By Anne Nugent Guignon, RDH, MPH
Branding an instrument or device as “ergonomic” is a catchy way to market products today. In reality, that which creates ergonomic bliss for one can turn into an ergonomic nightmare for another. When added up, it is often the little things that make a big impact on how we feel at the end of the workday.
The science of ergonomics creates or adapts a device, product, or activity to the user, not the other way around. Using devices or performing tasks without considering the ergonomic implications of the activity can create a situation where the user is subject to repeated micro-traumas over time. This leaves the worker at increased risk for developing a wide variety of workplace-related musculoskeletal disorders.
Dentistry is risky business and many dentists, assistants, and hygienists are experiencing repeated micro-traumas everyday. There are some very simple things you can do that will lessen your chances for developing a workplace-related musculoskeletal disorder.
Small-diameter instrument handles, causing clinicians to increase their pinch-grip, create unnecessary hand fatigue.
Maintaining a solid grip on your instruments should not result in hand fatigue. Many things come into play that can dramatically affect how comfortable one can be with handheld devices.
Take a look at your instruments. The weight and diameter of the instrument handle is important. Larger-diameter instruments lessen the pinch-grip that is required to maintain control. Weight plays an important role as well. Lighter-weight instruments are generally recommended; however, there are instruments that are so light that some clinicians actually increase their grip in order to keep the instrument under control.
Years ago, instrument handles were skinny and made from solid metal, which added to the overall weight. Today, there are dozens of designs that range from hollow metal handles to resin/metal combinations, all-resin handles, and silicone-padded handles.
The overall balance of the instrument also is important. Unbalanced instruments are heavier at one end. They require the user to exert more pinch-grip or to grip the handle in a position that reduces the overall control of the instrument’s working end. Unless you are familiar with a particular brand, it is wise to evaluate instruments firsthand before purchasing. There are several ways to do this - a dental convention, an in-office lunch-and-learn program, or an appointment with a dental supply company representative.
If you have a drawer filled with skinny instruments, an after-market medical-grade silicone grip can be added that can increase the diameter of the handle in addition to providing a more comfortable gripping surface that is color-coded and textured.
Today’s clinicians can choose from a wide variety of larger-diameter, textured and padded instruments.
Speaking of texture, this is one of the most important features we should look for when selecting equipment. Texture equals traction. The oral cavity is, at best, a moist environment, so products that feature some type of surface texture naturally lessen the user’s pinch-grip. Imagine walking across an icy parking lot in the winter. Your boots should have texture to help prevent you from falling. The same applies to gloves, instruments, and handpieces.
Gloves are such an integral part of our day. Gloves that are too small continually stress delicate nerves, blood vessels, tendons, and ligaments in our hands. In contrast, gloves that are too large force users to strain their hands just to keep the glove material in place without bunching up.
Gloves should comfortably fit the width of the palm as well as the clinician’s wrist and fingers. Properly fitted gloves reduce hand strain. More and more clinicians are selecting hand-specific gloves that are fabricated with the thumb in a natural position. Ambidextrous gloves force the thumb into the same plane as the other fingers, creating thumb and hand discomfort for some wearers. Hand-specific gloves are now nearly the same cost as ambidextrous varieties. Ambidextrous gloves were intended to be used for short periods of time. Clinicians should be wearing hand-specific gloves for procedures that are longer than an exam. Any perceived difference in cost will be well worth the overall increase in comfort. After all, our hands are doing an incredible amount of work all day, every day.
While proper infection-control procedures must be followed in the clinical setting, certain barrier techniques can cause clinicians unnecessary strain. The loose, baggie-type coverings placed over a dental chair or an X-ray head do not create the same type of problems as the loose vinyl barriers that are used to cover devices like handpieces, air/water syringes, or ultrasonic handpieces. Clinicians must maintain a steady grip on these implements. Barriers that are slippery or loose cause them to exert a tighter pinch grip to maintain control over the devices.
Self-adhesive barriers, which attach firmly to the covered surface, reduce slipping and allow the clinician to maintain a lighter pinch-grip. These films are easy to remove and replace when the procedure is finished.
The saliva ejector on the left is bent for hands-free suctioning in contrast to the standard configuration.
Suction devices can be another source of micro-trauma. An individual saliva ejector apparatus is generally user-friendly because the apparatus is often positioned so it hangs freely in the corner of the patient’s mouth. Even if a clinician or dental assistant holds this type of device, minimal weight is usually involved. Flip switches that activate the saliva ejector suction are easier to operate than the traditional dial switches.
There are saliva ejector devices specially designed to keep the patient’s tongue away from the operating field. There are also mirrors, fabricated with tiny holes on the perimeter, which function as a suction device. The surfaces of many disposable mirror suction devices are not that precise; however, the all-metal mirror suction devices tend to be heavy.
The high-volume evacuation (HVE) devices present a much greater threat to the user. The HVE hose apparatus weighs much more and is stiffer than a standard supple saliva ejector hose, creating more strain on the user. In addition to the weight, users often must position their wrists in a non-neutral posture in order to place the suction tip in the right place in the oral cavity.
An HVE suction device has been developed to remedy this situation. The autoclavable, all-metal device features a fingertip swivel with a removable neoprene sleeve, creating a more comfortable padded surface.
Curly, heavy hoses add unnecessary weight and create strain on the user’s wrist.
The hoses that attach to handpieces, saliva ejectors, and air/water syringes are a definitive source of micro-trauma. If your office has the old, curly hoses, replace them with newer, lightweight straight hoses at pennies per foot. While weight is an obvious issue, the resistance created by a curly cord can be deceptive. It is quite inexpensive to put on new ones, and your wrist and hands will appreciate this small change. For those who are handy, new hoses and tubing are readily available from dental supply companies.
Most dental offices take impressions to fabricate patient-care devices such as bleaching trays and occlusal guards. Different types of stone and plaster are used to fabricate mouth models. Ergonomically designed mixing spatulas, specifically developed for either a right- or left-handed user, are now available. The hand-specific grip places the user’s thumb and fingers in a comfortable position.
Newer, more pliable mixing bowls that come in standard and small sizes allow for a more comfortable grip during mixing. Some are even flexible enough to turn inside-out, which makes cleaning a snap.
New ergonomically designed mixing spatulas are designed with hand-specific handle grips. Ultra-flexible mixing bowls making cleaning a snap.
Since we’re just starting a new year, why not take a few minutes to evaluate how you’re working and what you’re using? After all, the little things add up!
Anne Nugent Guignon, RDH, MPH is an international speaker, with her popular programs including talks on ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. She has practiced clinical dental hygiene in Houston, Texas, since 1971. She can be reached at [email protected] or (713) 974-4540.
