Back Care for Dentists and Surgeons

Alan Hedge, Ph.D., FErgS, AFBPsS
Professor, Ergonomics
Cornell University
Ithaca, NY, USA

Most of us do not relish our periodic visits to the dentist nor do we eagerly await undergoing surgery. In these situations sympathy usually lies fairly and squarely with the patient. What many people fail to appreciate, however, is that these situations place considerable musculoskeletal demands on those health professionals, such as dentists and surgeons, whenever they are treating us in an attempt to improve the quality of our lives.

For the patient, a dental visit typically involves sitting in a reclined or even supine position, and the dentist often has to contort the body to perform the oral work. In an operation we are usually unconscious, and supine on an operating table, and the surgeon must contort the body to perform the necessary surgery. From a physical effort standpoint there are many similarities between the work of dentists and surgeons: both professions typically involve working in a standing posture, both require prolonged stooping over a reclined or supine patient, both must use a variety of hand tools in a delicate manner, and both occupy extended periods of time, typically less than an hour per patient for a dentist and often considerably longer than an hour for a surgeon. The kinds of posture-related musculoskeletal problems reported by dentists and surgeons are comparable to those found in other professions involved prolonged standing work in poor postures.

Ergonomics Research on Dentists and Surgeons

A number of studies have examined the ergonomics issues associated with dentists and surgeons. Most of this work has focused on the symptoms experienced by dentists, perhaps because of their repetitive daily activity patterns when treating patients.

A questionnaire survey and an associated time study of 16 male dentists working in an urban clinic found that dentists spend around two-thirds of each day actually performing dental work. There was a relationship between work-related physical complaints and daily-performed dental practices. Electromyograms of back muscle activity were taken from ten different postural positions. The inclination of the body was used to categorize three types of dental care postures. The most common posture among the dentists, who were right-handed, was a right-forward leaning position. The dentists reported a number of musculoskeletal problems with their arms, neck and shoulders, with their eyes and hands, and with the low back, and the number of problems differed among the three types of postures. When the dentists were in postures involving lateral bending of 30 degrees, and internal rotation (twisting) of 15 degrees the amplitude of the electromyograms was substantially increased. The daily repeated deviated body positions of the dentists were associated with an increase in their work-related musculoskeletal complaints.

The estimated one year prevalence for troubles among members of the Danish Society for Craniomandibular Disorders found that 65% of members reported neck and shoulder problems, and 59% reported low back problems. A follow-up in a field study of postures and electromyography (shoulder/neck) during the three most common work tasks was conducted. Results showed that dentists worked with high static muscle activity levels in the back and shoulders, with prolonged upper arm abduction, and with prolonged neck flexion Previous research suggests that prolonged working for more than 75% of the time with the neck above 15 degrees flexion may be hazardous. The present study showed that dentists spent 82% of their time working in of more than 30 degrees. Also, dentists who spent the longest times with their patients reported the most problems.

A recent book titled "Ergonomics and the Dental Care Worker" (1) describes results from several different surveys of dentists in Nebraska, South Carolina, Canada, Denmark, Poland and Norway, which consistently showed that around 40%-60% report cervical symptoms and low back pains.

Using a mail questionnaire, the prevalence of subjective complaints among 54 male orthopedists and 63 male general surgeons was investigated. Respondents were asked about their subjective musculoskeletal complaints. On average the age of the surgeons was in the early 40's, and they had worked as surgeons for between 16 and 18 years. They worked an average 9.5-hour day. Results showed a higher prevalence of musculoskeletal complaints among the orthopedists than the general surgeons. Shoulders and lower back pain symptoms were the most frequently reported complaints, followed by neck problems.

Together, research results show that back disorders are relatively commonplace among dentists and surgeons, and this problem relates to their working postures, equipment design and duration of working. Fortunately, there are steps that can be taken to minimize back problems.

Prevention of Neck, Shoulder and Back Disorders

Ergonomic recommendations for minimizing the risks of back injuries focus on improving working posture and equipment design. These include:

1) Change Posture - Alternate between sitting and standing to reduce postural fatigue and maximize postural variety, which helps to reduce static muscle fatigue.

2) Use Support - When sitting or standing, don't lean forwards or stoop in an unsupported posture for prolonged periods. If you are sitting, sit up straight or recline slightly in a chair with good back support, and use a good footrest if necessary. If you are standing for prolonged periods try to find something to help you lean against.

3) Safe reaching - Avoid having to reach awkwardly to equipment and work close to the patient. Keep the items used most frequently within a distance of about 20 inches (50 cm). Use assistants to help move equipment into this zone.

4) Normal arm posture - Keep elbows and upper arms close to the body and don't raise and tense the shoulders when working. Also, ensure that hand postures are not deviated because this could lead to wrist problems.

5) Use Comfortable Equipment - Use equipment that isn't too heavy, that can be used without awkward upper body posture, and that feels comfortable to use. Ergonomically designed equipment helps to minimize stresses on the upper extremities and the back.

6) Manage Time - Avoid long appointments where possible, or intersperse these with frequent short rest breaks in which you change posture and relax the upper extremities.

1. Ergonomics and the Dental Care Worker. Denise Murphy, MD (Editor). American Public Health Association, Washington, DC. October 1998.

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