Welcome to the 2nd post of The Pre-Dental Guide’s Ergonomic series. This blog post serves to provide guidance on how you can kickstart your clinical training on the right ergonomic foot. It’s no coincidence the first lecture in the UCSF operative course is fully dedicated to ergonomics. Did you know, chronic pain and musculoskeletal disorders are the top contributors to dental disability and dentist burnout? According to The White Coat Investor, 1 in 7 health care professionals will utilize their disability insurance in their lifetime.
I’ll share with you an anecdote of how I learned the importance of ergo my first month as a Navy dentist. While earning my certificate in Tactical Combat Casualty Care with a task to control hemorrhage of simulated wounded soldiers, I tore the ulnar collateral ligament of my dominant thumb while dragging an 180lb mannequin to safety. Thankfully, I’ve been able to return to work and my hobbies (tennis, pickleball, cooking) to nearly regained function after a year of occupational therapy rehab and injury prevention. Needless to say, self-care has taken a new form for me in the form of maintaining my hands, wrists, shoulders and entire body.
I’m going to share the two concepts that have improved my strength, function, and overall relationship with dentistry:
Practicing with ergonomics in mind
Proper visualization with loupe magnification and lighting
Practicing ergonomics
Consider the upper body as one functional lever that flexes at three sites (type 1: finger, type 2: wrist, and type 3: shoulder). To minimize strain on your scapular muscles that stabilize our upper body, focus on operating in type 1 and 2 finger and wrist motions and minimize type 3: shoulder.
Pro-tip: I learned this diagnostic trick from a board-certified endodontist to assess how often our upper body “cheats” while practicing dentistry. Tie a medium to light resistance band around your biceps (pictured below of my co-worker) and do an operative procedure. Take note of how often you are using type 3 movements ie. raising your shoulder or extending your reach to grab an instrument, move your tray, etc. You'll quickly notice how the resistance band will snap you right back into a neutral ideal posture.
2. Room and dental assistant positioning
Get comfortable working at the 11-12 o'clock position as 70% of restorative work can be completed from this view.
Make a habit of setting your tray, rheostat, and overhead light in the same position. Your operator tray should stay at the same height where the air water syringe and handpiece are in a muscle memory position for you to grab without hinging at the hip.
Utilize four-handed dentistry so your assistant is an extension of your arms. Create a workflow where you are handed your next instruments/materials rather than reaching over the tech’s tray or your own to grab.
3. Equipment modifications for common hand-related injuries such as thumb pain, carpal tunnel, or de quervain's tenosynovitis:
Composite warmer: ejecting heated composite (ideal 131 F) from a dispensing gun requires much less force than room temp composite.
Utilizing thicker tips for expressing higher viscosity restorative materials from syringes ie. liners/bases/core build-ups
Local anesthetic delivery: Use the inner palm of the hand to squeeze the thumb ring and expel the local anesthetic to reduce dominant thumb strain.
Proper visualization with loupe magnification and lighting
Our goal in dentistry is to be able to provide quality dental care while minimizing our postural strain. In my journey to better improve my posture, I came across Enova’s Ergo Elite 5.5x loupes that have tangibly improved my working day experience.
What are ergo loupes?
They are a style of prismatic loupes angled in two planes (out and down) allowing you to look straight in front of you while being able to see into the mouth.
Use of the ergo loupes has eliminated a large need to have flexion of the neck, shoulder tension, and encourages you to engage your core strength to sit upright.
While they do have a learning curve, the greatest part of the ergo loupes is that it trains you to be disciplined and not “cheat” in your posture while working. 2. Adequate light source:
The operator light should always be directly parallel and above the provider for the best light source.
To supplement this light source, utilizing Enova’s Axis LED light system has allowed me to gain a bright working field even when restoring posterior dentition. I am currently using the hybrid neck battery pack which eliminates tugging of the chord at my hip.
TLDR: We make a large financial, emotional, and physical investment to become dentists. To find joy in the process, I want to encourage you to prioritize your ergonomics and health. Much like dentistry, I am tackling ergonomics from a comprehensive and preventive approach, rather than passively allowing poor habits to manifest into chronic pain. Adding ergonomic loupes, higher magnification, and a bright light paired with a mindful approach to ergonomically practicing dentistry helps me find more joy in the day. I’m hoping these tips will give you the same alleviation and preserve the careers we worked so hard to get into!
First time buying loupes? Or looking to upgrade your current pair? Check out my previous blog post on Four Factors You Must Understand When Purchasing Your Loupes..
If you select Enova as your loupe of choice and found this blog post helpful, share it with a friend in dentistry or hygiene and use the code “TPDG24” online/with your local representative. In our next development of the ergonomic series, we’ll be diving into a comparison of three popular loupe and light brands (DRV, Q-Optics, Enova) that I’ve used for a few years to help you make the best loupe purchase fit for you!
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