The Effects of Finger Rest Positions on Hand Muscle Load and Pinch Force in Simulated Dental Hygiene Work

Effect of a Novel Adaptive Handle Design on the Ergonomic Performance of Periodontal Curettes in Dental Hygienists with and without Musculoskeletal Disorders: A Pilot Clinical Study

(1) Background: Musculoskeletal disorders (MSDs), discomfort, fatigue, pain, and other acute and chronic work-related injuries are common among dental clinicians. Hand instruments constitute a primary risk factor for these conditions. The overall goal of this study was to compare in dental hygienists with healthy hands, and in those with MSDs, the effect of three different handle designs on instrumentation-related muscle work, comfort, fatigue, and quality of tactile feedback. (2) Methods: Clinicians tested three periodontal curettes: one with a novel adaptive silicone handle, another with a rigid resin handle, and the third with a rigid silicone handle. Ten hygienists-five with MSDs and five without-each scaled three typodonts using the three different curettes. Statistical analysis was performed using a General Linear Model (GLIM) and Tukey's post hoc test, and a significance level of p < 0.05 was implemented. (3) Results: On average, mean comfort and fatigue across all instruments were significantly worse in testers with MSDs, who also expended significantly more work to complete the same task. In all testers, a novel adaptive handle design was associated with significantly reduced total muscle work and post-instrumentation fatigue, as well as better comfort than conventional rigid handle designs. (4) Conclusions: An adaptive curette handle design demonstrated significantly better ergonomic outcomes than conventional rigid curette handle designs. Hygienists with MSDs expend significantly more muscle work during dental instrumentation.

A Novel Ergonomic Curette Design Reduces Dental Prophylaxis-Induced Muscle Work and Fatigue

BACKGROUND

To compare fatigue, comfort, and muscle work associated with the use of two periodontal curettes during scaling: one with a novel adaptive design, the other with a conventional non-adaptive design.

METHODS

Twelve hygienists scaled a typodont using two Universal Barnhart 5/6 curettes: (1) a prototype featuring an adaptive silicone-covered handle (Curette A), and (2) a stainless-steel curette (Curette B). Surface Electromyography (sEMG) traced muscle work. Hand positions, fatigue, comfort, pinch, and grasp strength were recorded. Paired t-tests and a repeated measures ANOVA with covariates were tested for differences. The significance level was set at p < 0.05.

RESULTS

Curette A performed significantly better in all categories. Pinch and grasp strength and fatigue were significantly reduced post-instrumentation for Curette B. Curette A required significantly less (i) total muscle work and (ii) work in individual muscles. Comfort, correct grasp, and blade adaptation were significantly better using Curette A.

CONCLUSIONS

A curette featuring a novel adaptive handle design demonstrated significantly improved ergonomic performance. Additional clinical studies are needed to solidify our understanding of the potential short- and long-term benefits of the novel curette handle design.

PRACTICAL IMPLICATIONS

A novel adaptive curette handle design that enables the clinician to adapt the instrument across the index finger may reduce musculoskeletal burden and fatigue, as well as improve comfort during periodontal instrumentation.

Poor neck posture and longer working duration during root canal treatment correlated with increased neck discomfort in dentists with <5-years' experience in endodontics

OBJECTIVE

This study investigated the effects of neck posture and working duration during each step of root canal treatment (i.e. opening the canal [OC], length determination, mechanical instrumentation, try main cone, and filling the root canal) on neck discomfort (ND) in dentists with <5-years' endodontic experience.

METHODS

Twenty-four dentists performed a one-visit endodontic treatment of an upper molar in a phantom head model. A video was recorded to evaluate the dentists᾽ neck postures using the Modified-Dental Operator Posture Assessment Instrument (M-DOPAI) and treatment duration. The M-DOPAI divides the dentists᾽ neck postures into three categories: acceptable, compromised, or harmful posture. The participants rated their ND using Borg᾽s CR-10 scale every 10 min. and at the end of each treatment step. The relationships between neck posture/treatment duration and Borg᾽s CR-10 scores were examined using partial correlation.

