Optimizing Ergonomics: A Guide to Creating a Healthy Work Environment for Dental Hygienists

In recent years, ergonomics has emerged as a crucial concept in the dental industry. This science and study of our work examines the individual, their environment, and the tools and equipment used. Many dental professionals grapple with chronic and acute work-related pain. Ergonomics offers a viable solution. By focusing on the posture and movements of the clinician, ergonomics can significantly improve the health and well-being of dental professionals, making it an extremely relevant and important topic in our profession.

Studies show that 97% of dental professionals experience pain in their careers.¹^,² While many factors contribute to pain and injury in dentistry, ergonomics plays a significant role. Maintaining proper posture throughout the day can be challenging for dental professionals, who often sit in awkward positions with their heads down. The dynamic nature of dental work –involving the practitioner, the patient, the chairs, and various equipment – adds complexity to maintaining good ergonomic practices. In this article, we’ll explore the main elements necessary for proper ergonomics and, thus, improved health and well-being for dental professionals.

It All Starts with Posture

Our posture is the cornerstone of ergonomics. As dental professionals, establishing proper posture is the first and most crucial step. Posture, or what we commonly refer to as neutral posture, occurs when our body is in alignment. Our body functions optimally in this state, utilizing and requiring less energy to perform tasks and reducing the recovery time needed afterward.

Here are a few key points for achieving a neutral sitting posture:

• Sit tall, maintaining the natural curves of the spine.
• Align head over shoulders over hips.
• Roll shoulders down the back for an open-hearted feeling in the chest.
• Maintain elbows by your side at a 90-degree angle (give or take 5-10°).
• Keep wrists neutral (not bending forward or pinching back)

• Ensure hips are even—both side to side and front to back.
• Hips are higher than knees, depending on saddle stools vs operator chairs.
• Align hips, knees, and heels, keeping legs and feet symmetrical.

While sitting for extended periods is not ideal for the body, dental professionals can mitigate its adverse effects by paying attention to how they sit, how often they sit, and how they rebalance their bodies from sitting and potentially awkward positions. Clinicians should be aware of their go-to habits and maintain a neutral posture as much as possible.

If someone sits most of the day, it’s essential to take breaks: get up, stretch, walk around, drink water, go to the bathroom, etc. Additionally, alternating between sitting and standing while treating patients can help alleviate strain on the body and works well for some clinicians. Regardless of the position chosen, practitioners should prioritize finding a neutral posture before adjusting other elements in their workspace (such as the patient, patient chair, and equipment).

Finding the Right Position

Once a neutral posture is established, it’s crucial to understand how to position yourself and the patient. To help maintain a neutral posture, clinicians should work from 9 to 12 o’clock (or the opposite for left-handed clinicians). When clinicians work from a 7 to 8 o’clock position, they may experience torso twisting, so it’s necessary to align the head, shoulders, and hips with the patient. Framing the patient and workspace is essential to stay balanced and reduce the risk of injury.

Next up: patient positioning. While every patient is different, clinicians should get used to adjusting the patient chair and headrest to help support better visibility while also utilizing cushions and asking their patients to help. By taking the time to change the patient's chair, the practitioner can remain neutral and reduce the risk of developing an MSD, pain, and fatigue. When working on the maxillary arch, the patient will be supine with the headrest tilted slightly back to help lift the chin and give better access. When treating the mandibular arch, the patient will be semi-supine, with the headrest tilted forward, allowing the chin to tuck slightly. Pillows and cushions can be used behind the patient's neck or lower back for better comfort and visibility. Clinicians can also use verbal cues to guide their patients into a better position by lifting/lowering their heads or turning side to side to help reduce reaching, leaning, or twisting to see better.

While certain patients may present with limitations that don’t allow ideal positioning, clinicians should aim for good ergonomics at least 80% of the time. In challenging cases, practitioners should prioritize their ergonomic practices while considering alternative strategies to accommodate patients with mobility issues or other limitations.

Optimizing Your Workspace

Ergonomics aims to support the user. Ideally, clinicians should ensure that everything they use throughout the appointment is within arms reach, including the air/water, suction, instruments, handpiece, and easy access to the computer for charting. While common, rear delivery systems may pose challenges as clinicians must twist behind them to access equipment and instruments. However, there are strategies to optimize the workspace regardless of the current setup. Swivel trays stands, or carts can improve accessibility and reduce strain on the body, allowing dental professionals to perform their tasks effectively while prioritizing their health. Practitioners should evaluate and organize their workspace to support their bodies.

Maximizing Tools, Instruments, and Equipment

Hand pain, carpal tunnel syndrome, and tennis elbow are common among hygienists. Our tools and equipment become extremely important because we use our hands so much. That’s why choosing the right tools, instruments, and equipment is essential for achieving ergonomic mastery in dentistry. When it comes to instruments, we want lightweight, balanced on both sides and easy-to-maneuver instruments with a wide textured grip to help reduce strain on the hand and forearm. Paradise Dental Technologies (PDT), HuFriendy’s Harmony series, and American Eagle sharpen-free instruments are great options. For optimal ergonomics, instruments are maintained well and in excellent condition.

Did you know that a handpiece cord can weigh up to 20 pounds? Think about the force needed to grip that handpiece while polishing. Heavy handpieces and cords can cause the muscles throughout the hand, arm, and shoulder to overwork. This strain, over time, can lead to pain, an injury, or MSD for dental hygienists. Because the handpieces and corresponding cords we use can add or reduce strain on the body, we want lightweight and easy-to-manage equipment. Innovative cordless handpiece options by companies like Young Innovations and Pac-Dent provide additional flexibility and freedom of movement compared to some corded options.

There are many options for dental hygienists who struggle with suctioning during appointments. Holding the suction can become problematic because of the force used to grip it and hold it in place. Devices for low-speed suctioning, like the Pink Petal by Zirc and ReLeaf, and high-speed evaluation, like the ErgoFinger and VacuVUE, are great options for practitioners who want to reduce the strain of slow-speed suction. These options offer various solutions, depending on the practitioner's needs.

Prioritizing ergonomics in the dental workplace is essential for promoting the health and well-being of dental professionals. By focusing on proper posture, positioning, workspace optimization, and the selection of ergonomic tools and equipment, dental hygienists can mitigate the risk of work-related pain and injury while enhancing the quality of patient care. While challenges inevitably arise with patients with unique needs or limitations, practitioners can protect themselves by implementing proper ergonomic principles.

By embracing ergonomics, dental hygienists create a healthy work environment that supports longevity and sustainability in their health and careers.

References

1. Kumar M, Pai KM, Vineetha R. Occupation-related musculoskeletal disorders among dental professionals. Med Pharm Rep. 2020;93(4):405-409. doi:10.15386/mpr-1581
2. Saccucci M, Zumbo G, Mercuri P, et al. Musculoskeletal disorders related to dental hygienist profession. Int J Dent Hyg. 2022;20(3):571-579. doi:10.1111/idh.12596