Wmsd's I Dentistry-Scientific Talk-6666

Afternoon
Again
Scientific
session
LIFE IS SWEEEEEEEET !!!!! HAVING A
FRIEND
Work Related Musculoskeletal
Disorders In Dentistry
Listening is
unspoken caring
“To provoke laughter is to
encourage health.”
- Francis Rabelais
INSTITUTE FOR ENVIRONMENT, SAFETY AND OCCUPATIONAL HEALTH RISK ANALYSIS
? WMSDs in Dentistry
?
? ?
? ? ?
?
? ?
?
? ?
?
?
What is Ergonomics?
Job Human
Characteristics Capabilities
ERGONOMICS is a way to work smarter--not

harder by designing tools, equipment, work
stations and tasks to fit the job to the
worker--NOT the worker to the job
What is Ergonomics?
 “Ergo” means work
 “Nomos” means natural laws or systems
n
n Ergonomics is the science of work
n Ergonomics is much broader than
preventing work-related
musculoskeletal disorders
n Ergonomics plays an important role in
preventing injury and illness
n
USAF Dental Evaluation & Consultation Service

What is Ergonomics?
n An applied
science
concerned with
designing and Worker
arranging Capabilities
things people Job Demands
use so that the
people and
things interact
most efficiently
and safely "fitting the job task to the
n
person performing the job"
Consequences of Poor
Design
n Fatigue
n Discomfort
n Illness/Injury
n Absenteeism
n Errors
n Lower productivity
n Customer dissatisfaction

Ergonomic Design Goals
n Enhanced
performance by
eliminating
unnecessary
effort Worker
Capabilities
n Reduce Job Demands
opportunities
for overexertion
injury
n Improve comfort
by curtailing the
development of "fitting the job task to the
fatigue person performing the job"
n USAF Dental Evaluation & Consultation Service
Goals
n Improved
n Productivity
n Safety
Worker
n Health Capabilities
n Job Job Demands
Satisfactio
n
n
n
"fitting the job task to the
person performing the job"
“Be a good listener - you
never learn much from
talking.”
- Will Rogers
Work-Related Musculoskeletal Disorders
(WMSDs)
WMSDs in Dentistry
Reasons for Early Retirement Among
Dentists
♦Musculoskeletal Disorders (29.5%)
♦ Cardiovascular Disease (21.2%)
♦ Neurotic Symptoms (16.5%)
♦ Tumors (7.6%)
♦ Diseases of the Nervous System (6.1%)
Source: Burke et al., 1997

WMSD Symptoms Among
Dentists
80%
70%
60%
50%
40% Males
30%
g %
R
rtin
o
p
e
20%
10%
0%
Neck Shoulder Upper Lower Elbows Wrists/ Knees
Back Back Hands
Body Part
Source: Finsen et al., 1998

WMSD Symptoms Among
Dental Hygienists
Dental Hygienists Dental Assistants
80
70
% Reporting
60
50
40
30
20
10
0
*Diagnosed *Hand-wrist *Shoulder *Neck pain Low Back
CTS pain pain pain
* indicates difference is significant

Source: Liss et al., 1995
Consequences of Poor
Design
♦ Discomfort  Chronic Pain
♦ Accidents  Injuries
♦ Fatigue  Increased
Errors
♦ Work-Related
Musculoskeletal
Disorders (WMSDs)
− Low back pain
− Tendonitis
− Epicondylitis
− Bursitis
YOU CAN STAY YOUNG
AS LONG AS YOU
LEARN
Musculoskeletal
Disorders (MSDs)
n Include a group of conditions
that involve nerves, tendons,
muscles, and supporting
structures such as
intervertebral discs
Severity of Symptoms
Mild periodic Severe chronic &

debilitating conditions

MSDs = Ergonomics
n Musculoskeletal problems
are the problem and
ergonomics is a solution.

