Avoiding Potential Health Risks as a Dental Hygienist

If anything has become more apparent over the past 2 years, it’s that we have come to see how crucial the role of the healthcare system and healthcare professionals are. We have seen healthcare professionals hailed as heroes while we have also seen public health experts attacked. We have seen how volatile our healthcare system is and how important it is that we support our healthcare providers to care for those in need. Unfortunately, we may be failing at this goal as we have seen many healthcare professionals leave their professions recently.

One of the many reasons we have seen healthcare professionals leave their careers, specifically in the dental industry, is because of the toll that our jobs are taking on our personal health. As healthcare professionals, it is important for us to be aware of our own needs. We are constantly caring for others and often neglect ourselves. There are many health risks in dentistry that can have both short- and long-term effects on us and affect our ability to have long and fulfilling careers and thrive in our personal lives.

I recently asked my social media networks about their perceptions of the greatest risks to our health from working in dentistry. Overwhelmingly, musculoskeletal disorders (MSDs) were the greatest concern. Especially as clinical dental hygienists, we stay in the same position for long periods of time and complete repetitive tasks that can be taxing on our bodies. Luckily there has been a lot of research on ergonomics and prevention of MSDs recently leading to some excellent products and education to help us be proactive about our physical health.

Dental loupes have become widely utilized over recent years. The first loupes were introduced to the market in 1980s and were primarily used for surgical and endodontic procedures. By providing magnification and a better angle of declination, dental professionals can maintain better posture and position patients in a more ergonomic position. One peer-reviewed study stated, “A systematic review pointed out that using loupes was found to be beneficial for reducing musculoskeletal disorders (MSDs) that are common among dental professionals, especially those in the hands, arms, and shoulders. The study found little evidence, however, that loupes were effective for easing neck pain.”¹ The newer prismatic lenses also help with neck pain by allowing the practitioner to further improve posture and look straight ahead rather than tilting the head down. Loupes can also be beneficial for helping to reduce eye strain, especially in individuals over 40 years of age. Whichever style of loupes you choose, having them measured properly and made to fit you is the key according to ergonomic advocate Anne Guignon, RDH.

“A custom pair of loupes takes into consideration working distance, pupillary distance, convergence point, and declination angle.”Said Guignon in an article.²

Stephanie Botts, Owner of Posture Pros which provides ergonomics assessment and coaching agrees

“It's crucial to be measured in neutral posture!” says Botts. “If not, the loupes will be designed to reinforce unhealthy posture which will only make things worse in the long run."

I also strongly recommend that you find a light system that works with your loupes. In addition to avoiding the reach and strain for the overhead lighting system, it ensures that your light is always directed where you’re looking which helps reduce neck and eye strain.

We have also seen great improvements in seating options for operator stools. Much of what I learned in hygiene school just 13 years ago has already changed regarding operator positioning. Research supports dental hygienists working in a neutral spine position, and for each person that requires something different. Seating is an area where 1 size does not fit all. You really need to be selecting your operator seating, or positioning, based on your height, weight, hip width, and other personal factors. Many clinicians have found saddle stools to be helpful as they can encourage a neutral spine position and encourage a straddle leg positioning. 

“For most people, I recommend saddle stools. They allow the clinician to be seated much higher which is great for the hips and low back,” says Botts. “In addition, because of its design, it allows the legs to be 'out of the way' therefore allowing the clinician to get much closer to the patient (reducing the tendency to lean and reach forward."

There are now many saddle stools available, but it is important to look at the features available and determine which one is the best fit for you. Many saddle stools on the market allow for adjustable height and adjustable seat tilt. This feature is very important when finding your optimal position.

Another option for positioning is to try standing during treatment. Botts has found that standing during treatment can help with provider positioning because you are not as limited by trying to fit your legs underneath the patient chair. Alternating between sitting and standing throughout the day can also help since you aren’t just staying in the same position all day.

