Improving dental ergonomics

You’re in the chair, but your dentist feels the pain. The UBC Dentistry program is changing that

Hunching over like Quasimodo can take its toll, but until recently, dentists didn’t know they had a choice.

“Traditionally, pain was considered part and parcel of the profession,” says Dr. Lance Rucker, professor in the Faculty of Dentistry and director of Clinical Ergonomics and Simulation. “As a result, three out of five dentists live with pain and end up losing days of practice each year.”

Recent North American statistics show that 67 per cent of dentists and 80 per cent of dental hygienists in North America experience musculoskeletal problems, primarily in the neck and back. However, over the past 15 years, there has been a major awakening, says Rucker.

“Clinicians have started to realize that chronic discomfort and injuries are preventable.”

And since the 1990s, Rucker—a leading global expert on dental ergonomics education and ergonomics clinical assessment—has been helping to refine UBC curriculum and develop specialized teaching equipment.

”We’ve heard from many of our students that one of the reasons they’ve decided to come to UBC is for the integrated clinical ergonomics,” says Rucker. “The word on the street is that our graduates do not undergo the same wear and tear as graduates from other universities.”

Indeed, a 2001 B.C. Workers Compensation Board survey showed that UBC-trained dentists and dental hygienists—about half of those working in the province—were statistically less likely to suffer low back pain.

Rucker explains that from the outset, UBC students develop muscle memory for working in balance—rather than contorting their bodies—while wielding the required instruments and accessing the necessary areas to operate in the patient’s mouth.

Students also learn how to optimally adjust equipment, from tilting the patient’s headrest to controlling the angle of the operatory light.

“Although most modern dental equipment is designed with basic ergonomics in mind, I always tell students, if the setting isn’t working for you, then you’re working for the setting,” says Rucker, who also specializes in operatory design concepts.

He recently took part in a World Health Organization initiative to provide enhanced simulation training for oral health care workers in Thailand and elsewhere in Southeast Asia.

And over the past five years, he has consulted on the design and construction of many new educational and private clinic facilities in North America, including Jamaica’s first oral health training facility in Kingston, which just opened for patient care in September 2010.

To further spread the ergonomics message, Rucker is working with longtime research collaborator Dr. Michael Belenky, former professor at the University of Maryland, Baltimore Dental School, to produce an online manual for clinical ergonomics assessments and tools.

Working with oral health professionals throughout North America, Rucker provides ergonomic practice assessment that first identifies the factors that contribute to the ergonomics risk profile of the clinician. He then provides practical solutions to prevent further musculoskeletal injuries and to reduce risk factors linked with musculoskeletal symptoms.

“Within four to six weeks after a few retraining sessions, most motivated clinicians can re-educate their muscles to operate in balance as a matter of habit,” says Rucker.

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UBC Reports | Vol. 57 | No. 4 | Apr. 6, 2011

The key is to develop muscle memory for working in balance, says Dr. Lance Rucker. Photo by: Martin Dee

The key is to develop muscle memory for working in balance, says Dr. Lance Rucker. Photo by: Martin Dee

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Balance range for back: Vertical spine in balance at 0° (left) slightly out of balance at 10° (centre) and strained out of balance at 15° (right)

Balance range for back: Vertical spine in balance at 0° (left) slightly out of balance at 10° (centre) and strained out of balance at 15° (right)

Students are taught to always check five key factors for ergonomic dentistry:

  1. The clinician’s seat is stable and at the correct height for balance.
  2. The patient’s oral cavity should be at clinician’s heart height and centered in front of the clinician.
  3. The patient’s headrest must be adjusted so that the patient’s maxillary plane (upper jaw) is vertically positioned for best access.
  4. There is clearance around the supine patient’s head to allow unimpeded operator access from the 10 o’clock position to the 2 o’clock position.
  5. The overhead operating light beam is within 15 degrees of the clinician’s eye-line.

Retraining muscle memory

Burnaby, B.C. dentist Dr. P.J. Murphy, 43, credits Prof. Lance Rucker for helping him return to a full-time practice, a goal he had been struggling with for a number of years following a road accident in 1995.

While riding his bike, Murphy was struck by a car, leaving him with broken ribs, a broken leg and soft tissue damage in his back.

“After a long time of rehab,” recalls Murphy, “and trying all sorts of therapies, everything from massage to chiropractors, I could only put in about four hours a day before the pain got to be too much.”

In 1999, Murphy heard about Rucker and arranged for a clinical assessment.

“Before that I had never heard of dental ergonomics,” says Murphy, who holds a doctor of dental surgery degree from Dalhousie University.

“But Lance transformed my practice. He did me a huge favour,” says Murphy.

Murphy learned techniques to retrain his muscles for balance and posture along with basic techniques to ensure correct operatory set-up.

“Within a few months I went from part-time to full-time.”

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