RESULTS

The number of compromised and harmful neck postures during the endodontic procedure (r = 0.43, P = .04) and treatment duration (r = 0.58 P = .005) significantly correlated with ND at the end of treatment. The number of compromised and harmful neck postures during the OC step (r = 0.75, P < .001) and the duration of the OC step (r = .70, P < .001) significantly correlated with ND at the end of the step.

CONCLUSION

Poor neck postures and long working duration during endodontic treatment correlated with ND among inexperienced dentists. Neck pain interventions should focus on neck postures and work duration during root canal treatment, particularly in the OC step.

Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of <10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P> .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P>.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

The biomechanical demands of manual scaling on the shoulders & neck of dental hygienists

The purpose of this study was to evaluate the postural and muscular demands placed on the shoulders and neck of dental hygienists when performing a simulated manual scaling task. Nineteen healthy female dental hygienists performed 30-min of simulated manual scaling on a manikin head in a laboratory setting. Surface electromyography was used to monitor muscle activity from several neck and shoulder muscles, and neck and arm elevation kinematics were evaluated using motion capture. The simulated scaling task resulted in a large range of neck and arm elevation angles and excessive low-level muscular demands in the neck extensor and scapular stabilising muscles. The physical demands varied depending on the working position of the hygienists relative to the manikin head. These findings are valuable in guiding future ergonomics interventions aimed at reducing the physical exposures of dental hygiene work. Practitioner Summary: Given that this study evaluates the physical demands of manual scaling, a procedure that is fundamental to dental hygiene work, the findings are valuable to identify ergonomics interventions to reduce the prevalence of work-related injuries, disability and the potential for early retirement among this occupational group.

Working position influences the biomechanical demands on the lower back during dental hygiene

This investigation monitored the biomechanical demands on the lower back during simulated dental hygiene work. A total of 19 female, registered dental hygienists performed 30 continuous minutes of manual scaling (plaque removal) of a manikin's teeth while seated. We monitored the working location and orientation of the dental hygienists, with respect to the manikin, along with their spine kinematics, spine extensor muscle activities and seat pressure, throughout the 30 min. A clock representation was used to express the working location. The location significantly influenced the dental hygienists' pelvic orientation with respect to the manikin, spine posture, erector muscle activity and pressure distribution. Findings from this study suggest that the prevalence of lower back pain amongst dental hygienists may be directly related to low-level tonic activity of the spine's extensor musculature, and the combined flexed and axially rotated spine postures. Practitioner Summary: Low back pain (LBP) is prevalent in dental hygienists, yet occupational demand on the low back has not been investigated. Posture, muscle activity and seat pressure were monitored. Combined spine rotation and flexion, and tonic activity of the extensor musculature may be related to LBP in dental hygienists.

Removal of simulated biofilm: a preclinical ergonomic comparison of instruments and operators

BACKGROUND

Periodontal scaling might cause musculoskeletal disorders, and scaling instruments might not only have different effectiveness and efficiency but also differ in their ergonomic properties. The present study assessed ergonomic working patterns of experienced (EO) and less experienced operators (LO) when using hand and powered devices for periodontal scaling and root planning.

METHODS

In an experimental study using periodontally affected manikins, sonic (AIR), ultrasonic (TIG) and hand instruments (GRA) were used by 11 operators (7 EO/4 LO) during simulated supportive periodontal therapy. Using an electronic motion monitoring system, we objectively assessed the working frequency and positioning of hand, neck and head. Operators' subjective evaluation of the instruments was recorded using a questionnaire.

RESULTS

Hand instruments were used with the lowest frequency (2.57 ± 1.08 s(-1)) but greatest wrist deviation (59.57 ± 53.94°). EO used instruments more specifically than LO, and generally worked more ergonomically, with less inclination of head and neck in both the frontal and sagittal planes, especially when using hand instruments. All groups found hand instruments more tiring and difficult to use than powered instruments.

