Common MSDs That Plague the Dentists

Ergonomics in Dental Clinics

Work-related musculoskeletal disorders (WMSDs) are prevalent among dental professionals. They are caused by holding poor posture positions in the course of their practice. It is reported that two out of three dentists and dental hygienists are suffering from WMSDs that might cause them pain in the neck, shoulder, hand, back, low back, etc.

Most dental professionals are not aware of the mistakes they make regarding their workstation ergonomics or the beneficial exercises they can do that would prevent them from experiencing excruciating pain. Musculoskeletal disorders may cause injuries and even disabilities, that can potentially make dentists unable to continue their careers for the rest of their lives. So, it is vital to exercise precautionary steps to prevent WMSDs and eliminate the risk of any pain, syndromes, or injuries.

Dental professionals should consider rectifying their adverse mistakes during career performance. Most dentists and hygienists are at risk of WMSDs due to ergonomic errors including:

1) 10 O’clock Position

Working while holding the 10 o’clock position can lead to shoulder, arm, and hand pain as it would mean lifting one’s arms over the patient and leaning to one side. The 12 o’clock position is the optimum posture for preventing these types of ailments. In the 12 o’clock position, arms are not elevated and dentists can easily straddle the patient’s head. Dental professionals should keep in mind that 70% of treatment can be performed in the 11-12 o’clock position.

 2) TTL Loupes

A forward head posture that is greater than 20 degrees can lead to severe neck pain. Through-the-lens (TTL) loupes do not allow dentists to keep a safe head posture. Also, utilizing long barrel (high magnification) scopes mounted in through-the-lens frames potentially result in an increased amount of pressure on the cervical spine that is usually combined with poor declination angle, leading to severe neck pain and dysfunction. The optimal head posture angle is less than 20 degrees.

 3) Sitting Too Low

When thighs are parallel to the floor while sitting on a flat seat pan, the pelvis is rolled backward and the low back curve is flattened. Flattening of the lumbar curve has a detrimental effect on both spinal musculature and the discs. Hips should be higher than knees. Adjusting operator stool to a higher level can result in thighs sloping more steeply downward which helps the lumbar curve maintain its position. When hips are positioned higher than knees, muscle strain, disc pressure, and low back pain can be prevented.

Bad Posture
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MSDs & Neck Pain

Neck pain is one of the most prevalent musculoskeletal complaints among dental professionals, particularly dentists. There are several measures to avert neck pain such as:

 

1. Maintaining Safe Head Posture

As mentioned earlier, the optimum declination angle is less than 20 degrees. Bending the neck forward for more than 20 degrees would result in severe neck pain. Ultra-lightweight vertically adjustable flip-up loupe with its very steep declination angle when positioned lower than the pupil can provide dentists with an optimal head posture with less than 20 degrees of neck flexion.

2. Taking Postural Correction Exercise

Slouching places great strain on the trapezius muscle attached to the cervical vertebrae that can result in developing acute neck pain. There are many correction exercises available that can be done chairside with gloves on.

3. Preserving the Cervical Curve

The cervical curve should be preserved as many musculoskeletal problems stem from the loss of this curvature. Using a neck support cushion or inserting a round, cylindrical cervical roll into pillowcases at night will support the cervical curve. Buckwheat hull pillows are optimal for the prevention of developing neck pain, and it is for the same reasons that feather pillows should be avoided. Furthermore, sleeping on one’s stomach can intensify neck pain due to its flattened position.

4. Using Armrests

The armrests of a chair can act as reminders of how a neutral position that puts the least amount of pressure and strain on the shoulders should be. This is especially important for the dentists to use since much of their practice requires them to operate on the patient with their arms lifted for long intervals.

5. Treat Trigger Points with Caution

The upper trapezius muscles are the muscles most sensitive to emotional stress. Therefore, high tension can lead to neck pain. Moisture, heat, and stretching can be helpful to relieve this pain.

Common Improper Postures in Dentistry

Dentists are mostly aware of how to position themselves during treatment, however, the root of their problem seems to be related to dental chairs as they force patients into prolonged and awkward positions. Consequently, they must compensate for the difference in positioning by holding postures that place undue strain on their bodies (especially their back and neck). Dentistry is a profession with a high-risk factor regarding the development of musculoskeletal disorders due to the visual demands that necessitate the use of a static working posture. Headaches and vertebral pain have been found to be positively related to dentists’ poor ergonomic working posture.

