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Why Ergonomics Should Be Emphasized in Dental School Curricula
Jeffrey G. Phebus, DDS
Dentists are exposed to occupational health hazards on a daily basis. Risk factors include static awkward postures, repetitive motions, use of force for certain procedures, poor lighting and visual acuity, and even noise exposure that can damage hearing. As with any occupation, job stress is also considered an occupational health hazard.1
Health issues related to the practice of dentistry have been a concern for many years. The vast majority of these issues include musculoskeletal disorders (MSDs). Some studies have shown that back, neck, shoulder, and/or arm pain is present in approximately 81% of dental professionals.2 The historic shift from standing dentistry to a seated posture was intended to address the issue, specifically, of lower (lumbar) back pain. This change in practice philosophy, however, has made little difference in how frequently dental operators report having pain.2 Instead, these practice alterations have caused dental professionals to experience pain in different parts of the body. Seated dentistry may also predispose the dental professional to pain in the neck, shoulder, and arm, as well as the lower back.2
As a dental student in the mid 1980s, I do not recall a great deal of emphasis placed on applicable clinical ergonomics instruction. Only occasionally were we instructed how to sit, how to position the patient, where to position the unit, where to position the instruments, etc. Most of the procedures performed in dental school were completed without an assistant, although didactic principles of four-handed dentistry were part of the dental school curriculum. Without clinical application of these principles, much of what was learned was unproductive. When working with a dental assistant, effective four-handed dentistry was practiced, allowing for a, presumably, more efficient use of time and, in turn, increased productivity and decreased detrimental health-related issues.
Recently, more emphasis has been placed on enhanced clinical as well as didactic ergonomics education (positioning simulation, improved instrument and equipment design, and appropriate relaxation techniques) in dental school curricula. As a neck pain sufferer, I believe emphasis should be placed on routine reinforcement of clinical application of these principles. One study has shown that 61% of dental students surveyed reported experiencing musculoskeletal symptoms related to dental school activities.3
Four-handed dentistry has eliminated unnecessary movements such as reaching, bending, and twisting. Concurrently, four-handed dentistry requires the operator to remain in a prolonged static posture (PSP), a model often perceived as an ergonomic benefit. However, recent studies have suggested that PSPs may actually contribute to operator pain and dysfunction.2 Dentists frequently assume static postures, which require more than 50% of the muscles (in use) to contract in order to hold the body motionless while resisting gravity.2 The static forces resulting from these postures have been shown to be significantly more taxing than dynamic (moving) forces.2 This logic agrees with existing philosophies that a sedentary lifestyle is unhealthy and movement is advantageous. So if unnecessary movement(s) are damaging, and prolonged static postures are also potentially destructive, then what is the solution?
It appears that increased preventive measures aimed at minimizing the detrimental effects of practicing dentistry seem to be the answer. Nutrition, ergonomics (application), and appropriate exercise designed specifically to counteract the potential physical and mental shortcomings of a career in dentistry should be a major part of dental curricula. “Ergonomics awareness programs” have been used effectively in several workplace settings to counteract the negative attributes of a specific task.4 In dental academia, ergonomics instruction should be designed to evaluate specific clinical tasks and provide diagnostic feedback in a simulated or actual human experience, with exposure to these concepts early and often.4
Dental students may not realize that the subject of ergonomics in the workplace is applicable at such an early stage in their careers. Certainly, these concepts may not seem as important as performing a root canal procedure, preparing a cavity, or delivering a crown. The study of ergonomics will not directly deposit money into one’s bank account. However, students must be made to realize that the practice of dentistry is more than multiple patient appointments per day, performing intricate, “perfect” procedures, and/or the unrestrained pursuit of financial gain. Proper nutrition, adequate exercise, and good ergonomic practices can help to ensure a long, prosperous, and pain-free career.