Mary Govoni, RDH, MBA, discusses ergonomics in the dental practice.
Dr. Jameson: Mary, define the term "ergonomics" and how it affects dental professionals on a day-to-day basis?
Mary Govoni: The scientific definition of ergonomics is "Fitting the workplace to the worker so that you not only create an efficient environment, but you also create an environment with minimal risk factors for injuries (back, neck, muscle pain, strain), etc." Correctly considering your team's potential ergonomic risk and addressing that proactively creates longevity for your team because they're more comfortable and therefore happier throughout the day.
These days, the typical dental office is designed based on the layout of equipment and space, which causes dental professionals to compromise themselves physically all day long to accommodate their working environment. A lot of dental professionals are now recognizing that the aches and pains they have, whether it's at the end of the day or during the day, are really related to what they're doing at work, how they're going about their jobs, and what type of equipment they're using.
Dr. Jameson: What are the signs and symptoms of these "compromising" positions you're speaking of?
Mary Govoni: The most important thing for everyone to pay attention to is posture. Mom was right when she said "Sit up straight." Most of the problems I see in dental practices with ergonomic injuries relate to posture. Pain is what team members need to look out for. Ask yourself if your neck, shoulders, back, hands, wrists, etc., hurt when you're working. Try to pinpoint what kind of posture or position you're working in when you experience that pain. Then, move to a different position to relieve or take away some of the pain.
The biggest concern I have is that we have worked so hard to make dentistry pain-free for the patients, but now we block out our own pain to accommodate the patient rather than keeping in mind some key ways to take care of ourselves and keep patients comfortable. Remember — patients spend the least amount of time in that treatment room and they're going to be somewhat uncomfortable just because of the psychological "I'm at the dental office" awareness. Dental team members can do simple things that allow better visibility or leverage to the area they need to work on, without asking too much of the patients. So, don't be afraid to ask patients to turn their heads one way or another. Take care of yourself as well as you take care of the patient! It's possible to do both very well, for everyone's benefit.
Dr. Jameson: Are there particular roles within the practice that are more prone to long-term, chronic problems as ergonomically compromising situations?
Mary Govoni: Ergonomic problems are equal opportunity — they'll hit everyone, but in different ways and to different degrees. For example, assistants working in the business office often have problems with carpel tunnel syndrome stemming from data entry, keyboard and mouse work, etc. There are things that can be done to alleviate those problems. They also experience neck problems if they work without a telephone headset because, if they're trying to talk and write or type at the same time, they'll clamp the telephone between their ear and their shoulder and develop neck and shoulder problems as well.
Hygienists probably have the highest number of ergonomic injuries for a number of reasons. Their tasks are more repetitive, in particular, scaling teeth. They usually don't have the most up-to-date equipment in the office, often resulting in carpel tunnel syndrome, neck problems, and sometimes low-back injuries from sitting on the edge of their stools to accommodate patients.
Dental assistants have problems with carpel tunnel syndrome from holding the suction, often with their wrists in a bent position. They have problems in their upper back and neck from trying to accommodate the dentist's posture. As the dentist leans over the patient, the assistant's view is blocked. Assistants then twist and bend their spines to regain visualization of the patient, and get into a bad posture.
Dentists most commonly have neck injuries because of their head position — they're trying to look directly at a tooth during a tooth prep instead of using mirrors and magnification. Dentists also tend to get carpel tunnel syndrome in their nondominant hand. So, again, ergonomic problems affect all team members in different ways because of the tasks they do.
Dr. Jameson: What are the first things a dental practice can do if these symptoms and ergonomic injuries sound familiar?
Mary Govoni: The first thing is to correctly identify all of the ergonomic issues. This includes behavioral issues such as poor posture habits, and it also includes identifying any needs for a redesign of a treatment area. Then, look at each problem and identify how it can be fixed. Consider first what can be done to improve your existing equipment or the way it is being used. If correction is not possible through existing means, other changes in a treatment room need to be considered for creating a better work environment. Going out to buy a whole bunch of new equipment is not always the answer. Just go through your office and think of comfort — comfort not only from your patient's standpoint, but also your dental professional's standpoint. As you make future purchases, do the same thing. Don't just sit or recline in the patient chairs as if you were the patient, but practice working around them from the perspective of the hygienist, the assistant, and the dentist. Develop a plan that includes team encouragement to help one another sit up straight. The plan might include purchasing hygiene instruments with larger-diameter, lighter-weight handles so hygienists don't have to grasp them quite so tightly in use. Maybe the hygienists need to incorporate using more mechanical sonic or ultrasonic scalers during hygiene procedures to alleviate some of the stress of the hand-scaling. Developing and implementing the plan is key. Ask yourselves, "What can we do to address the problems we've identified?" Then, set team goals and begin implementing your plan to take good care of yourselves.
Dr. John Jameson is Chairman of the Board for Jameson Management, Inc., an international dental consulting firm. Representing JMI, he writes for numerous dental publications and provides research for manufacturers and marketing companies, as well as lecturing worldwide on the integration of technology into the dental practice, and leadership. He also manages the technology phase of the consulting program carried out by JMI consultants in the United States, Canada, and Europe. He may be reached at (877) 369-5558 or by visiting www.jamesonmanagement.com.
