Dentist back and neck pain is avoidable! New dental loupe designs

Each month, Dr. Gordon Christensen answers a question from readers about everyday dentistry.

Q: I have been practicing for nine years and really enjoying most days. However, after a few days of busy practice, my back and neck are beginning to bother me. I know that unless I change something, these conditions will only get worse. You have been practicing for many years. What have you done to avoid these problems?

A: As you know, dentists have significant chances of getting musculoskeletal problems. Unless dentists plan some physical activity on a routine basis, they have minimal body movement during a workday. In the past, most dentists stood while practicing, and they moved constantly to facilitate specific treatment procedures. Now, most sit with minimal movement as they are delivering oral care. Additionally, some dental patient chairs are so wide that they do not allow the operator to get close to the patient. This situation forces operators to bend their back and lean forward to facilitate patient care.

Consider loupes relative to the challenge. Some loupes are designed to have a short focal distance, forcing the operator to lean forward even more and tip the head forward at a significant angle. Many articles in the literature are based on this topic. A good systematic review is “Prevention and Rehabilitation of Musculoskeletal Disorders in Dental Professionals: A Systematic Review” by SC Roll et al.¹

I have summarized the major challenges and potential solutions below.

A summary of the overall literature states that typical musculoskeletal disorders for dentists, dental hygienists, and dental students occur in about 60% to over 90% of practitioners. The most commonly occurring areas for pain are back (about 30%–60%), neck (about 20%–85%), and wrist (mainly hygienists, about 60%–70%).

Other areas of pain are the shoulders, hands, arms, and legs. Women suffer more than men, mainly because typical dental treatment facilities are related to average male body size, which is usually larger than the average female size.

It is estimated that dental practices lose millions of dollars of income due to canceled appointments by practitioners related to musculoskeletal pain. Most of these challenges are preventable!

What can be done to prevent or reduce pain?

I suggest you implement the following proven ergonomic changes as soon as possible.

• Make the operatory design fit your body. Don’t make your body adapt to an operatory that is too large or too small.
• Dental operator chairs: purchase chairs that allow you to sit in the most ergonomic position with your lower arms near parallel to the floor.
• Dental patient chairs: many chairs are too wide for normal body size and have arms that do not let the operator sit close to the patient. These larger chairs have been produced because of the significant percentage of obese patients today. Find patient chairs narrow enough and with narrow arms that allow you to sit close to the patient with your back perpendicular to the floor.
• If you have many obese patients, have at least one operatory that accommodates them, but not all your operatories and chairs.
• Situate patients at a height that allows you to operate in a position with your lower arms near parallel to the floor.
• Currently, magnifying loupes are a concept considered important relative to musculoskeletal problems, especially neck pain (figures 1-4). Almost all practicing dentists use loupes when operating, ranging in magnification from 2.5x to 10x. The ergo deflective loupe design allows the operator to sit with their eyes looking straight ahead and with the back perpendicular to the floor. The operator sees the image at a preset focal length angle lower than eye level.
• When operating, take occasional breaks to walk around the office.
• If you feel your operatory design and equipment are too complex for you to manage, ask your local dental supply distributor to suggest someone in your community with knowledge in ergonomics and the ability to design an office to fit your body.
• Some empirical observations on ergo loupes that I have seen in both live hands-on courses and in large-attendance continuing education courses include:
• Those who have never used any type of loupe before change rapidly to ergo loupes.
• Those who have previously used conventional loupes require a few days or longer to adjust to ergo loupes and the significantly different posture and set focal distance much below eye level.
• Some have tried ergo loupes and decided to stay with conventional loupes instead.
• Ergo loupes are very appropriate for narrow-width-of-field needs. Most crowns and implants placed by general dentists are singles, and the narrow width of field needed for those procedures adapts easily to ergo loupes.
• For those routinely accomplishing wide-field procedures such as a full mouth of crowns or many implants, accommodating to ergo loupes is much more difficult.
• In my many hands-on courses, such as implant placement and fixed prosthodontics, those using ergo loupes usually have easily observed high-quality results.
• In all life activities, move. Walk, sit, run, stand—don’t just stay in one position for more than a few minutes.

To summarize my answer to your original question as to what I have done not to have musculoskeletal problems, I have always moved constantly while practicing and in all areas of life, and I do not have any neck or back pain after six decades of practice.

Summary

Dental practice is hard work, requiring many different contortions of the operator’s body to accommodate the procedures being done. It is well known that dentists, dental hygienists, and assistants have more musculoskeletal problems than the normal population. Most of these maladies can be prevented or at least reduced if the characteristics in this article are observed. There are many other innovations in loupe design, including new headlamp controls that reduce body movement, and those discussed here represent only three popular brands.

For more information, visit Practical Clinical Courses at pccdental.com or call (800) 223-6569. 

Editor's note: This article appeared in the March 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Reference

1. Roll SC, Tung KD, Chang H, et al. Prevention and rehabilitation of musculoskeletal disorders in dental professionals: a systematic review. J Am Dent Assoc. 2019;150(6):489-502. doi:10.1016/j.adaj.2019.01.031