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When operating on the maxillary teeth in the dental upper arch, as an example, the location of the occlusal plane can force the dentist to hold an improper posture in order to have better access for the operation. Dentists and their assistants must be able to position the occlusal plane of the upper arch 20-25 degrees behind the vertical in order to maintain the most optimal working posture. Patients, on the other hand, cannot sit in this position for long periods of time because most double articulating headrests cut into the occiput, making positioning uncomfortable. To compensate for this, operators shift patients forward, sacrificing their own neutral posture in the process. As a result, the operator is forced to work in a forward, hunched position.

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Another thing that can result in muscle imbalance is a forward-head posture which contributes to a rounded shoulder posture. When reaching for items, this posture may predispose the practitioner to supraspinatus tendon impingement (rotator cuff impingement). Furthermore, a static posture with the arms elevated by more than 30 degrees restricts blood flow to the supraspinatus muscle and tendon. Prolonged arm abduction can result in trapezius myalgia chronic pain and upper trapezius muscle trigger points. Some of the commonly held postures that lead to chronic pain in dentists include:

  • Tilting to gain advantage point
  • Lifted arms for long hours without support
  • Holding one shoulder in an awkward position (either the round position or holding it up)
  • Lumbar curvature reduction
  • The angle between thighs that form due to having uncomfortable sitting and obstructed access

A rigid body attitude is not necessarily required for a balanced posture. The dentist has the freedom to move within certain boundaries so that no harmful positions are formed. The active balanced posture entails the dentist only using paravertebral muscles tonicity to keep the back straight (the physiological spine curvatures, also referred to as “S” spine form). The use of lumbar support provided by the seat distinguishes the passive balanced posture. Meaning that given the appropriate setting holding the proper posture would not be either restrictive or distracting.

Chiropractic Services as a Potential Treatment for MSDs

It is not uncommon for dental hygienists to experience recurring pain in their hands, wrists, neck, shoulders, and back after a hard day’s work. Working in the same position or holding an improper posture for an extended period of time is likely to result in musculoskeletal injury.

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In order to better understand the benefits of chiropractic care in case of MSDs and similar ailments it would help to know the structure of the spine and the reason why one might experience pain from improper postures. The spine is made up of four natural curves that are interdependent. Naturally, when one curve flattens, it affects the other curves. Many people seek chiropractic services to treat musculoskeletal disorders and to relieve pain. When the spine is out of balance (exaggerated or flattened), the bony structures of the vertebrae rest on top of each other, and the curves are supported by muscles, ligaments, and soft tissue.

When performing dental hygiene services and operations, dentists frequently avoid using their stool’s lumbar support in order to get better access to the specific tooth that is being worked on. Such a position would lead to flattening the lower back curve. Ischemia (lack of oxygen to the muscles), lower back pain, tensions (tight muscles), and possible disk herniation can all result from this (central portion of an intervertebral disk bulges out). Chiropractic care is a type of complementary medicine that specializes in the treatment of nerve, muscle, and bone dysfunctions. Chiropractors believe that nerve irritation is the root cause of pain and discomfort.

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Spinal manipulation or spinal adjustment is one of the most commonly used chiropractic methods in the treatment of musculoskeletal disorders. Spinal adjustments are performed by gently and mildly pressing on the spinal area. This procedure is only performed by licensed and experienced chiropractors. The primary goal of this procedure is to realign the normal anatomical structure, curvature, and position of the spine. Using chiropractic care to treat musculoskeletal disorders has been shown to be effective and safe. Several studies were conducted by various researchers to determine the efficacy and safety of using chiropractic treatments to relieve pain. This is one of the reasons why chiropractic care is gaining popularity around the world.