"I recommend a mixture of sitting and standing when practicing,” says Botts. “This not only incorporates different muscle groups but it promotes healthy blood flow and allows us to get much closer to our patient, especially during more difficult procedures."

For dental hygienists, we don’t often have much input on the design of our workspace or operatory. As many hygienists are employed in traditional dental settings, we usually in a space that has been set up previously by a dentist, architect, or dental equipment distributor. The problem is that the needs of a hygienist during their daily workflow are different than the needs of a dentist and dental assistant during dental procedures. It is important for us, as hygienists, to evaluate our workspace and create systems and workflows that work for us and protect our health. Some things within the operatory can easily be moved or adjusted to help reduce strain and reach throughout the day. We recently reorganized all of the drawers in our hygiene rooms where I work as we realized the items we used for room turnover were on opposite sides of our room, and the items we needed during procedures were too far away. I recommend using a drawing or photo of your workspace and walking through an appointment, procedure, or your day and mapping out where you go, or reach, for items you need. By making a map of your workflow, you can see where the biggest risks for you are and determine if they can be adjusted easily. Other things like standing or adjustable computer desks, patient chairs with adjustable settings, and layout of cabinetry may be more difficult to change but might be something that can be added to plans for future office updates. Identifying the needs is the first step to creating a healthier workspace.

To best support our bodies and prevent MSDs, it is important that we prioritize a healthy lifestyle. Our muscles need oxygen and water to maintain their strength and tone. It is important that we integrate exercise into our daily lives, stay hydrated, and include stretching throughout the day. A strategy I learned from Botts during my ergonomics coaching called “microbreaks” has helped me incorporate stretching during procedures. Microbreaks short 20-30 second stretch breaks that I take several times during a patient visit, especially on more difficult procedures where I’m not moving around much. Stretching helps restore blood flow to our muscles and helps prevent fatigue and injury. These breaks are also helpful for me mentally to clear my brain, take some deep breaths, and refocus for the rest of the procedure.

As we know, our overall health includes more than just our physical health. A recent survey showed that up to 40% of dental hygienist respondents reported experiencing burnout.³ Another study showed that 81% of the dental hygienist respondents reported having high or moderate daily stress levels, largely contributed to work.⁴ Mental health is part of our overall health and an important part of us being available and ready to care for our patients. Exploring new career opportunities or working in multiple settings can often help with our mental health as well as it offers variety and excites us to new potential. For me, volunteering has helped me with my mental health and helped me to prevent burnout. I have volunteered clinically at various events, volunteered with my professional association, and volunteered with causes outside of dentistry that I am passionate about. By giving back to others, I feel valuable and can see my contributions to my community in a new way.

Unfortunately, when we neglect our own mental health, we see a higher incidence of substance use disorder (SUD) as well. According to the National Survey on Drug Use and Health (NSDUH), 19.7 million American adults (aged 12 and older) battled a substance use disorder in 2017.⁵ We know that healthcare professionals are not exempt from these statistics and even may be at a higher risk for SUD related to our stress levels. Luckily, there is more attention on the mental wellbeing of healthcare professionals overall, specifically in the dental profession. Many states have begun implementing peer health programs which allow healthcare professionals to seek treatment for mental health and SUD in a monitored environment which ensures that they can continue to practice safely. Removing the stigma around mental health needs and SUD is important so that people can seek help when they need it and continue in their fulfilling careers.

While there are things that we cannot change about our work environments, there are several things that we can do to help with our mental health. Stretching and exercise can be so helpful for our mental health in addition to our physical health. Exercises such as yoga help us to stretch, meditate, and clear our minds to refocus on what’s important to us.

