Proprioception is the sense of the relative positions of parts of the body and describes the amount of effort used at rest or in motion. Proprioception tells a person how far to reach, how much to lean, how much to crane the neck, and the extent of the stress the dental professional experiences while working. Members of the dental team can use their innate sense of proprioception to meet ergonomics halfway and thereby decrease the stress, strain and discomfort of providing dental care.

Martin et al.3 identified seven primary risks that can exacerbate work-related musculoskeletal pain. They are:

  • Repetition
  • Force
  • Mechanical stresses
  • The temperature of the treatment room
  • Extrinsic stress
  • Intrinsic stress
  • Posture

Let us review these risk factors, starting with repetition. Dental professionals perform identical movements numerous times in a day’s work. Muscle pain and fatigue occur in the antagonistic tendon and muscle groups used to stabilize the body and extremities. Repetition without rest is fatiguing; unrelieved repetition is painful.

Force implies the use of large amounts of energy. Controlled force, which fatigues fingers and hands, is used routinely as one places instruments intraorally. Using hemostats to retrieve a buccal cotton roll or matrix band are examples of conserving energy. The hemostat minimizes the probing and twisting of the fingertips as the cotton roll is removed from the mouth.

Mechanical stresses are micro- or macro-traumas caused by reaching, grasping, balancing, or manipulating. Consider the incorrect grasp while gripping an enamel hatchet. The “correct” pen grasp brings the finger pads into play to cushion the pressure, while an incorrect grasp stresses the unprotected sides of the fingers.

Room temperature should be set for the comfort of the dental personnel, not the patients, as dentists must deal with the treatment room environment all day and every day.

Extrinsic stress reflects the objective nature of our situations. Butler4 lists five common extrinsic stressors: time pressures, patient demands, uncooperative patients, high levels of concentration, and team issues. These stressors are ominous; they only appear to be within the dentist’s easy control.

Intrinsic stressors are self-imposed. Anxiety and worry are two examples. Dentists are excellent worriers; worry keeps a person alert for danger, yet excessive worry is counterproductive. Two examples of behavior resulting from excess intrinsic stress are situational depression and burnout syndrome. Physical symptoms, such as headache, stomach ulcers, and chronic pain can also result from these intrinsic stressors.

Finally, postural stress is caused by assuming an extreme posture near the limits of the normal range of motion. Many dental professionals over-reach and over-twist throughout the work day, often ignoring the discomfort. Postural stress is perhaps the most important of Martin’s seven risk factors.