CONCLUSION

Regardless of operators' experience, powered instruments were used more ergonomically and were subjectively preferred compared to hand instruments.

CLINICAL RELEVANCE

The use of hand instruments has potential ergonomic disadvantages. However, with increasing experience, operators are able to recognise and mitigate possible risks.

Detecting within- and between-day manifestations of neuromuscular fatigue at work: an exploratory study

Cumulative neuromuscular fatigue may result from exposure to physically demanding work, such as repetitive and/or sustained work with insufficient recovery. The aims of this exploratory study were to develop a battery of field usable fatigue measures and to document hand/arm fatigue in physically demanding work over multiple workdays and after a weekend break. Sixteen plumbers were observed for five days and measures of handgrip force, variability, tremor and discomfort were obtained pre-, mid- and post-shift. This exploratory study demonstrated increasing fatigue of the hand/arm over the day and persistent fatigue from Tuesday to Friday, and that a number of the measures did not return to baseline values following a weekend break. The findings provide preliminary evidence of cumulative fatigue in residential plumbing and insight into neuromuscular fatigue measurement. However, further work is needed to develop and refine a set of fatigue measures to detect neuromuscular fatigue at the workplace.

PRACTITIONER SUMMARY

Cumulative fatigue has been linked to long-term health outcomes, including work-related musculoskeletal disorders. This paper presents findings from a physically demanding job (i.e. plumbing) revealing persistent fatigue over the work shift(s) and insufficient recovery after a weekend break, and provides insight into fatigue measurement at the workplace.

Ergonomics in dentistry

Ergonomics is much broader than preventing work‑related musculoskeletal disorders. The successful application of ergo‑ nomics assures high productivity, avoidance of illnesses and injuries, and increased satisfaction among workers. Unsuc‑ cessful application, on the other hand, can lead to work‑related musculoskeletal disorders (MSDs). This article sets forth broad important background information on ergonomics so that the dental practitioner can have a general awareness of ergonomic risk factors as well as some basis for understanding the ongo‑ ing dialogue about ergonomics, its diagnosis, treatment, and regulation. This article provides alternatives to be considered by the practitioner in light of the practitioner's own circumstances, experiences and goals. A practitioner wishing to improve his or her work environment, for whatever reason, may wish to follow an incremental approach to such efforts, as is briefy discussed here. How to cite this article: Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in Dentistry. Int J Clin Pediatr Dent 2014;7(1):30-34.

Physical workload in neck, shoulders and wrists/hands in dental hygienists during a work-day

Physical workload was recorded by electromyography, inclinometry and goniometry for twelve female dental hygienists during authentic work. Their work was, in relation to other types of work, characterised by pronounced head flexion (90th percentile 46°), high loads on the forearm extensor muscles (90th percentile 23% and 18% of maximal EMG (MVE), for the right and left sides, respectively), average loads on trapezius muscles (90th percentile 15% and 14% MVE), average arm elevation (99th percentile 83° and 72°) and average wrist flexion and velocities (50th percentiles 17° of extension and 7.3°/s, for the right side). Manual scaling and machinery (use of ultrasonic scaling and hand-pieces) showed higher loads on the trapezius muscles, regarding muscular rest, as well as the 10th and 50th percentiles, than the other tasks, and for the forearm extensor muscles, an almost complete lack of muscular rest (0.1% time), and much higher loads regarding the 10th and 50th percentiles. Further, more pronounced head flexion and lower head and upper arm velocities were found, indicating more constrained postures for the neck and shoulders for the manual scaling and machinery. Use of ultrasonic scaler reduced the 50th percentile loads on the right forearm extensor muscles, but had no effect on the fraction of muscular rest and on the 10th percentile load. These findings are consistent with the high prevalences of musculoskeletal disorders among dental hygienists.

