Smile, Being A Dentist Does Not Have to Hurt
BACKGROUND: The US Army Dental Command (DENCOM) has identified musculoskeletal pain and discomfort as a possible source of increased injuries within the command. Recent balanced scorecard data1 reflects injury rates that are impacting patient services. Army dental care providers in many instances many be worse off than their civilian counterparts. A past Army field survey showed that motivated Soldiers and civilians continue to work even though they are suffering from symptoms or are injured.2 Another study focusing on Army dental personnel showed that they are at a significantly greater risk for developing carpal tunnel syndrome than the working public.3
DICOMFORT INFORMATION: To accurately gauge the current musculoskeletal health of their Soldiers and workers DENCOM developed a snapshot of the work related musculoskeletal pain and discomfort experienced by the DENCOM workforce. Questions regarding frequency, severity, duration, and cause of pain across a variety of body parts were used to achieve this goal. The survey was administered for a seven week period to all DENCOM personnel via a voluntary paper survey. Of an on-board workforce of approximately 4,460 people, 2,412 responded for a 54% response rate. A copy of the questionnaire is provided. The majority (69%) of respondents were currently experiencing musculoskeletal pain or discomfort in at least one body part. In fact, these respondents actually averaged 3 to 4 body parts currently causing them pain or discomfort. Additionally, over 20% of those 1,655 respondents had pain or discomfort in at least half of the twelve body parts asked about in the survey. In general, respondents just ‘hurt’. Lower back (43%) and neck (36%) were most body parts respondents most frequently currently experienced work related pain or discomfort. Back, in general (22-43%) was the body region with the highest percentage of respondents reporting current pain or discomfort. Arms (9-13%) and legs (16-17%) were two general body regions where a relatively low percentage of respondents reported current pain or discomfort. In comparison civilian research literature has noted high prevalence rates of discomfort, carpal tunnel syndrome, and back injury amongst dental care providers. Although many in the dental profession have the mindset that pain is “part of the job” the reality is musculoskeletal disorders are an important occupational health issue as they represent the highest incidents of early retirement from the dental profession. Reported musculoskeletal pain in the civilian dental community (dentists, dental hygienists, and dental students) has a prevalence rate of 64-93%. The most prevalent region of pain for dentists is the back at 36-60% and for dental hygienists the most prevalent region pain is the hand/wrists at 60-69%.4
CONCLUSIONS: To most significantly impact musculoskeletal pain and discomfort the Army as well as the other services should focus on decreasing pain and discomfort in the neck and lower back and reducing the impact that repetition and posture has on the services dental care providers. Improving these aspects would target the biggest perceived causes and body parts most affected with musculoskeletal pain and would hopefully provide the biggest return on investment.
PROPOSAL: My proposal to improve the needs of dental care is to develop a prototype workstation focusing on provider and patient chair improvements as well as hand tool design. It is hoped these intervention can become the foundation of an ergonomically beneficial work environment.
FINDINGS: Findings can easily be applied across the Army, Department of Defense, and into the civilian sector.
TIMELINE: Study should take one year to perform from date of approved Internal Review Board concurrence.
PILOT STUDY: One Army location at the discretion of DENCOM will be selected. A small pilot population of eight dental care providers who are currently experiencing musculoskeletal pain in the neck and back will be selected. Typical ergonomic survey methods to include but not limited to posture assessment, biomechanical modeling, time motion analysis, and psychosocial questionnaires will be used.
- U.S. Army MEDCOM balanced scorecard.
- Rice VJ, Nindl B, Pentikis JS. Dental workers, musculoskeletal cumulative trauma, and carpal tunnel syndrome, Who is at risk? A pilot study. International Journal of Occupational Safety and Ergonomics 1996;2:218-233.
- Lalumandier JA, McPhee SD, Riddle S, Shulman JD, Daigle WW. Carpal Tunnel Syndrome: Effect on Army Personnel. Military Medicine 2000;165:372-378.
- Hayes MJ, Cockrell D, Smith DR. A systematic review of musculoskeletal disorders among dental professionals. International Journal of Dental Hygiene 2009;7:159-165.