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Aches, pains, sore necks and bad backs are common complaints of suffering dentists. What can be done to prevent or minimise these pains? By Kerryn Ramsey
Occupational chronic pain is a common experience for many dentists. Holding posture for long periods, bending and stretching in an unnatural manner, sitting incorrectly on a stool or chair, and grasping and using instruments for long periods, can all be contributing factors.
The recent National Workspace Week revealed that work-related musculoskeletal disorder (WMSD) is the most frequent work, health and safety issue impacting Australian workers at a cost of $55.1 billion annually to the Australian economy.
With such high numbers of dentists affected by WMSD, it’s clear that more education and awareness about the issue is required in the dental profession. Peak bodies such as the ADA need to be involved, and universities should include information in their curriculum.
Dr Penelope Jones is an endodontist and founder of WorkingPosture, a company providing WMSD solutions specifically for dentists. She believes that all dental schools need to make musculoskeletal wellness a part of basic training. Regular CPD courses would also help improve things.
“Surgeries need to be professionally ergonomically assessed, and dentists need to learn how to move their bodies correctly,” she says. “You can have the Rolls Royce of dental equipment and still harm yourself.”
Unfortunately, it is the very nature of the job that causes many dentists to be affected by WMSD.
“While things are slowly improving, we can never make the work inherently risk-free,” says Dr Jean Wu, a dentist and clinical Pilates teacher who’s undertaking research into WMSD at the University of Melbourne. “Prevention is a far better option than cure, and education and awareness should be promoted. Ultimately, all dental professionals have a personal responsibility to find methods that work for them.”
Awareness, training and intervention instituted early in a dentist’s career provides the best outcomes. Dr Anikó Ball, a dentist and founder of Optimum Dental Posture, a company dedicated to reducing the risk of occupational chronic pain, would also like to see training at a university level. “Learning how to sit properly is one of the most important skills a dentist can have,” she says. “It’s about improving the quality of your work and life. It needs to be taken seriously.”
Minimise risk
Fortunately, there are ways for dentists to mitigate and avoid these issues. A good start is to recognise the problem and deal with the cause.
“Ignoring pain can lead to that part of their body going numb,” says Dr Jones. “Sufferers lose proprioception, the ability to sense movement, action and location. Hurting yourself without realising it’s happening is very serious.”
The impact of WMSD goes far beyond just the physical. People living with pain frequently find their mental health suffering and may even lose their sense of humour.
Surgeries need to be professionally ergonomically assessed, and dentists need to learn how to move their bodies correctly. You can have the Rolls Royce of dental equipment and still harm yourself.
Dr Penelope Jones, founder, Working Posture
“Surprisingly, younger clinicians are more likely to suffer from WMSD than older practitioners,” says Dr Wu. “This could be due to general inexperience as they figure out how to do the job. Furthermore, older clinicians suffering from chronic pain often have no choice but to take themselves out of the profession and retire.”
Inner and outer ergonomics
To avoid WMSD, look at the layout of your dental surgery. Is there enough space around the dental chair? Can the dentist’s knees fit under the headrest? Do loupes allow the clinician to hold their head at the correct angle?
“I call that outer ergonomics,” says Dr Ball. “A well-designed surgery can go a long way in reducing WMSD. Dentists also need to be aware of their inner ergonomics, particularly how to bend over a patient without damaging their spine. All the muscles of the shoulder, arm and hand are movement muscles not designed for prolonged contraction. What’s needed is a re-training in how they do what they do.”
There are varied factors that contribute to musculoskeletal pain for dentists. While there’s no quick fix, incorporating more movement into a workday is beneficial.
“A lot of dentistry is sedentary,” says Dr Wu. “Even if a posture is ergonomically correct, the research has shown that when you hold a static position for any length of time, it causes the small supporting muscles to tire. Movement, whether it’s stretching between patients, walking at lunchtime or getting involved in Pilates, can help overcome issues.”
Moving correctly
While a visit to a doctor, chiropractor or physiotherapist can offer short-term solutions to localised pain, the long-term answer is to learn how to move properly. Utilising appliances such as saddle chairs, microscopes and loupes can also assist but they must be used in the right way.
“At WorkingPosture, we use the Feldenkrais method, a way of working with how the nervous system organises muscles for good movement.” says Dr Jones. “The object is to have the body supported by the skeleton in correct alignment with the muscles and the nervous system. Instead of rigidity when a dentist performs precise work, we need stability and flexibility. We guide our clients in this method during Working Posture workshops.”
Many dentists instinctively turn to loupes or microscopes to deal with sore necks and shoulders. These can help but, once again, they must be used in the correct manner.
“Microscopes are often set up so the chin is up, leading to spinal compression,” says Dr Ball. “I’ve worked with endodontists who needed spinal surgery because they were looking into a microscope at the wrong angle.
Non-refractive loupes require dentists to pivot their torso forward and look down. Refractive loupes allow the dentist to sit upright without spinal bending, provided the working distance is correct.”
It is possible to perform dentistry without compromising musculoskeletal wellness. Dentists just need to engage in basic training on how their bodies work. If professional bodies, universities and dental schools promoted and directed dentists towards the appropriate courses, the rate of WMSD in the profession would be dramatically lowered.
If you’re suffering from a work-related musculoskeletal disorder, your first stop should be your GP. Help can then be sought through the two organisations mentioned in this article.
Optimum Dental Posture: Dr Aniko Ball. optimumdentalposture.com
Working Posture: Dr Penelope Jones. workingposture.com.au