An investigation into the impact of safety features on the ergonomics of surgical scalpels

In the case of surgical scalpels, blade retraction and disposability have been incorporated into a number of commercial designs to address sharps injury and infection transmission issues. Despite these new designs, the traditional metal reusable scalpel is still extensively used and this paper attempts to determine whether the introduction of safety features has compromised the ergonomics and so potentially the take-up of the newer designs. Examples of scalpels have been analysed to determine the ergonomic impact of these design changes. Trials and questionnaires were carried out using both clinical and non-clinical user groups, with the trials making use of assessment of incision quality, cutting force, electromyography and video monitoring. The results showed that ergonomic performance was altered by the design changes and that while these could be for the worse, the introduction of safety features could act as a catalyst to encourage re-evaluation of the ergonomic demands of a highly traditional product.

Electromyographic assessment of apple bucket intervention designed to reduce back strain

The authors previously developed an apple bucket that was modified by use of a hip belt to reduce muscle fatigue. The intervention of belt use was accepted by workers and shown not to interfere with productivity. However, use of this intervention did not appear to reduce muscle fatigue when measured by tests of voluntary muscle strength. The purpose of the present study was to evaluate the intervention's effect on muscle fatigue employing surface electromyographic (EMG) amplitude. Amplitude measurements on 15 muscles were taken from 10 laboratory volunteers who were carrying a full bucket of apples, once while wearing the intervention belt and once without the intervention. These measurements were taken for seven different postures (four angles of trunk flexion (0 degrees , 20 degrees , 45 degrees , 90 degrees ) and three raised-arm positions (both up, dominant up, non-dominant up)) common to apple harvest work. Participants were measured in these conditions both with the bucket carried in front and with the bucket carried to the side. Significant reductions in amplitude favouring the intervention were seen for 11 of the 15 muscles in models considering the four body flexion angles. Ten of these were of the middle and lower back. These control/intervention differences were seen with both bucket-carrying positions (front vs. side) and tended to increase with increasing flexion angle. In contrast, no significant intervention effects were observed in models considering treatment by arm-raised position. One significant main effect (upper trapezius, side bucket) showed an amplitude reduction in the treatment condition. Another main effect showing increased amplitude in the intervention condition use was observed in the dominant levator scapulae (side bucket). Thus, the use of the intervention belt reduces EMG amplitude among a number of mid- and lower-back muscles. This is suggestive of a protective effect against back strain.

A laboratory study to determine the effects of universal and rotating ultrasonic inserts on wrist movement and scaling time efficiency of dental hygienists

PURPOSE

The purpose of this study was to determine if differences existed in range of wrist movements and scaling time efficiency of dental hygienists using a rotating ultrasonic insert when compared with a standard universal insert.

METHODS

A convenience sample of 32 consenting experienced dental hygienists who met inclusion criteria was invited to participate. Using a cross-over research design, the 32 participants were randomly assigned to one of the two subgroups. Subgroup A (n = 16) used the rotating universal ultrasonic insert on a typodont, rested for 15 min and the standard universal insert on a different typodont. Subgroup B (n = 16) used the standard universal ultrasonic insert on a typodont, rested for 15 min and the rotating universal ultrasonic insert on a different typodont. Each participant used the rotating and standard universal ultrasonic scaling inserts to remove 2 cm3 artificial calculus from two different typodonts for up to 15 min per insert. Scaling time efficiency was determined using a Modified Volpe-Manhold Calculus Index, measuring the amount of artificial calculus remaining after ultrasonic scaling. While scaling, each participant wore the WristSensor goniometry gloves, which determined changes in wrist movements (flexion and extension and ulnar and radial deviations), measured as a deviation from the neutral position.

RESULTS

A paired t-test (P = 0.05) using 30 subjects with useable data, revealed no statistically significant differences between the two different inserts in terms of wrist movements and scaling time efficiency. A multivariate analysis of variance revealed no statistically significant differences in the percentage of time dental hygienists were in high, medium or low-risk posture categories while using the rotating ultrasonic insert compared with the standard universal insert. Based on the results of this laboratory study, dental hygienists using a rotating ultrasonic insert appear to experience no ergonomic advantage in terms of wrist postures or timesavings over a standard insert.