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

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WMSDs in Dentistry

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What is Ergonomics?

Job Characteristics

Human 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 Ergonomics is the science of work Ergonomics is much broader than preventing work-related musculoskeletal disorders Ergonomics plays an important role in preventing injury and illness

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USAF Dental Evaluation & Consultation Service

What is Ergonomics?n

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An applied science concerned with designing and Worker Capabilities arranging Job Demands things people use so that the people and things interact most efficiently and safely "fitting the job task to theUSAF Dental Evaluation & Consultation Service

person performing the job"

Consequences of Poor Designn n n n n n n

Fatigue Discomfort Illness/Injury Absenteeism Errors Lower productivity Customer dissatisfactionUSAF Dental Evaluation & Consultation Service

Ergonomic Design Goalsn

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Enhanced performance by eliminating unnecessary Worker effort Capabilities Reduce Job Demands opportunities for overexertion injury Improve comfort by curtailing the development of "fitting the job task to the person performing the job" fatigueUSAF Dental Evaluation & Consultation Service

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Goalsn

Improved n Productivity n Safety n Health n Job Satisfactio n

Worker Capabilities Job Demands

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"fitting the job task to the person performing the job"USAF Dental Evaluation & Consultation Service

Be a good listener - you never learn much from talking.- Will Rogers

Work-Related Musculoskeletal DisordersINSTITUTE FOR ENVIRONMENT, SAFETY AND OCCUPATIONAL HEALTH RISK ANALYSIS

(WMSDs)

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

WMSDs in Dentistry

WMSD Symptoms Among Dentists80% 70% 60% 50% 40% 30%g n i t r o p e R %

Males

20% 10% 0% Neck Shoulder Upper Back Lower Back Elbows Wrists/ Hands Knees

Body Part

Source:

Finsen et al., 1998

WMSD Symptoms Among Dental HygienistsDental Hygienists 80 70 60 50 40 30 20 10 0 *Diagnosed *Hand-wrist CTS pain *Shoulder pain *Neck pain Low Back pain Dental Assistants

% Reporting

* 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 discsSeverity of Symptoms

Mild periodic

Severe chronic & debilitating conditionsUSAF Dental Evaluation & Consultation Service

MSDsn

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Ergonomics

Musculoskeletal problems are the problem and ergonomics is a solution.


Types of MSDsn

Neck and Shoulder Disordersn n

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Hand and Wrist Disordersn n n n n n

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Myofascial Pain Disorder Cervical Spondylolysis Thoracic Outlet Syndrome Rotator Cuff Tendinitis/Tears

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Back Disordersn n n

n Herniated Spinal Disc Lower Back Pain Sciatica USAF Dental Evaluation & Consultation Service

DeQuervains Disease Trigger Finger Carpal Tunnel Syndrome Guyons Syndrome Cubital Tunnel Syndrome Hand-Arm Vibration Syndrome Raynauds Phenomenon

MSDsn

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Decreased range of motion Deformity Decreased grip strength Loss of muscle function

Signs Symptoms

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Pain Numbness Tingling Burning Cramping Stiffness

nUSAF Dental Evaluation & Consultation Service

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

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What Factors Contribute to WMSDs?n

Forceful hand exertionsn n

Grasping small instruments for prolonged periods Forceful squeezing/release of instruments

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Repetitive movementse.g., scaling, root planing, polishing

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Fixed or awkward posturesn n n n n

Neck, back, shoulder posture Hand/wrist positions Standing/sitting Operatory organization Patient positioning

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Prolonged use of vibrating hand toolsdental handpieces, laboratory equipmentn


Contributing Factors for WMSDsn n

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A risk factor is not always a causation factor 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 Usually a combination of multiple risk factors (vs. a single factor) contributes to or causes a MSDUSAF Dental Evaluation & Consultation Service

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Contributing Factors for WMSDsn

Do not focus solely on the workplacen

Risk factors may be experienced during nonoccupational activities (e.g., certain sports, exercising, working with computers, needlework, playing musical instruments)


What Factors Contribute to WMSDs?

Repetitive motions (e.g., scaling,


S ta ti n e ck , b a ck , a n d sh o u l e r p o stu re s c d


ra sp i g sm a l n stru m e n ts fo r p ro l n g e d p e ri n li o o


Pro l n g e d u se o f vi ra ti g h a n d to o l o b n s


Applying Ergonomics Principles to Dental WorkxTools/Instruments x Workstations x Work Practices


Ergonomics in DentistryTool/Instrument DesignGoals: 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


Ergonomics in DentistryHand Instruments

Look for: Hollow or resin handles Round, knurled or compressible handles Carbon steel construction (for instruments with sharp edges)


Ergonomics in DentistryAutomatic HandpiecesLook 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


Ergonomics in DentistrySyringes and DispensersLook for: Adequate lumen size Ease in cleaning Knurled handles (no finger cutouts) Easy activation and placement


Ergonomics in DentistryMagnification Systems

Goal: Improve neck posture; Provide clearer vision Consider: Working distance Depth of field Declination angle Convergence angle Magnification factor Lighting needs


Ergonomics in DentistryWorkstation 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


Ergonomics in DentistryOperator Chair

Goal: Promote mobility and patient access; accommodate different body sizesLook for: Stability (5 legged base w/casters) Lumbar support Hands-free seat height adjustment Adjustable foot rests Adjustable, wrap-around body support Seamless upholstery


Ergonomics in DentistryPatient 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


Ergonomics in DentistryPosture/Positioning

Goal: Avoid static and/or awkward postures Potential Strategies: Position patient so that operators elbows are elevated no more than 30 degrees. Adjust patient chair when accessing different quadrants Alternate between standing and sitting


Ergonomics in DentistryWork Practices

Goal: Maintain neutral posture, reduce force requirements

Potential Strategies: Ensure tools are sharpened, well-maintained Use automatic handpieces instead of manual instruments where possible Use full-arm strokes rather than wrist strokes


Ergonomics in DentistryScheduling

Goal: Provide sufficient recovery time for staff to avoid chronic muscular fatigue Potential Strategies: 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 patients recall interval


Ergonomics in DentistryProsthetics 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



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



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 techs 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. Its 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 xrays, 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 Danesh1, Markus Schilgen2, Burkhard Drerup3 and Lars Hackenberg4


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







wmsd's i dentistry-scientific talk-6666

Documents

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pain dental assistants

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