As healthcare professionals working in a clinical setting, we are also at risk of encountering and contracting infectious diseases. We have a lot of research and evidence now to support the Centers for Disease Control (CDC) guidelines and Occupational Safety and Health Administration (OSHA) standards for dental settings. The use of standard precautions includes avoiding health risks for the provider by implementing personal protective equipment (PPE) standards and implementing workplace controls. What’s even better is when some of these things also help with ergonomics and personal comfort. Especially as we come to this phase in the COVID-19 pandemic, we now have high volume evacuation products (Aerosol Assist, Cordeze, Purevac, NuBird, and ErgoFinger), face shields (Ambience, Hygienius shield, and Z Shield), and N95 masks (Readimask strapless N95) that are designed to reduce strain and improve ergonomics. Not only are these products likely to be part of our future in the dental practice for infection prevention, but allow us to still practice ergonomically and comfortably, reducing our overall health risks.

Occupational exposures ranked lowest on my social media survey concerning perceived health risks of dental hygienists. And while, it may not be the top concern for dental professionals at this time, we are learning new things every day about risks in our practice environments. Chemical exposures have been a concern in healthcare for many years. There have been some major improvements over recent years like eliminating “cold sterile” or glutaraldehyde solutions which are known to be related to respiratory and skin irritations. Many offices have moved to hydrogen peroxide-based disinfectants and other products with less health risks documented on the safety data sheets. Most offices have also moved to digital radiographs to reduce exposure to radiation for patients and professionals. There are companies that supply radiation monitoring badges which report radiation exposure over time for dental professions. This is a great way to track radiation exposure, confirm your equipment is working properly, and ensure your team is using equipment appropriately. Our office uses a handheld device for radiographs with radiation monitoring badges and we have always been below the negligible amount.

Gaining some traction in recent years, is the concern over hearing loss in dentistry. Many of the instruments and equipment we use in the dental setting produce high pitched sounds. Angela Grover RDH BASDH recently wrote in an article, “Within the dental community, generally there are not 8 continuous hours of noise levels at or above 85 dB, rather exposure to repeated smaller bursts of noises over time, therefore it is not mandated by OSHA that dental personnel wear HPDs.”⁶

While it may not be required by OSHA, many dental professionals, including myself, have started looking into ear protection options to reduce the risks of hearing loss in the future. Custom-fitted ear protection is generally recommended to ensure that they fit well and allow only the high frequency noises to be filtered out so that you can still communicate well with patients and other team members.

So yes, our jobs are risky. Our health is at risk every day, in many ways, but the good news is that we, as dental hygienists, are prevention specialists. We preach prevention to our patients all day and understand the importance of small steps routinely over a long period of time to reverse and prevent disease. So, let’s apply that to our own self-care. Many of these risks can be minimized or avoided with small changes to our daily activities over the duration of our careers. We chose this profession because of our passion for helping others achieve health and it’s time that we realize that helping patients with their health begins with us taking care of ourselves.

References

1. Aboalshamat K, Daoud O, Mahmoud LA, et al. Practices and attitudes of dental loupes and their relationship to musculoskeletal disorders among dental practitioners. International Journal of Dentistry. 2020;2020:1-7. doi:10.1155/2020/8828709

2. Guignon A. Searching for loupes? RDH Magazine. Published June 1, 2018. Accessed April 19, 2022. https://www.rdhmag.com/patient-care/article/16408107/searching-for-loupes.

3. Hartley M. Career satisfaction survey, part 2: What role does Burnout play in dental ... Dentistry IQ. Published March 21, 2017. Accessed April 19, 2022. https://www.dentistryiq.com/dental-hygiene/article/16365688/career-satisfaction-survey-part-2-what-role-does-burnout-play-in-dental-hygiene..

4. Barnard SA, Alexander BA, Lockett AK, et al. Mental Health and Self-Care Practices Among Dental Hygienists. J Dent Hyg. 2020;94(4):22-28.

5. Editorial Staff Drug & substance abuse addiction statistics. American Addiction Centers. Published March 11, 2022. Accessed April 19, 2022. https://americanaddictioncenters.org/rehab-guide/addiction-statistics.

6. Grover A. Hearing loss in dentistry: A silent topic. Today's RDH. Published February 16, 2022. Accessed April 19, 2022. https://www.todaysrdh.com/hearing-loss-dentistry-silent-topic/.