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John Pentikis
U.S. Army Center for Health Promotion and Preventive Medicine,
ATTN: MCHB-DC-OER, 5158 Blackhawk Road, APG, MD 21010-5422
Abstract.
The health focus care at U.S. Army dental clinics is to provide the patient
with a comfortable environment when a dental procedure is performed.
However, little consideration has been given to the comfort of the dental
provider performing a procedure. This has resulted in documented injuries
to dental providers at a U.S. Army dental clinic. U.S. Army ergonomists have
taken a three-step approach in resolving this problem. First, management
was asked to endorse the idea of providing ergonomics training to dentists
and dental hygienists. Second, human performance training in dentistry was
offered to dental care providers so they could learn about working in
neutral postures. Additional training addressed the value of patient
scheduling and rest breaks. Finally, U.S. Army ergonomists offered their
services to the U.S. Air Force Dental Investigative Service, which performs
testing of all dental equipment used by the Department of Defense. This
partnership will help to ensure that the equipment purchased for the dental
clinics will offer appropriate support for the dentist and dental hygienist
while they perform their duties.
1. Background
Work related musculoskeletal pain and injury in the dental profession has been reported
for over 35 years [1]. Reportedly dental care professional have accepted
this as part of the job [2]. This combination of pain, injury, and
acceptance has created a profession where, being symptomatic for an upper
extremity, neck, or back injury is “part of the job”. This mindset has
damaging consequences to the U.S. Army. Having dental care providers in
discomfort or pain challenges the readiness of the U.S. Army as preventive
and acute dental work may not be delivered in a timely fashion to all the
soldiers needing these services. Also, military dental care providers may
not be able to effectively perform their required soldiering tasks.
Furthermore, if the job demands of the U.S. Army dental care providers are
causing musculoskeletal problems, then retaining the dental care providers
may not be possible as they may not be able to meet minimum physical fitness
standards thereby no longer being eligible for military service. Lastly, it
has been demonstrated that motivated soldiers and civilians in the U.S. Army
continue to work even though they are suffering from symptoms or are injured
[3]. This condition may cause dental care providers not to seek out
treatment until they find it physically impossible to work, increasing the
likelihood of a long-term injury [4].
2. Literature Search
Statistical Review
A comprehensive
literature search indicates dental care providers are at high risk for
suffering a workplace musculoskeletal disorder (WMSD). Studies have
reported that: dental workers who suffer a WMSD injury have a lost work day
average of 93 days [2]; sixty-two percent of dental hygienists have
complained of neck problems and eighty-one percent complained of shoulder
pain in one or both shoulders [5]; between six and seven percent of all
dental hygienist report being diagnosed with carpal tunnel syndrome [6, 7];
fifty-nine percent of dentists have reported musculoskeletal pain [8]. A
survey of a U.S. Army dental clinic reported that over seventy-five percent
of all dental workers complained of one or more carpal tunnel syndrome
symptom, over fifty percent complained of back and shoulder pain, and eleven
percent were diagnosed as having carpal tunnel syndrome [3, 9].
Work Practices
To many people, a visit to the dental clinic is perceived as a stressful occurrence.
Therefore the dental professional is constantly aware of the customer and
trying to put the customer at ease. Unfortunately, in the course of putting
the patient at ease, the dentist will not accept a new delivery system
because they fear their patients will not accept it. This may lead to the
dental provider using poor delivery styles that cause physical damage to the
body [2].
Research has indicated that the majority of all WMSD problems are cause by
fixed working postures, static loads on the arms, scheduling, and
insufficient knowledge of basic ergonomic principles [10, 11, 12, ].
Properly aligning the body via a wedge, dental scopes, and or mirrors is
essential in maintaining a neutral seated posture [14]. Using naturally
occurring pauses in a procedure as a rest break [14] and scheduling tasks
for no more than six hours per day [13] has proven to be effective in
reducing the likelihood of suffering from symptoms associated with WMSD.
Performance Logic, a propioceptive self-derivation of an ideal posture and
position for work, has also been suggested as a method of improving the
posture of dental care providers posture [8]. It has even been suggested
that improving the dental care providers posture via the above mentioned may
even be more effective than buying new furniture.