Types of MSDs
n Neck and Shoulder n Hand and Wrist
Disorders Disorders
n Myofascial Pain n DeQuervain’s
Disorder Disease
n Cervical
n Trigger Finger
Spondylolysis
n Carpal Tunnel
Syndrome
n Thoracic Outlet n Guyon’s Syndrome
Syndrome n Cubital Tunnel
n Rotator Cuff Syndrome
Tendinitis/Tears n Hand-Arm
n
Vibration
n Back Disorders Syndrome
n Herniated Spinal n Raynaud’s
Disc Phenomenon
n Lower Back Pain
n Sciatica USAF Dental Evaluation & Consultation Service
MSDs
Signs
Symptoms
n Decreased n Pain
range of n Numbness
motion n Tingling
n Deformity n Burning
n Decreased grip n Cramping
strength
n Stiffness
n Loss of muscle
n
function
n
Don't
compare
yourself
with any
one in this
world.
If you
compare, you
are insulting
yourself.
Contributing Factors for
Work-Related MSDs
(WMSD)
n Routine exposure to:
n Forceful hand exertions
n Repetitive movements
n Fixed or awkward postures
n Vibrating tools
n Unassisted frequent or heavy
lifting

n
What Factors Contribute
to WMSDs?
n Forceful hand exertions
n Grasping small instruments for
prolonged periods
n Forceful squeezing/release of
instruments
n Repetitive movements—e.g.,
scaling, root planing, polishing
n
n
n

to WMSDs?
n Fixed or awkward postures
n Neck, back, shoulder posture
n Hand/wrist positions
n Standing/sitting
n Operatory organization
n Patient positioning
n
n

to WMSDs?
n Prolonged use of vibrating hand
tools—dental handpieces,
laboratory equipment


WMSDs
n A risk factor is not always a
causation factor
n The level of risk depends on
n Length of time a worker is
exposed to these conditions
n How often they are exposed
n Level of exposure
n Usually a combination of multiple
risk factors (vs. a single factor)
contributes to or causes a MSD
WMSDs
n Do not focus solely on the
workplace
n Risk factors may be
experienced during non-
occupational activities (e.g.,
certain sports, exercising,
working with computers,
needlework, playing musical
instruments)

What Factors Contribute to
WMSDs?
♦ Repetitive motions (e.g., scaling,

WMSDs?
♦S ta tic n e ck , b a ck , a n d sh o u ld e r p o stu re s
WMSDs?
ra sp in g sm a llin stru m e n ts fo r p ro lo n g e d p e rio

WMSDs?
♦Pro lo n g e d u se o f vib ra tin g h a n d to o ls

Applying Ergonomics Principles to

Dental Work
◆Tools/Instruments
◆ Workstations
◆ Work Practices
Ergonomics in Dentistry
Tool/Instrument Design
Goals: Reduce force exertion;
Maintain hand/wrist in neutral posture
Considerations:
♦ Overall shape/size
♦ Handle shape/size
♦ Weight
♦ Balance
♦ Maneuverability
♦ Ease of operation
♦ Ease of maintenance
Hand Instruments
Look for:

♦ Hollow or resin handles

♦ Round, knurled or
compressible handles
♦ Carbon steel
construction (for
instruments with
sharp edges)
Automatic Handpieces
Look for:
♦ Lightweight, balanced
models (cordless preferred)
♦Sufficient power
♦Built-in light sources
♦Angled vs. straight-shank
♦Pliable, lightweight hoses
♦Swivel mechanisms
♦Easy activation
♦Easy maintenance
Syringes and Dispensers
Look for:

