Musculo-skeletal and Work-related Disorders

Dental professionals know that “incorrect working posture is the major cause of musculoskeletal problems in dentistry”16 Improved vision and a balanced posture are easier to accomplish if the patient is in a supine position. In addition, bending can be relieved if the chair is void of wide wings and has a thin and narrow back (Figure 2).

Figure 2. Patient Dental Chair with Thin Back.

Thin back patient dental chair
Courtesy of DentalEZ, Malvern, PA.

Operator stools are available that help maintain the natural “S” curve of the spine thus improving posture (Figures 3a and 3b). Assistant stools need to provide abdomen and back support bars (Figure 4). In addition, eyestrain and headache are related to poor posture. Trigger points in the sternocleidomastoids can be activated by maintaining the head and neck in unbalanced positions.

Figure 3a. Operator’s Stool with Elbow Support.

Operator stool with Elbow support
Courtesy of DentalEZ, Malvern, PA.

Figure 3b. Basic Operator’s Stool.

Basic operator stool
Courtesy of DentalEZ, Malvern, PA.

Figure 4. Assistant Stool with Back and Abdominal Support.

Assistant's stool
Courtesy of DentalEZ, Malvern, PA.

Treatment room set up with all equipment in place for true Four Handed Dentistry. Note the dental unit is near the assistant to reach within 21 inches (Figure 5).

Figure 5.

dental treatment room setup

Dental treatment room setup with ergonomically designed patient chair, transthoracic dental unit, operator and assistant stools, and mobile cabinet in place for the assistant.

Courtesy of HSP, Inc, Birmingham AL.

Concern for ergonomics should not lay claim only to the clinical areas of the dental office but should be a concern for the business office, too. The same factors that relate to reaching and stretching are factors for stress in the business area (Figure 6).

Figure 6. Business Office Assistant Seated Properly.

Business Office Assistant Seated Properly
Adopted from Finkbeiner BL, Finkbeiner CA. Practice Management for the Dental Team. Elsevier. 2016.

Apply the principles of motion economy to the business office by considering the following:

  • The height of the working area in the dental business office should be at elbow height or one to two inches lower.
  • The feet should rest on the floor.
  • Position materials as close to the point of use as possible.
  • Use motions that require the least amount of movement.
  • Minimize the number of materials to be used for a given procedure.
  • Use smooth continuous motions instead of zig-zag motions.
  • Organize materials in a logical sequence of use.
  • Use ergonomically designed stools or chairs to provide good posture and support.
  • Minimize the number of eye movements.
  • Provide lighting that eliminates shadows in work areas.
  • Position computer monitors to allow for a line of sight to the screen that is within 10–40 degrees horizontal.
  • Provide work areas that are at elbow level or one to two inches lower.

Because dentistry is a sedentary profession it is incumbent upon the dental professional to exercise regularly. Short stretching or exercise breaks have benefits such as:

  • reduced muscle tension
  • increased range of motion
  • enhanced muscle coordination
  • increased circulation
  • increased energy.17

Stretching is very important and can be integrated into a daily routine. An aerobic exercise program is recommended along with chair side exercises that target specific areas. Kumar et al. aimed these exercises to withstand the forces involved in activities a dental professional performs daily. They made them as simple as possible so they could be practiced chairside.18

  • Tucked Chin: Sit in the chair and try to tuck the chin (take the chin towards larynx) until a stretch is felt near the posterior hair line. Now gently apply pressure on the occipital region while tipping the head forward.
  • Hand Stretch: Raise the arm with elbow and wrist extended and spread the fingers wide. With other hand bend the wrist and fingers into more extended position (a stretch is felt under the wrist).
  • Lateral Trunk Stretching: Sit in the chair and bend to one side with opposite hand raised above the head (stretch is felt on the side of the trunk).
  • Upper Thoracic Extension Exercises (stretches anterior chest wall): Sit in the chair and place both hands behind the head. Inhale and take both elbows backwards.
  • Hip Flexor Stretching: Stand with one leg forward and the other backward (legs three feet apart). Bend the front leg forward at the knee while maintaining the back leg straight with knee extended and the heel slightly raised. Shift the body weight on to the front leg (a stretch is felt over the anterior thigh).

Physical activity seems to play a pivotal role in the presence and severity of musculoskeletal pain in members of the dental profession. A study performed by Koneru and Tanikonda compared musculoskeletal pain among dentists who engaged in yoga, those who engaged in physical activities, and those who were inactive. The practitioners who practiced yoga had the least amount of musculoskeletal pain at 10.5%, those participating in other physical activities were second at 21.7%, and the patients with no physical activities exhibited the greatest amount of pain at 45.6%. They concluded that the role that physical activity plays is significant in the quality and quantity of work related MSD’s, with yoga more efficient because of its controlled nature and positive effect on the psychological stress and strain.10 A study by Gupta et al. looked into how complementary and alternative medicine (CAM) therapies, such as acupuncture, herbal medications, meditation and music therapy, along with massage and yoga exercise, affected muscle pain. The authors noted that the dentist’s degree of pain decreased significantly after using CAM therapies.19