Adverse Side Effects of MSDs’ Medications

There are several medical and non-medical treatments to help you at different times and in different ways when experiencing musculoskeletal disorders. Although these treatments can help control symptoms like pain, swelling, and stiffness, none of them cures MSDs completely. They only slow down the progression of your condition. Besides, although these medications have a wide range of benefits and pain-relieving effects, they have serious side effects which are dangerous for one’s health. Below you will find some of the side effects of these medications:

  • Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs block specific enzymes (cyclooxygenase or COX) that are involved in the process of inflammation. Consumers of NSAIDs may experience stomach problems – pain, nausea, and diarrhea. They would also be prone to the risk of gastrointestinal ulceration and bleeding. Although COX-2 inhibitors can reduce these risks, they can also cause long-term problems and lead to serious medical emergencies such as heart attacks.

  • Acetaminophen

They can cause liver damage, particularly if taken with alcohol.

  • Opioids

Opioids, such as Endone (oxycodone) and OxyContin (extended-release oxycodone), can be beneficial for people with severe and persistent non-cancer pain. Opioids can lead to physical dependency or addiction. Some side effects such as drowsiness, dizziness, and respiratory depression will disappear with long-term use but constipation tends to persist. Other possible side effects include:

  • Muscle Relaxants

Drowsiness is the main side effect of these medications. Also, carisoprodol (Soma) can cause dependency due to its conversion into a drug similar to barbiturates in the body; cyclobenzaprine (Flexeril) can cause dry mouth, constipation, confusion, and loss of balancemethocarbamol (Robaxin) makes the color of urine green, brown, or black; people with liver problems should take both metaxalone (Skelaxin) and chlorzoxazone (Parafon Forte, DSC) with caution.

  • Anti-Anxiety Agents

Side effects of these agents include:

Moreover, they can cause sedation if used with opioid analgesics or alcohol.

  • Antidepressants

Some of the more traditional tricyclics antidepressants used for pain relief have anticholinergic side effects such as:

The newer antidepressants which are serotoninnorepinephrine reuptake inhibitors (SNRIs) with less risk of anticholinergic issues have harmful side effects like:

 

  • Corticosteroids

Corticosteroids are used to reduce inflammation. They include Predsolone (prednisolone) and Hydrocortisone sodium succinate (hydrocortisone) and could even be injected directly into the joint. This type of medication would lead to the development of hypertension and swelling as well as some psychological disorders such as mood swings and delirium.

Corticosteroid Liquid or Tablets – they could be used in the early stages of your condition, to control inflammation and pain or prescribed if you’re going through a flare. They can have side effects if used for long periods like:

 

  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs such as Methoblastin (methotrexate), Plaquenil (hydroxychloroquine), and Salazopyrin (sulfasalazine) are medications meant to control an overactive immune system when the immune system mistakenly attacks healthy tissues – in and around joints – as would occur in some musculoskeletal disorders. They also help relieve pain, lessen inflammation and reduce or prevent joint damage. The working mechanism of this type of medication is focused on modifying the disease’s process and managing the ensuing symptoms. It can take several months for any noticeable changes to take place, so it would be necessary to take other medications to control the pain experienced. Regular blood tests should be done to monitor the effects of the medications and the possible side effects.

  • Biologics and Biosimilars (bDMARDs)

 bDMARDs such as Humira (adalimumab) and Enbrel (etanercept), unlike similar drugs, are other disease-modifying drugs with a working mechanism focused on controlling the immune system and targeting specific damaged cells and proteins. They derive from a biological source like human cells i.e. they are made of protein. bDMARDs are not prescribed for everyone due to their high cost and possible side effects.

  • Anti-Neuropathic Pain Medications

These medications include the more traditional anti-depressants like Endep (amitriptyline), anti-epilepsy medications like Lyrica (pregabalin), and some blood pressure medications. They take effect on the nervous system and reduce neuropathic pain caused by injury, disease, or dysfunction. Anti-neuropathic pain medications have significant side effects such as:

  • reduced concentration
  • sleepiness
  • weight gain

There are also some other medications for MSDs which have negligible side effects such as Osteoporosis medications, Antiresorptives, Anabolic medicines, Hormone replacement therapy (HRT), and Supplements (calcium and vitamin D).

 

Furthermore, there are also topical treatments that relieve pain including rubs, gels, ointments, sprays, and creams. These treatments are applied directly to the skin and have two advantages, one being that the treatment is topical and the second one being  the pleasure of receiving a mini massage.

There are also a number of treatments that are non-medication based which are suggested prior to prescribing serious medication and taking more invasive measures. These could potentially include: