heart of the prescribed treatment. You are not alone. Everyone in the office should be repeating a united message.

Being realistic and having realistic expectations with your patient, the doctor, office, and self should be a part of your comprehensive stress management program. Being empathetic but forthright during a patient’s appointment about positioning for a specific procedure (including prophylaxis) will help to keep the hygienist comfortable and more productive. Using social media in a positive light can offer new ways of delivering evidence-based patient education for treatment. Know what information is out there and how to steer patients into watching or reading scientifically based literature or videos on dental diagnosis, treatments, and materials used.

Having a way to alleviate cumulative stress throughout the day is essential. Don’t hold your tongue. Speak up about your well-being and remember it is OK to put your physical and mental health and safety first. The result will not only be a happier you; a longer successful career and happier patients with better care in the long run.

Originally published in 2018 and updated regularly


  1. White SW. Ergonomics U How does dentistry fit you? WDJ 2003; 1(1):58-62
  2. Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in Dentistry. Int J Clin Pediatr Dent 2014;7(1):30-34.