3. Background
The U.S. Army has recognized the need for resolving the issues surrounding the health of
their dental care providers. The methods for accomplishing this is a
three-step approach. First, management was asked to endorse the idea of
providing ergonomics training to the dentist and dental hygienists. Second,
human performance training in dentistry was offered to dental care providers
so they could learn about working in neutral postures. Additional training
addressed the value of patient scheduling and rest breaks.
Finally, U.S. Army ergonomists offered their services to the U.S. Air Force Dental
Investigative Service, which performs testing of all dental equipment used
by the Department of Defense.
A top down approach to ergonomics acceptance was requested since it would
demonstrate the commitment of the U.S. Army's commitment of improving the
working conditions of its soldiers. Also, this approach would facilitate
the establishment of an ergonomics program at the dental clinics in response
to a Department of Defense (DOD) policy that dictates an ergonomics program
will be established at all DOD assets.
Training is being offered to dental care providers in hopes that they can
perform all their job functions comfortably and efficiently throughout their
wok day and working career. A multi-faceted approach is being attempted.
The approach includes performance logic training; use of the naturally
occurring pauses during dental procedures to reduce fatigue; and scheduling
patients to ensure that workloads are distributed evenly among providers and
the physical effort required to serve a patient is also equal amongst all
the providers.
Partnerships between the armed services is essential in today's environment
of doing more with less. Avenues that are available or being pursued are a
partnership with the U.S. Air Force Dental Investigative Service and the DOD
Ergonomics Working Group.
Partnering with the U.S. Air Force Dental Investigative Service to integrate ergonomics into
their evaluations. This will help to ensure that the equipment purchased
for the dental clinics will offer appropriate support for the dentist and
dental hygienist while they perform their duties. Partnering with the DOD
Ergonomics Working Group, which acts as a collective group to provide
consistent ergonomics guidance to the DOD will allow all research and field
survey work to be reported in an arena where all information collected can
easily be distributed throughout the department of defense.
[1] E. J. Green and M. E. Brown, An Aid to the Elimination of Tension and Fatigue: Body Mechanics
Applied to the Practice of Dentistry. Journal of the American Dental Association, 1963; 67: 679-697.
[2] R. Pollack, Dental Office ergonomics: How to Reduce Stress Factors and Increase Efficiency. Journal, 1996,
Vol. 62, No. 6: 508-509.
[3] V. J. Rice and J. S. Pentikis, Dental Workers, Musculoskeletal Cumulative trauma, and Carpal Tunnel
Syndrome: Who is at Risk? A Pilot Study. International Journal of Occupational Safety and Ergonomics, 1996, Vol. 2, No. 3, 218-233.
[4] T. J. Armstrong, Analysis and Design of Jobs for Control of Upper Limb Cumulative Trauma Disorders. Handout,
PDC #95, American Industrial Hygiene Conference and Exposition, 1992.
[5] T. Oberg and U. Ogberg, Muskuloskeletal Complaints in Dental Hygiene: A Survey Study
from a Swedish County. Journal of Dental Hygiene, Vol. 67, No. 5, 257-261.
[6] G. Macdonald et al., Carpal Tunnel Syndrome Among California Dental Hygienists. Dental Hygiene, July/August 1988, 322-327.
[7 J. B. Osborn et al., Carpal Tunnel Syndrome Among Minnesota Dental Hygienists. Journal of Dental Health,
February 1990, 79-85.
[8] G. C. Colangelo and M. M. Belenky, Performance Logic: A Key to Improving Dental Practice. Journal of Dental
Practice Administration, October/December 1990, 173-177.
[9] V. J. Rice and J. S. Pentikis, Ergonomic Worksite Analysis of an Army Dental Clinic,
Tech. Rep. No. T11-92, U.S. Army Research Institute of Environmental Medicine.
[10] A. Hope-Ross and D. A. Corcoran, A Survey of Dentist's Working Posture. Journal of Irish Dental
Association, 1985, Vol 32, 13-20.
[11] N. Hallgren, Pain and Discomfort in the Locomotor System Among Dentists and Dental Nurses. A
Report from the Occupational Health Service in Blekinge Lans Landsting, 1985.
[12] H. Murtumaa, Conceptions of Dentists and Dental Nurses about Ergonomics. Ergonomics, 1983, Vol 26, 879-886.
[13] B. Rundcrantz et al., Occupational Cervico-Brachial Disorders Among Dentists. Sweden Dental Journal, 1991, Vol. 15, 105-115. |
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