1. The Five Bad Choices of a Hygienist

The Five Bad Choices of a Hygienist

By Dee Humphrey, RDH, BHSc

It is a well-known fact that a Dental Hygienist’s job is strenuous and has the potential to cause serious musculoskeletal injuries, but this does not slow us down from providing treatment services. I am a young dental hygienist who graduated over 6 years ago, and now my clinical career is hanging on by a thread (literally). With a past minor injury to my upper neck and lower back, clinical dental hygiene combined with a few bad choices has become the ultimate career killer. With limited knowledge about ergonomics, technology and the specialized equipment to further the longevity of my career, I jumped into the ‘Hygiene World’ as superwoman trying to save the world one mouth at a time. My mentality was to pay off those bills, not worry about my health or body aches, and just earn a pay check without actually investing in myself or my career. For that matter, who actually has the money for those loupes with the little fancy light? Or that luxurious ergonomic chair that aids in better support for one’s neck and back? And forget about those high quality instruments that stays sharp longer…the dentist would rather spend the money somewhere else. Liability insurance, who cares… I am not going to get hurt. How about spending my money on those little designer hand-bags to take on the expensive exotic vacation that I can actually enjoy? Although this is not the mentality of some, it tends to be the mindset of most Clinicians, especially new Hygienist’s. Why do we intentionally choose to make bad choices that affects our careers and livelihood? The average Hygienist does not invest in the longevity of their career and continues to work in unnecessary pain. It is vital to understand that the choices we make impacts more than one area in our lives and it does change our future for the better or worse.

After graduating hygiene school, I couldn’t wait to get a job and get my feet wet. I felt the urgency to get started and was willing to work anywhere. So, I took the first offer I was given in a local Community Dental Clinic and worked Monday thru Friday eight hours a day. It seemed like the ultimate dream job for a new grad like me. Being in public health, I didn’t have to modify treatment to accommodate for limited funding and there was unlimited access to debridement’s and full mouth SRP’s on any given day. Soaking up all the experience I could get my hands on, I learn a lot about the public health sector, oral pathology/diseases and how to remove calculus quickly, yet proficiently. Taking a time off was put on the back burner and I would occasionally stretch my hands and wrists to compensate for whenever I felt an ache or two. #1 bad choice: failure to prevent risk factors for potential body injury and compromising the overall body health by not taking time off to alleviate muscle fatigue.

After a few years, I began to notice that my neck, left arm and lower back was starting to bother me, but I thought it was all a part of the job! As long as I had a cavitron and decent instruments [3-5 years old], I had everything under control (so I thought). I wore loupes with no attached light and knew my ergonomics was not the best, but blamed it on the 15-year-old dental chair that I kept sliding out of on a daily basis. My dominant hand was removing calculus just like it always did, but my opposite mirror holding hand was starting to have some major issues. I would occasionally drop things on the floor, but I thought it was no big deal while I kept trucking along. After all, repetitive work is what we do! As I would reach over to pick up items from the assisting table, burning pain became a constant indicator that my career was starting to wear on me. But, as long as I continued to religiously stretch and do ergonomic exercises, I thought I had nothing to worry about. I didn’t actually have the time to take off to go to the doctor and didn’t think this was some issue to worry about. Many months of the “neck tingles” protruding down my left arm to the tips of my fingers, I began to notice the use of ice packs, a 10’s-unit, stretching for my hands, shoulders and arms was not alleviating symptoms anymore. Terrible stress headaches and chronic muscle fatigue in the upper and lower back were somewhat combated with ibuprofen, but it continued to escalate beyond my control.

Compromising your own health due to lack of knowledge or limited funds is the remedy for a short term career. It is vital to know your limitations and listen to your aches or pain in accommodating appropriately. Ignoring our bodies natural warning signs only cause future problems. It wasn’t until I was diagnosed with cervical Radiopathy and had two herniated discs located in the lumbar region, which needed surgery in the C5-C6; L4-L5 regions, that I was really doing a disservice to myself and my patient’s. If I was hurting on a daily basis, was I truthfully taking care of them to the best of my potential? The answer was #2 bad choice: failure to reduce potential for overexertion and ignoring results to injury; causing serious musculoskeletal damage.

Over the years, numerous RDH’s were asked if they experienced similar musculoskeletal problems and to my findings these were common issues. To make it more relevant to my years of practicing, I asked a few of my classmates if they were experiencing similar issues. It was no surprise to learn that 4 out of the 5 Hygienists were already on a regular regimen for chiropractic care and/or received multiple deep massages per month to compensate for any denoting pain or aches. Occasionally I would be asked the questions from other Hygienist’s about practice management within our office and if I was keeping current with beneficial ergonomic equipment. Our office did not have current practice management plans in place, nor was researching for purchasing ergonomic equipment a priority. Was I using the most beneficial equipment that decreases muscle strain and tension on the body? To my findings, the answer was #3 bad choice: failure to educate on ergonomics and not using the most beneficial equipment.