♦ Adequate lumen
size
♦ Ease in cleaning
♦ Knurled handles
(no finger cut-
outs)
♦ Easy activation and
placement
Magnification Systems
Goal: Improve neck posture; Provide clearer
vision
Consider:
♦ Working distance
♦ Depth of field
♦ Declination angle
♦ Convergence angle
♦ Magnification factor
♦ Lighting needs
Workstation Layout
Ensure:
♦Instruments, materials,
medications, etc. are
accessible while seated
♦Hoses are positioned
away from the body
♦Set-up can be adapted
for different operators
Operator Chair
Goal: Promote mobility and patient access;
accommodate different body sizes
Look for:
♦ Stability (5 legged base w/casters)
♦ Lumbar support
♦ Hands-free seat height adjustment
♦ Adjustable foot rests
♦ Adjustable, wrap-around body
support
♦ Seamless upholstery
Patient Chair
Goal: Promote patient comfort; maximize
patient access
Look for:
♦ Stability
♦ Pivoting or drop-down arm
rests (for patient ingress/egress)
♦ Supplemental wrist/forearm
support (for operator)
♦ Articulating head rests
♦ Hands-free operation
Posture/Positioning
Goal: Avoid static and/or awkward postures
Potential Strategies:

♦ Position patient so that operator’s elbows are

elevated no more than 30 degrees.
♦ Adjust patient chair when accessing different
quadrants
♦ Alternate between standing and sitting
Work Practices
 Goal: Maintain neutral posture, reduce force
requirements
♦Ensure tools are sharpened, well-maintained
♦Use automatic handpieces instead of manual
instruments where possible
♦Use full-arm strokes rather than wrist strokes
Scheduling
Goal: Provide sufficient recovery time for staff
to avoid chronic muscular fatigue

♦ Increase treatment time for more difficult

patients
♦ Alternate heavy and light calculus patients
within a flexible scheduling system
♦ Vary procedures within the same appointment
♦ Shorten patient’s recall interval
Prosthetics Labs
Naval Station Rota Spain Clinic Case Study: Lab techs mentioned chronic back,
shoulder & neck discomfort / pain during periodic Industrial Hygiene survey from
working at non-adjustable bench in obviously stressful static postures -- with no
forearm support nor bench edge padding
Prosthetics Labs
Naval Station Rota Spain Clinic Case Study -- Post intervention improvements offered by
Kavo ergonomic lab benches :
Lab techs affirm GREATLY increased comfort / decrease in back, shoulder & neck
discomfort / pain.
KAVO dental prosthesis lab benches offer ample forearm supports and
workpiece support centering prosthesis directly below technician which optimizes
spinal / neck / head vertical alignment
Prosthetics Labs
Naval Station Rota Spain Clinic Case Study: Lab technicians now work in optimized
ergonomic posture. In addition to forearm supports and central workpiece support
(locally-ventilated for air contaminant removal !) , the table also has much improved
overhead lighting, a magnifying lens and a drill speed control operated by the tech’s right
knee
ERGONOMICS SUMMARY
• Good ergonomic design of tools, processes
and furniture DOES improve personnel
comfort, health, morale, productivity and
readiness.
• Individual effort as part of a workshop team
is the greatest means of identifying /
improving workplace ergonomic issues.
• It’s critical to seek prompt medical aid for
symptoms of ergonomic stress / CTDs
TIME TO USE YOUR

RISORIUS MUSCLES
He who laughs, lasts.
- Mary Pettibone Poole

"Always laugh when
you can. It's cheap
medicine"-
- Larry Gelbart,
Treatment and Management of
MSDs
• Obtain an accurate diagnosis from a
qualified health-care provider
– Early intervention is key
• Self-diagnosis is not recommended
– MSD origins are complex with a
broad range of symptoms

–



Treatment and Management of
MSDs
• Diagnostic tests may include physical
exams, provocative tests, and
electromyography
• Treatment may range from pain-relief
medications and rest to surgery,
and ergonomic interventions both at
work and home

–

How are WMSDs recognized?

The evaluation of WMSDs includes identifying
workplace risks. Evaluation begins with a discussion of
the person's employment and requires a detailed
description of all the processes involved in a typical
workday. Consideration is given to the frequency,
intensity, duration, and regularity of each task
performed at work.
Diagnosis of WMSDs is confirmed by performing

