By Myriah Shimatsu
From the Fall 2019 Journal of the Colorado Dental Association
It’s a no brainer that the dentist is the most valuable asset to any successful dental practice. However, it is estimated that more than half of practitioners have some sort of musculoskeletal disorder that is career related. The research suggests that 64%-93% of dentists, hygienists and dental students have an episode of skeletal or muscular pain. With the most prevalent areas being in the lower back (36.3%-60.1%) and neck (19.5%-80%). Musculoskeletal problems are the leading cause (29.5%) for early retirement in the dental profession, followed closely with cardiovascular disease (21.2%).
Dentistry typically does not contribute itself to good ergonomics, though with the proper equipment and tools, along with practice to correct bad postural habits, it is possible (Figure 1). A dentist can spend upward of 60,000 hours in a lifetime of practice in tense, distorted positions resulting in stress, pain and long-term musculoskeletal problems. The scope of ergonomics in dentistry is extensive; dentists need to alter and guarantee good working postures, adequate lighting and easy access to required tools for different working practices, while keeping the patient and operator comfortable.
When looking at lower back pain as the leading musculoskeletal issue, consider your operating stool as a piece to the puzzle. There are six key elements to consider when choosing an operating stool: gender, lumber curve, height, operatory, disc health (Figure 2) and body type. Of these six factors, lumbar curve is probably the one that will yield the biggest impact on lower back pain. You need to assess your natural lumbar curve and be able to maintain that position when seated and working on a patient. The seatpan influences lumbar posture significantly; most people want the seat pan tilted down to help achieve a natural lumbar curve. Lumbar support is the number one way to reduce lower back pain and relieve symptoms of musculoskeletal issues (Figure 3).
Neck pain is another common musculoskeletal issue in dentists resulting, most of the time, from rounded shoulder posture and working with the neck flexed greater than 20 degrees (Figure 4). Repositioning the operator, patient and loupes are great options to improving neck pain. However, when choosing lens loupes, you must also consider the proper ergonomics of face shape, distance between eyes and nose bridge. Thus, consider the correct ergonomic frames for loupes to be most effective.
Another factor to consider is whether your operating stool has an arm rest. The absence of an arm rest can cause stress in neck related musculoskeletal issues. Using a stool with an armrest can allow the shoulders and neck muscles to relax, therefore reducing tension and pain in the neck region. It is important to use head posture exercises and trigger point therapy to address these issues. A great simple neck exercise to perform before each patient is a chin tuck (Figure 5).
Although some of these issues require assistance from a manual therapist, new tools or equipment to improve ergonomics, others can be addressed through small changes and self-discipline. Start to make alterations in your posture and the way you practice by integrating some of these suggestions into your daily routine and office. You will discover that you have less fatigue and pain at the end of the day, and you will be able to offer the quality of service that you and your patients mandate.
Here are seven guidelines for a dentist to improve wellness while working more comfortably with less fatigue—which ultimately can extend his/her career:
- Correct the ergonomic problems in the office and treatment rooms. Hire an ergonomic specialist to assess the environment and tools.
- Seek help from manual or physical therapists, chiropractors and massage therapists if experiencing musculoskeletal pain and discomfort.
- Musculoskeletal problems and major trigger points should be resolved before any strengthening exercises are attempted.
- Engage in strengthening and mobilizing programs specifically for problematic areas like the shoulders, neck and back (Figure 6).
- Understand it takes time to reverse years of poor posture and be persistent with the new preventative plan of action.
- Incorporate movement and stretching throughout the workday to avoid microtrauma and muscle imbalances as an important piece to the puzzle.
- Practice good posture in every function of life to improve muscle imbalances and posture (Figure 7).
Bonus tip: Schedule a 10-minute stretch break for the whole office to participate once a day.
Myriah Shimatsu is the co-owner of Movement 1st Wellness and has been certified by the National Strength and Conditioning Association (NSCA) for over 12 years. She holds her bachelor’s degree in adult exercise science with a minor in nutrition. Through onsite wellness programs and training, Myriah has been able to impact people’s health, wellness and lifestyle where they spend most of their day—at the office. Learn more about proper ergonomic set-up or other services by contacting firstname.lastname@example.org.
Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in Dentistry. Int J Clin Pediatr Dent 2014;7(1):30-34.
Farooq Shah, Aasim, Tangade, Pradeep, Batra, Manu, Kabasi, Soumik. Ergonomics in Dental Practice. Int J Dental Health Science. 2014; pg:68-78.
Valachi, B. (2019). How to select an Ergonomic Stool that fits you. Retrieved from https://posturedontics.com/dental-stools-one-size-does-not-fit-all/