I continued to research and educate myself over what I could do to change this dynamic and learned that proper treatment planning, time management and investing in myself is vital to one’s career. After having two surgeries, multiple changes were needed and extensive equipment research was done. Upon returning back to clinical hygiene, I began using a light that attached to my loupes. Then I was encouraged to video how many times my arms were raised during an hour appointment using loupes without a light attachment and with it. To my surprise in the first 2 minutes of the video (without the light attachment), I raised my arm over 13 times to fight with the overhead light. In collaboration with my neurologist, I learned that raising my arm that much in an 8-hour work day would cause musculoskeletal issues. After months of using a light attached to my loupes, it tremendously decreased the muscle fatigue and stress I was having. I was amazed at these findings and can’t image the damage being done to those Hygienist who choose to not use a light attachment or purchase loupes altogether.

My next purchase was to examine my 2-3-year-old instruments, which were ordered for me by another Hygienist. Questions were asked as to why we chose this brand and if these were the best ergonomically for our practice. Answers given was “that’s what I always used”, and “why bother using something different, there all the same”. This forced me to research and contact local reps to further educate myself on this data. Upon talking with a rep, I was given a new commercial brand instrument (stainless steel) and then purchased a different kind that he suggested was not as good. I was asked to used it, and compare my findings to which was more beneficial to my patient and me. The results after a month totally sickened me. I had used multiple stainless steel instruments for the past 5 years (new ones and old ones), and continued to experience fatigue and muscle stain just like I always did. While switching to other instruments with a different type of metal, known as titanium nitride, I immediately felt a difference and so did my patients. The sound was different and I did not experience hand fatigue or pain in my upper extremities. When relaying these findings to the local rep, I was told that I was sadly mistaken as to which instruments were better and needed to continue using the same stainless steel instruments for better calculus removal. This made me question as to if I switched sooner, would I be having the musculoskeletal problems that I was. #4 bad choice: don’t be afraid to try something new and educate yourself on products regardless of what others use or tell you. Like every patient is different, so is every hygienist. What works for one, may not work for another.

Evaluations of the ultrasonic and prophy hand piece was my next focus, considering they both are necessary to my job performance. I was taught in school and through various CE courses that using a larger diameter ultrasonic hand piece helps ease hand fatigue and cordless prophy hand pieces eliminate strain on the wrist, but was too scared to ask for better equipment. Therefore, I worked for years with hand cramps just because of being too afraid. Years later, I finally got the nerve up to ask and got to switch over to a cordless hand piece and a different ultrasonic machine. It just so happens that the equipment I was using was over 10 years old and they were waiting for me to say something. I immediately noticed that I was not fighting against or felt the strain from the cord or having hand cramps for grasping the smaller diameter hand piece. Why didn’t I do this year’s earlier? It was instant freedom for my wrist and was ergonomically valuable for my expertise. #5 bad choice: don’t be scared to ask for better equipment and work years in pain, all they can say is no or not right now.

These findings along with many others dramatically changed the way I practiced and the experiment to make better choices continues (evaluations of the dental chair, cavitron, and prophy hand pieces were also taken into consideration). What I have learned along the way is priceless, but maybe too late for my clinical career. Purposely choosing to not invest in myself (whether the dentist could afford it or not) became the ultimate career killer. I could have purchased the things I needed if my career depended on it, and it did. Reducing the risk factors to one’s overall body health should be the utmost important resource in the life of a Hygienist, and there needs to be more awareness in how to extend the life of your career. I encourage all Hygienist’s young or not to stop making bad choices and continuing to work in unnecessary pain. Educate yourself and take ergonomics seriously. It’s only a matter of time before one choice will negatively affect your future forever. #1 good choice: Raise ergonomic awareness on product research and practice management among Hygienists to further the longevity of your career.

Dee Humphrey, RDH, BHSc

Dee Humphrey, RDH, BHSc has been infecting the masses with her contagious laughter and enthusiastic passion for Dental Hygiene. She has worked as a clinical dental hygienist and prevention specialist since 2010 in a Tribal Community Dental Clinic in Northeast Oklahoma and has respectfully earned valuable public health knowledge. Dee is an Author, Speaker, Influencer, who inspires and motivates people to take action; have faith. Dee sets on the visionary Board of Directors for the National Cancer Network, is on the Crest & Oral B’s Smile Council, an Educator of the Delaware Community Cooperation Partnership in Oklahoma.