laboratory and electronic tests that determine nerve or
muscle damage. One such test, electroneuromyography
(ENMG), encompasses two areas: electromyography
(EMG) and nerve conduction velocity (NCV).
Magnetic resonance imaging (MRI), an alternative to x-
rays, provides images of tendons, ligaments, and
muscles and improves the quality of the diagnostic
information.
“ THE ONLY
DISABILITY IN LIFE
IS A BAD ATTITUDE ”
- SCOTT HAMILTON
PREVENTION OF MUSCULOSKELETAL
DISORDERS IN CLINICAL DENTISTRY
ARIOUS DENTAL WORK POSTURE
How are WMSDs treated?
The treatment of WMSDs involves several approaches including the

following:
Restriction of movement
Application of heat or cold
Exercise
Medication and surgery
Restriction of Movement
The first approach to treatment of WMSDs is to avoid the activities causing
the injury. This often requires work restrictions. In some cases, transfer to a
different job should be considered. A splint can also be used to restrict
movements or to immobilize the injured joint. However, the use of splints in
occupational situations requires extreme caution. If used inappropriately,
splints can cause more damage than good. Splints are usually used for two
reasons: to mechanically support a joint where an excessive load on the joint
is anticipated, or to restrict the movement of the injured joint.
In the occupational context, splints should not be used as a mechanical
support for the joint. Instead, the job should be redesigned to avoid the
extreme load on the worker's joint in the first place. To be effective, the use
of splints to immobilize an affected joint also requires that the work activity
that caused the injury be stopped or changed. If injurious work continues,
then the worker is exposed to risk of injury to other joints that have to
compensate for the one that is splinted.
Conclusion
Conclusion
WMSDs of muscles, tendons and nerves are a major cause of lost

work in many labour-intensive industries. Occupational risk factors
include continual repetition of movements, fixed body positions,
forces concentrated on small parts of the body, and lack of sufficient
rest between tasks.
Prevention must aim at eliminating the repetitiveness of the work by

proper job design. Where this is not possible, preventive strategies
such as good workplace layout, tool and equipment design, and
proper work practices should be considered. Early recognition of
these disorders is very important because medical treatments are
unlikely to be effective once these injuries become longstanding.
Preventive and control measures, in order to be truly effective,
require significant involvement on the part of the workers, their
representatives, and management to improve occupational health and
safety.
Conclusion
The measurement of the body posture by means of
rasterstereography
is known to provide accurate information on
the back shape and the sagittal profile without entailing
radiographic strain for the patient. With this system no
correlations between the sagittal jaw position and
variables
of the kyphotic, the lordotic or the pelvic inclination
could be found. Further studies are necessary to provide
cephalometric measurements of the craniofacial skeleton
and to correlate them to the examined parameters used in
the present study.
BMC Musculoskeletal Disorders

Research article Open Access
Sagittal jaw position in relation to body posture in adult
humans –
a
rasterstereographic study
Carsten Lippold*1, Gholamreza Danesh†1, Markus
Schilgen†2,
Burkhard Drerup†3 and Lars Hackenberg†4
On a romantic day sardar’s

girlfriend asks him: Darling on our
engagement day will you give me
a ring.
Sardar : Ya sure, from landline or

mobile.

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Afternoon

ERGONOMICS is a way to work smarter--not

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

Source: Burke et al., 1997

Source: Finsen et al., 1998

* indicates difference is significant

Mild periodic Severe chronic &

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

USAF Dental Evaluation & Consultation Service

♦ Repetitive motions (e.g., scaling,

ra sp in g sm a llin stru m e n ts fo r p ro lo n g e d p e rio

♦Pro lo n g e d u se o f vib ra tin g h a n d to o ls

Applying Ergonomics Principles to

♦ Hollow or resin handles

♦ Position patient so that operator’s elbows are

♦ Increase treatment time for more difficult

TIME TO USE YOUR

- Mary Pettibone Poole

USAF Dental Evaluation & Consultation Service

How are WMSDs recognized?

Diagnosis of WMSDs is confirmed by performing

The treatment of WMSDs involves several approaches including the

WMSDs of muscles, tendons and nerves are a major cause of lost

Prevention must aim at eliminating the repetitiveness of the work by

BMC Musculoskeletal Disorders

On a romantic day sardar’s

Sardar : Ya sure, from landline or

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