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.
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.
References
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- [2] R. Pollack, Dental Office ergonomics: How to Reduce Stress Factors and Increase Efficiency. Journal, 1996, Vol. 62, No. 6: 508-509.
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- [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.
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- [13] B. Rundcrantz et al., Occupational Cervico-Brachial Disorders Among Dentists. Sweden Dental Journal, 1991, Vol. 15, 105-115.